Being Mortal: Medicine and What Matters in the End.

Gawande, A. (2014).

New York, NY: Metropolitan Books Henry Holt and Company LLC. 279 pages.

In his book Being Mortal: Medicine and What Matters in the End, Dr. Atul Gawande tackles the complex issues faced at end of life. It should be required reading for all healthcare providers. Using his father's declining health and examples from his practice as a surgeon, he questions the reluctance of the medical establishment to recognize the inevitability of death, and the role they could play in extending quality rather than quantity of life. As Dr. Gawande eloquently expressed in his book: "Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don't want a general who fights to the point of total annihilation. You don't want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can't, someone who understands that the damage is greatest if all you do is battle to the end." To continue with Dr. Gawande's analogy, how often are patients asked what territory is important to them to fight for? Unfortunately, not often enough. Rarely is an older patient asked about his or her personal definition of quality of life. To be fair, there is reluctance on the part of some people to enter into a conversation about their own mortality with their healthcare providers; this undoubtedly contributes to the silence. But there are many older adults who would welcome a frank discussion during which they can be guided to make decisions based on their personal goals and desires. Too often patients find themselves in a battle for which winning the battle means losing at meaningful life.

-Contributed by Maureen Anthony, PhD, RN