In 1985, Alice Hobson, 77, lived independently, still mowing her own yard, fixing her own plumbing and driving her big Chevrolet Impala, often delivering meals-on-wheels to others. Seven years later, at age 84, Hobson still lived on her own, doing her shopping, going to the gym and taking care of her house. Later that year, though, she fell several times and began to experience mental lapses. Her children then faced an increasingly common dilemma: to move Hobson to a facility that could take care of her physical needs but rob her of her autonomy, or allow her to live on her own, or with them, where she would retain autonomy but face physical challenges.
Hobson’s story is one of many that New Yorker writer and surgeon Atul Gawande relates in Being Mortal: Medicine and What Matters in the End, a compelling account of modern medicine’s failures to deal humanely and wisely with aging and dying. As he points out, “the waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. They are spent in institutions—nursing home and intensive care units—where regimented, anonymous routines cut us off from all the things that matter to us in life.”
Gawande interviews geriatricians, hospice workers and innovators in the assisted living movement and discovers that while a growing number of individuals and institutions provide places where the aging can live out a life filled with meaning, change comes slowly. In the end, he says, we must “recognize that the aging have priorities beyond merely living longer and that giving them the chance to shape their story is essential to sustaining meaning in life.”
Nothing short of a manifesto, Gawande’s book should be on the shelf of every health care professional as well as required reading for anyone—which is to say, most of us—facing the prospect of providing for an aging family member.