What Matters Most?

EARLY IN Being Mortal, surgeon Atul Gawande tells the story of Joseph Lazaroff, a patient with incurable prostate cancer. His medical team pursued multiple treatments, including emergency radiation and surgery, but Lazaroff ultimately died. What most struck Gawande later was that he and the team avoided talking honestly about Lazaroff’s choices—even when they knew he couldn’t be cured.

“We could never bring ourselves to discuss the larger truth about his condition or the ultimate limits of our capabilities, let alone what might matter most to him as he neared the end of his life,” Gawande writes. “The chances that he could return to anything like the life he had even a few weeks earlier were zero. But admitting this and helping him cope with it seemed beyond us.”

Why is that? For one, Gawande’s medical training didn’t prepare him for dealing with frailty, aging, or dying, he writes. He and his peers were taught to “fix,” to heal people with expertise, tools, and tests. Like most doctors, he approached his patients’ challenges as medical problems to solve, whether they were the accumulations of old age or terminal illness.

But a decade into his practice, Gawande is arguing for a change. Being Mortal is a conversation about why and how. For all its triumphs, medicine doesn’t—and shouldn’t—hold all the answers when it comes to aging and death.

Gawande looks at aging and societal shifts over the last decades, particularly the development of nursing homes (hospitals needed a place to put elderly patients who had nowhere else to go) and their limitations—something he saw through the experience of his grandmother-in-law, Alice Hobson.

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