Being Mortal: Medicine and What Matters in the End

Atul Gawande’s Being Mortal is a brutally honest, but carefully crafted confrontation with mortality. None of us comes here to stay, but it is rare to spend time thinking strategically about earthly departure, until it seems near and inevitable. In the throws of terminal illnesses, Americans often choose costly medical procedures that don’t prolong life and that sometimes shorten and hinder the little bit of life that remains.

Gawande challenges us to begin to think critically about how we will spend our final days. He doesn’t just ask how we want to die, he’s more concerned with how we want to live. He asks the reader to consider what fulfills us. What is our purpose? What gives us a reason to live? Then he encourages us to build decisions about our medical care and end of life plans around our purpose, choosing options that enable us to continue fulfilling our purpose as effectively as possible for as long as we are able. But issues of purpose and fulfillment are not medical. Rather, they are spiritual.

Medical professionals concentrate on the repair of health, not sustenance of the soul. Yet- and this is the painful paradox- we have decided that they should be the ones who largely define how we live in our waning days. page 168

Despite being extensively trained and highly educated, Gawande reminds us that medical professionals are ill-equipped for soul work. So then, who is equipped to care for the soul? Is there a space designed to help us discover what matters most? Where can we turn to learn to tap into our center and find our grounding? Dr. Claudette Copeland says that this grounding comes through the identification of and adherence to core values. Once you align your core, all other life choices can be tethered to the core. This tapping in and tethering begins with faith.

Having a belief system nourishes and repairs the soul and becomes the navigational center for direction in life. As a Christian, my faith is informed by the Bible, nourished by spending time in community with other believers, and strengthened by spiritual disciplines and self-reflection. It is through spiritual disciplines such as prayer and fasting, coupled with self-reflection that I have found my life’s purpose(s) and discovered what matters most. My life choices, including where and how I will spend the rest of my days will support and fulfill my purpose. Gawande suggests that the sequence of decision making should be: soul first, body second.

Being Mortal is 263 pages of difficult but necessary conversation out of which an important leadership lesson also emerges. Decisions are often based on needs as perceived by an external decision-maker, but it is a wiser, more responsible use of energy and resources to meet others’ actual needs rather than their perceived needs. This approach to leadership requires spending extra time engaging people to determine what their real needs are, rather than making assumptions from a disengaged space. It also requires the selection of leaders who are willing to invest the time to gather the information and who care enough to be guided by what they learn. Finally, it requires choosing men and women whose moral compasses hold them accountable to ethical decision-making, even when no one is looking.

As campaign season gears up for the 2016 presidential election and more candidates toss their hats into the ring, I wonder who has the strongest core. I wish there was some way to build a campaign platform based on history of moral and ethical decision making rather than lofty, empty promises. Which candidate has a demonstrated record of leading from a tethered place? Who has invested time in discovering their own core values and is willing to invest equal time in discovering what matters to future constituents? That’s the candidate that will get my vote.

The most valuable books for me are those that call me to continue in conversation with them long after I have closed their covers. Being Mortal is one of those books.

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