It began with a tingle in the surgeon's fingers and a pain in his neck. A couple of years later, he learned he had a tumor inside his spinal cord. That was when the difficult choices began. Should he have it removed right away in a risky operation, as his doctor recommended? Or should he take time to consider this question: At what point would the expanding tumor cause debility bad enough to justify the risk of greater debility or even death in trying to fight it?
The surgeon in the story is the father of Atul Gawande, who is also a surgeon as well as a writer for The New Yorker. His new book, "Being Mortal," is a personal meditation on how we can better live with age-related frailty, serious illness and approaching death.
It is also a call for a change in the philosophy of health care. Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is "to enable well-being."
If that sounds vague, Gawande has plenty of engaging and nuanced stories to leave the reader with a good sense of what he means. In a society that values independence, what happens when that is no longer possible? We need to reckon with the reality of the body's eventual decline, he argues, think about what matters most to us, and adapt our society and medical profession to help people achieve that.
Gawande writes: "For many, such talk, however carefully framed, raises the specter of a society readying 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?"
Medical professionals are the ones who are largely in control of how we spend our "waning days," he writes, yet they are focused on disease, not on living. "Medicine has been slow to confront the very changes that it has been responsible for — or to apply the knowledge we have about how to make old age better." The experts quoted here argue that doctors should not only treat disease but also concern themselves with people's functional abilities, and that most medical trainees should learn about geriatrics.