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Being Mortal

Atul Gawande. pp.288 Metropolitan Books, 2014. ISBN-13: 978-1846685811

Being Mortal is a discussion of loss of function, dying, and death. Endocrine surgeon Atul Gawande asks all of us: individuals; society at large; individual doctors; and the medical profession, to approach the inevitable with more honesty and bravery.

He does not specifically address orthopaedic surgeons, but he implicitly challenges us to think about our patients’ function more than their survival.

Gawande fans will recognise the easy style with which he tackles difficult problems. He describes his patients’ and his own father’s terminal illnesses with equanimity. He takes us to intensive care units, nursing homes and hospices, and he identifies loss of autonomy, because of loss of function and institutionalisation, as the greatest challenge of illness and aging.

He succinctly states a central dichotomy: “We all want autonomy for ourselves and safety for our loved ones.”

As orthopaedic surgeons, we do not deal with many terminal illnesses, but, for our elderly patients, it is often orthopaedic injuries – broken hips or vertebrae – that rob them of function, and thus lives of meaning and pleasure.

In many countries orthopaedic surgeons have worked hard to save the lives of elderly people with hip fractures. Perhaps our next challenge is to think harder about the quality more than the length of their lives.

Reviewed by Jason Brockwell