Like a lot of middle-aged children of elderly parents, I find myself these days doing a lot of research for the first time into how to best care for and help my parents as they approach the ends of their lives (a subject now known in the 2010s by the catch-all term “eldercare”), and find myself often feeling overwhelmed by the strange behavior and often contradictory impulses of such people as they reach their end-of-life years. For those like me, then, a fantastic place to start is with Atul Gawande’s 2014 Being Mortal: Medicine and What Matters in the End, which does a better job than anything else I’ve ever come across at explaining why so many elderly people end up adopting such strange attitudes at their ends of their lives, what in our society and our brains causes these attitudes, and what we can do as the people who love them to both adapt to and fight against these sometimes self-destructive behaviors.
And the reason this book is so good is because it never resorts to simplistic explanations, which by definition is going to make it hard to do a write-up today that explains why you should read it; because the answer, according to Gawande, is partly historical, partly sociological, partly biological, and partly psychological. It has to do with the way that eldercare has evolved as a subject in the first place; which, as he astutely shows, actually grew out of the Victorian institution of “poorhouses,” which were so terrible that the newly invented “hospitals” of the late 1800s were convinced to start taking in the elderly instead, a big reason why eldercare is still to this day defined mostly through medical-focused terms like the prolonging of life instead of the quality of that prolonged life.
And it has to do with elderly people’s rightful fear of being thrown into that hospital-based institutional life under which most nursing homes still operate, in which daily routines are as codified and standardized as those of prisoners or soldiers, with all dignity and chances for individual choices stripped away under the noble but misguided cause of being “safer” and “more efficient.” (According to Gawande, the three greatest negative factors that affect the elderly are feelings of hopelessness, loneliness and boredom, all three of which can be directly tied to our current institutional model of eldercare.) And it has to do with the way we quantify and justify these kinds of subjects, when it comes to things like laws, grants and government approval: after all, it’s much easier to definitively state, “We cured 58 percent of our patients’ respiratory illnesses” than, “Our patients are 58 percent happier than when they entered our facility.”
There are no easy answers to the subject of modern eldercare, and Gawande doesn’t try to present any. In fact, one of the most sobering yet interesting points he hammers home, over and over, is that the process of getting to the end of your life is simply the process of the universe taking away more and more of the options you used to have for living your life, an unalterable fact that none of us can get away from; and that the only thing we can do about it is to learn how to gracefully give up the yearning for these lost options, redefine the priorities in our lives under these new terms, and understand how to continue living a life of purpose and self-defined happiness no matter how physically or mentally impaired we might become.
That’s one of the major problems with 21st-century eldercare, when all is said and done; as Gawande thoroughly and meticulously shows, we’re simply not providing the space and opportunity for the elderly to do this kind of mental and emotional redefining, not when so much of eldercare is currently devoted to prolonging life no matter how much suffering it might cause, which inspires most people to have a mistaken “WE’RE GOING TO FIGHT THIS!!!” attitude about end-of-life medical issues, instead of encouraging and teaching them how to embrace their growing limitations and redefine the way they live their lives, which can only be done with the help and resources of the institutions that are currently not providing that help.The reason #AtulGawande's #BeingMortal is so good is because it's never simplistic Click To Tweet
I know I’m making this sound like a downer of a book, but it’s not actually as doom-and-gloom as it might appear; a huge chunk of its page count is devoted to the kinds of practical steps you as an individual can do to help the elderly person in your own life, as well as the issues you can be politically pushing for to improve the entire subject of eldercare when it comes to government regulations, punctuated by Gawande’s case-study profiles of industry innovators that he literally went out and personally visited in preparation for writing this, making it the rare Oprah-friendly nonfiction book that also has academic credibility.
But still, he doesn’t sugarcoat the fact that caring for someone at the end of their life is a difficult, frustration-filled process; and as those who are going through it know, that can ironically be a refreshing thing to hear in a book like this, within a genre that is mostly filled with happy little pink-covered guides about “Here’s How To Have a Sunny and Upbeat Disposition Every Moment Of The Day No Matter How Much It Ironically Causes Problems To The Person You’re Trying To Care For (And We’re Going To FIGHT This Thing, We’re Going to FIGHT It, You’re A FIGHTER and We’re Going To FIGHT THIS!!!)” It’s that kind of attitude which is one of the major problems with eldercare as we currently define it; and for those who have always suspected such in the back of their head, this is 100 percent the book for you.