Quote of the book
“The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society.”
5 key points
- Modern medicine has helped humans to have longer life expectancies, but at the same time sometimes this means that suffering is prolonged.
- Part of what makes a life meaningful is its wider context and the human story – Gawande mentions family, community, and society as three areas where this meaning could be found.
- Language is important in palliative care. An example given in this book is that: “If time becomes short, what is most important to you?” is better to say than “What do you want when you are dying?”
- Society has become increasingly distanced from death as it takes place in institutions away from the immediate home, and a consequence of this is that there is less thought to how life can be made worth living once people become weak or dependent.
- Interaction with others changes with age – rather than making new relationships, as people get older they tend to focus on their established relationships in their friendships and family with a greater focus on the present.
I’ve read a series of medical books now and this stood out as one of my favourites because of the way it brought out the philosophy, ethics, and human story side of medicine. This book will make you ponder on what is meaningful during life and what really matters at the end of life. I found that this characteristic of the book was reminiscent of the list of “Top five regrets of the dying” by Bronnie Ware. Some of the top regrets included not working so hard, maintaining friendships, and allowing yourself to be happier.
One thing that this book really made me appreciate is the importance of a good death, not just in the field of medicine and as part of the duty of a doctor, but in wider society as something which is meaningful for the individual and their families. Gawande shared what his patients tell him they fear the most upon getting older. They feared, not death, but the act of loss. In other words, becoming older or suffering from an illness usually involves a process of losing their independence, losing things in their lives such as their friendships, losing their senses as they slowly become weaker or losing their memory as it starts to weaken.
I was struck by a point that Gawande made near the start of the book, about how modern medicine has increased life expectancy whilst prolonging the number of years of pain and disease. When someone is in pain and close to death, how do we ensure that they can have a good, pain free death? This part raised some difficult questions about whether suffering rather than life is being extended and how we can reduce this suffering. Gawande also shared what some of the priorities of those who are at the end of their lives are: to minimise suffering, to forge closer relationships, to maintain independence as far as possible. He made an interesting reflection to connect these priorities to the role of doctors in supporting the quality of life of patients, but also to alleviate pain and improve health. He argues that a limitation of modern medicine is its ability to nurture the soul and help patients to have the best quality of life they can towards the end of their lives.
Another particularly interesting point was a study that Gawande included about people who have experienced a life or death situation, such as conflict or a terror attack, or who know that their remaining time is short. This study showed that people’s perspectives of what they prioritise in life changes after experiencing these events – their needs and attention changes towards their friendships and family rather than prestige. I thought this was interesting in the context of the pandemic which has also reshuffled a lot of people’s priorities, having experienced time with loved ones being rationed and limited. Perhaps that’s why Gawande thinks it is important to ask patients their fears, concerns, and what goals are most important to them.
Overall, I feel that this book is important to offer an alternative perspective to the end of life. Rather than fear it, perhaps it is better to understand what the options are before getting to that point, as well as learn from the priorities that those at the end of their lives shared with Gawande.
Overall rating: ⭐⭐⭐⭐⭐