by Atul Gawande
For years when looking for a book to read (or now to listen to) it has always been the epic fantasy and sci-fi novels that I have reached for. This book had been recommended to me so many times however, including by leaders and colleagues in our Next Gen GP programme, that I thought I would give it a try.
In this book Atul Gawande, a world-renowned American author and surgeon, explores what it means to be mortal in the 21st century. We are taken on his journey of facing our mortality, from the difficulties of aging to what it means to care, and finally to facing our ends. Challenging the beliefs we have as professionals and patients about the aims of healthcare.
This book is a sensitive and enlightening exploration of the trials that we face in healthcare in looking after an aging population, challenging many of the thoughts and practices that are commonplace. The reminder that in our attempt to do good and extend life, we can in fact cause harm and distress is a humbling one. Even when we feel that we are aware of these difficulties it is still a fascinatingly complex situation to navigate. Atul Gawande’s touching stories of his own experiences with his father’s illness and end of life expose and explore many of the anxieties and struggles that clinicians go through. The theme of personal experience and narrative runs through every part of this book. There is humour and inspiration from his encounters with the pioneers of elderly community care, and their paradigm breaking approaches to what people want vs what we think that they need - including the surprising success of filling a care home with hundreds of live animals! This humour is contrasted with the sensitive and heartfelt exploration of what the true consequences are of when we get it wrong, and the peace and life (and for that matter death) changing impact that can be had when we get it right.
Reading this book has already changed my practice, encouraging me to have the difficult conversations with families and relatives earlier, so that in their life they can be brought into the discussion of their wishes and their mortality. Moreover, it has changed the way that I have these conversations, considering what really is important to people is a very personal thing. As Gawande puts it “Our ultimate goal, after all, is not a good death but a good life to the very end.”
Finally, it has also changed my outlook on relationships with my family and loved ones. It has helped me realise that whilst care for others is at the heart of what we do we need to attend to ourselves and families as well, as – at some point – we all have to confront what it means to be mortal.
James Waldron, GP and Nottingham Next Gen GP Leader