Thoughts on “Being Mortal”

Atul Gawande’s marvelous book “Being Mortal: Medicine and What Matters in the End”, is a must-read for anyone who plans to age in the USA. Dr. Atul Gawande is a surgeon, a professor at Harvard Medical School and the Harvard School of Public Health, a writer for the New York Times, and the author of three bestselling non-fiction books on science and public health. He makes difficult subjects interesting and understandable. You don’t have to be a scientist to understand and enjoy his books.

In “Being Mortal”, Dr. Gawande writes eloquently about the history of how we care for our aging population and the importance of retaining the dignity and freedom to be the “authors of our own lives.” In the end, when all else is said and done, that is what matters.

This book has inspired me. This month, I spoke at the Arizona Geriatric Society’s Fall conference. My topic was “Managing Dysphagia Beyond Acute Care”. Once read this book, I reworked my presentation. I made sure to address the joy of eating, the social aspects of sharing a meal and the cultural significance of food. The medical professionals who attended this conference know the science so I shared with them my thoughts on the art and soul of eating.

“Being Mortal” is a call to action for doctors and other medical professionals to expand our responsibilities beyond trying to “fix” what is wrong and embrace the final years of living. This time period should be about living as fully as possible and having the best possible day (week/month/year); it should not be focused on dying.  As we reach advanced age or fight a terminal illness, much of what happens to our bodies can’t be “fixed”. Yes, we can eat right and exercise but there is nothing we can do to stop time.

For many of us, as we age, our ability to swallow can become impaired. Illnesses like oral cancer and dementia can rob us of more than our vitality; they can steal from us our ability to eat and enjoy food. According to the National Institutes of Health, one in six Americans over the age of 60 is having trouble swallowing. In 2013, over ten million Americans had a swallowing assessment.

In “Being Mortal” Dr. Gawande builds the case that “as our time runs down, we all seek comfort in simple pleasures – companionship, everyday routines, the taste of good food, the warmth of sunlight on our faces”. Not being able to eat and drink like everyone else can interrupt our everyday routines, be isolating and can lead to depression. Food and eating is basic to our survival, but is even more important to our quality of life and our joy of living. How we eat and with whom we eat feeds the spirit.

Caring for someone with swallowing problems is about more than the mechanics of feeding. Doing it right is science combined with art. With the right tools, creativity and information, it may be possible for those with swallowing problems to share and enjoy a meal. Diagnoses and food modifications help to sustain the ability to nourish the body but we should acknowledge that we need to feed the soul, as well.