A “dry, leathery corpse”introduces Atul Gawande to medical school and readers to his book, Being Mortal. Nothing else is revealed about the body; its former owner’s life and death are meaningless to the medical students who will dissect it. Gawande closes Being Mortal with a far different image: a memoir of his father’s illness, decline and death, that ends with spreading his ashes on the Ganges River, an “intensely moving experience” that connected them both to a “story going back thousands of years.” (p. 253)
The pages between follow a trajectory as familiar as the story recounted in the old Christian hymn, “I once was lost, but now am found; was blind but now I see.”Being Mortal is, at its heart, a conversion story, a narrative of a transformation in Gawande’s understanding of the meaning of death, and ultimately, his own life and work. His profession of faith comes early in the book, “I have the writer’s and scientist’s faith. . .that by pulling back the veil and peering in close, a person can make sense of what is most confusing or strange or disturbing.” (p. 9) There’s a strong undercurrent of religious imagery in “pulling back the veil” and in the transformative power of clear vision. Such rich imagery is one of the pleasures that await readers of Being Mortal. Reading the book flap biography, with its impressive list of credentials from Harvard, the MacArthur Foundation, and TED, a reader might expect a guidebook like his earlier work, The Checklist Manifesto, that changed operating-room procedures in countless US hospitals. Instead, Gawande offers his experience as testimonial and inspiration.
To ‘fight the good fight’is also an image common to conversion narratives, and it is an important one in Being Mortal. Gwande describes mortality as a battle “to maintain the integrity of one’s life—to avoid being so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or want to be.”(p 147) Professionals who care for the sick and dying “ought to be aiding people in their struggle” with human limitations and the constraints of biology. But for Gawande, the battle of being mortal is not a struggle to defeat an enemy but to gain the victor’s privileges. Life in the face of death is a battle for autonomy, and the purpose of autonomy is authorship. We may not control the circumstances of our aging, illness, and death, but we can struggle “to shape our response to them” (p. 210), “to keep shaping the story of our life in the world—to make choices and sustain connections to others according to [our] own priorities.”(p. 147)
And here is the most potent image in Gawande’s conversion narrative, his renewed understanding of narrative itself. “For human beings,” he writes, “life is meaningful because it is a story.” (p. 238) Stories have arcs, and within stories, endings matter, to the point that endings can reshape everything that comes before. Gawande faults current medical practice for its narrow focus on fixing problems that loses sight of the fundamental need to “remain writers of our own story. . .to shape our lives in ways consistent with our character and loyalties.” (p. 140)
among stories of scientists, philosophers, friends, patients, and practitioners. He knows the value of a punchy line, like “If end-of-life discussions were an experimental drug, the FDA would approve it.” (p. 178) He deftly displays self-deprecating humor: “Between the three of us we had 120 years in medicine, but [my father’s illness] seemed a mystery.”(p. 223) His account of his father’s diagnosis and life with cancer, decline and death will likely be as central and illuminating for most readers as it was for Gawande.
Gawande’s faith seeks understanding by looking closely and clearly at the human experience of mortality. He sees there a struggle for autonomy and authorship, and that stories, more than science or medicine, enable us to face our mortality. Gawande concludes his testimony with a deeper understanding of himself as a human being and a physician, as one who accompanies others as they shape their lives in the face of what medicine cannot fix.
And yet stories have their own autonomy, beyond the limits of any author’s intent. Once told, stories are the wildest things of all; when you turn them loose, who knows what havoc they might wreak? This description comes from another meditation on mortality, this time in the form of Patrick Ness’s young adult novel A Monster Calls. For all that storytellers like Ness and Gawande desire clear vision and courageous authorship, our stories can be untidy, elusive, and opaque. Veils remain between our understanding and experience of death. The final meaning of any life is unknowable until the time that we are no longer its authors. When our stories becomes as fixed as the stars, they will then be endlessly drawn into new constellations by the tales our survivors tell.