Being Mortal
Rating: 4 / 5 stars
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High-Level Thoughts
A deep book that makes you face the realities of old age and the tough decisions that need to be made. Gawande presents questions and stories vividly of what questions to ask when you have such little time remaining. This book is one that, while slow at times, is a reminder of what truly matters.
“You live longer only when you stop trying to live longer.”
Summary Notes
1: The Independent Self
“If you cannot, without assistance, use the toilet, eat, dress, bathe, groom, get out of bed, get out of a chair, and walk — the eight “Activities of Daily Living”-- then you lack the capacity for basic physical independence.”
“In America in 1890, people aged sixty-five or older constituted less than 2 percent of the population; today, they are 14 percent.”
“In Asia, where the idea of an elderly parent being left to live alone has traditionally been regarded as shameful– the way my father saw it– the same radical shift is taking place. In China, Japan, and Korea, national statistics show the percentage of elderly living alone rising rapidly.”
2: Things Fall Apart
“Research has found that loss of bone density may be an even better predictor of death from atherosclerotic disease than cholesterol levels. As we age, it’s as if the calcium seeps out of our skeletons and into our tissues.”
“To die of age is a rare, singular, and extraordinary death, and so much less natural than others: it is the last and extremest kind of dying”
“The job of any doctor, Bludau later told me, is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible and the retention of enough function for active engagement in the world”
“In a year, fewer than three hundred doctors will complete geriatrics training in the United States, not nearly enough to replace the geriatricians going into retirement, let alone meet the needs of the next decade. Geriatric psychiatrists, nurses, and social workers are equally needed, and in no better supply.”
“The risk of a fatal car crash with a driver who’s eighty-five or older is more than three times higher than it is with a teenage driver”
3: Dependence
“Old age is not a battle. Old age is a massacre.”
“How to make life worth living when we’re weak and frail and can’t fend for ourselves anymore.”
4: Assistance
“Cohabitation required adjustment. Everyone soon discovered the reasons that generations prefer living apart.”
“Home is the one place where your own priorities hold sway. At home, you decide how you spend your time, how you share your space, and how you manage your possessions.”
“Given the choice, young people prefer meeting new people to spending time with, say, a sibling: old people prefer the opposite.”
“How we seek to spend our time may depend on how much time we perceive ourselves to have. When you are young and healthy, you believe you will live forever.”
“The preferences of a young person with AIDS were the same as those of an old person.”
“‘We want autonomy for ourselves and safety for those we love.’ That remains the main problem and paradox for the frail.”
5: A Better Life
“I was willing to be rejected, That’s what allows you to be a good salesperson. You have to be wiling to be rejected.”
“The three plagues of nursing home existence: boredom, loneliness, and helplessness”
“When you have animals, things happen, and whoever is there takes care of what needs to be done, whether it’s the nursing home director or a nurse’s aide. It was a battle over fundamentally different worldviews: Were they running an institution or providing a home?”
“The value of autonomy…lies in the scheme of responsibility it creates: autonomy makes each of us responsible for shaping his own life according to some coherent and distinctive sense of character, conviction, and interest. It allows us to lead our own lives rather than be led along them, so that each of us can be, to the extent such a scheme of rights can make this possible, what he has made himself.”
6: Letting Go
“Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete.”
“‘Ninety-nine percent understand they’re dying, but one hundred percent hope they’re not,’ she told me. ‘They still want to beat their disease.’”
“Fighting for time to fighting for the other things that people value–- being with family or traveling or enjoying chocolate ice cream.”
7: Hard Conversations
“In the third stage, as a country’s income climbs to the highest levels, people have the means to become concerned about the quality of their lives, even in sickness, and deaths at home actually rise again.”
“What is most important to you? What are your worries? Then when they know your answers, they tell you about the red pill and then blue pill and which one would most help you achieve your priorities.”
“But it’s the meaning behind the information that people are looking for more than the facts. The best way to convey meaning is to tell people what the information means to you yourself”
“The choices don’t stop, however. Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.”
8: Courage
“Courage is the strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength.”
“The chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”
“He was at peace in sleep, not in wakefulness. And what he wanted for the final lines of his story, now that nature was pressing its limits, was peacefulness.”
