Silly, I know; aging and end-of-life issues are one of my Huge Main Interests and I never really get tired of them.
But, I dunno, I've read so much good on this subject recently, I was worried Gawande's book would feel repetitive.
It didn't. First of all Gawande is just a thoroughly competent writer. Man knows how to write a compelling bit of medical non-fiction. I am bit of a connoisseur of doctors writing things (is anyone surprised? please tell me no.) and while Gawande is not quite as delightful as, say, Oliver Sacks . . . he has his craft well in hand.
Second, most of the reading I've done re: end-of-life issues has been very focused on the very end of life, usually the last six months as that's what's covered under the States' paltry “hospice” benefit (and don't even get me started on that!). Here, though, he expands the focus a bit to also discuss issues of ordinary aging. I really enjoyed the perspective he brought to this.
One of the ways our culture is unintentionally cruel to the elderly is in our obsession with safety. We tell the elderly, “no, you can't eat that; you have to eat purees; you might choke!” We stop them from having relationships because we are worried they might be abused. We tell them not to live alone any more because they might fall and hurt themselves.
The thing is, though . . .if you're 98, perhaps being able to just eat a sandwich is worth more to you than avoiding chocking. Perhaps choking to death at a sandwich at the age of 98 (or, more likely, getting aspiration pneumonia from it) is a consummation devoutly to be wished.
Perhaps, at the age of 85, you're willing to take your own risks with relationships rather than being warned off — even if you're “demented.”
Perhaps living independently is more important to you than safety. Perhaps, as the end of life nears, what matters most is not planning to be around for five more years but to enjoy the time you have now.
Gawande talks about this sort of thing — about how all our good intentions sometimes (often?) conspire to make a misery of our elders' waning years.
This is a topic near and dear to my heart, and he did good work with it. If that was the only good part of the book it would still be worth reading, but there is even more going on. My verdict: well worth the time you might put into reading it. Just do it!