Book Review: Being Mortal
By Lina Huang
Primum non nocere, the Latin for “first, do no harm,” is the quintessential oath of physicians. Although the phrase’s origin is uncertain, it stands as a promise from physician to patient that the doctor standing above you with a scalpel or prescribing another round of chemotherapy has your best interests in mind. It is a pivotal oath for a physician to whom patients entrust their illnesses, bodies and even livelihood. Ultimately, it is an assurance against the infliction of additional harm.
But in today’s society of medical breakthroughs and impossibilities (landing on the moon, making smallpox obsolete, CRISPR-Cas9, etc.), this mission has been twisted around into something resembling, last, you will have done everything in your power for this patient, or perhaps, always, you will believe that there is always a human-manufactured, complicated, paperwork-laden solution. Atul Gawande’s Being Mortal confronts the relationship of medicine to quality of life, of physicians to patients, of hope and pain, and, ultimately, what its means for us to be mortal.
Mortal: the definition in the OED is inextricably tied to death, described as “one who is destined to die.” The definition of mortal is also tied to humans, us. But this inevitably of death is little talked about in medicine. “I learned about a lot of things in medical school, but mortality wasn’t one of them,” Gawande begins his book with. Instead, knowledge was the key pursuit, and a belief permeated that “the purpose of medical schooling was to teach how to save lives, not how to tend to their demise.”
Gawande cautions us against this one-sided view because the lives at risk, those whom physicians need to save, are also the ones in demise. In Being Mortal, he tells the stories of Lazaroof, a patient who underwent an operation in a fight for survival and who afterwards became paralyzed; Alice, who, undergoing the onslaught of old age, loses her privacy and control in efforts to mitigate her frailty; and many others.
Gawande shares these hard stories not out of a desire to evoke panic at our current situation, but to spark thought and change. “What goals are most important[?]” Gawande suggests to ask. “At some point… it becomes not only right but also necessary for a doctor to deliberate with people on their larger goals, to even challenge them to rethink ill-considered priorities and beliefs.” Gawande describes his own father, a surgeon with a spinal cord tumor who was still able to pursue the joys that mattered to him by confronting the truth of his situation and considering the hard choices ahead.
“Mortality can be a treacherous subject,” Gawande writes. “Some will be alarmed by the prospect of a doctor’s writing about the inevitably of decline and death. For many, such talk, however carefully framed, raises the specter of a society reading itself to sacrifice its sick and aged. But what if the sick and aged are already being sacrificed–victims of our refusal to accept the inexorability of our life cycle? And what if there are better approaches, right in front of our eyes, waiting to be recognized?”