I’ve been influenced by Atul Gawande as much as the next young doctor. I have Complications and Better sitting on my bookshelf, and they’ve travelled with me from New York to Chicago to California, set aside in my “keeper” pile through multiple book sales and donations along the way.

His new book, Being Mortal, is about end-of-life care. It’s getting attention as one of the best books of the year, but the entire premise bites and gnaws at me. It was so clearly written by, for and about people who have a certain kind of modern life experience. People who bury their elderly parents after a long illness, and who will be buried by their own children after a long illness. I know this can’t encapsulate Gawande’s full professional experience – after all, he is a surgeon, and has been exposed to all manner of unexpected tragedy. But, as he explains, it does seem to encapsulate his personal experience. And that personal experience (and lack of experience) strongly impacts his work (even though the book is non-fiction).

For example, he writes,

“The striking thing is that if you go back to the 19th century and before, people were at risk of dying at every moment in their lives. Families were bigger because you would lose a child, commonly, sometime through childhood. Mothers would die in childbirth. Being alive was associated with a special risk of death! Now we can live our lives without really feeling our lives are fragile at all. Without feeling there are limits to what we can do.”

This makes me want to scream: I am alive today, and it is not the 19th century. You’re describing my modern-day lived experience of life as thought it were a strange relic of the past!! My son died in (very early!) childhood and I was at high risk of dying during childbirth. I know that any moment of life, from conception onward, is associated with a special risk of death. I really feel (know) that my life is fragile! I feel (know) that there are limits to what I can do!

Who are you writing about, Atul Gawande?? Who are you writing to? Who is this “we”? Your “we” has nothing to do with me or my family. This book’s ideas about what medical students know, what residents think, how doctors function, is so far removed from what my life is like, what my brain is like, what my practice of medicine is like.

This discordance makes me feel isolated, outcast and misunderstood. I know this is a book about people dying in old age. But is facing mortality through the early death of a young loved one truly such a unique experience? Is the rest of the modern world as innocent as Gawande’s treatise makes it seem? Is he just expressing humility about his own knowledge level, or have I become so different from everyone else?

Before Sacha’s death, I found comfort and motivation in the feeling of belonging and purpose that I got from medicine.

Like in Helplessness Blues, by Fleet Foxes:

I was raised up believing I was somehow unique
Like a snowflake distinct among snowflakes, unique in each way you can see
And now after some thinking, I’d say I’d rather be
A functioning cog in some great machinery serving something beyond me

I still love my work very much, but I feel abandoned by the machine. I’m not a cog anymore. My story doesn’t fit. Like in Samson, by Regina Spektor (just replace “Bible” with “Atul Gawande’s Book”, or “conventional wisdom”, or even “UpToDate”):

And the history books forgot about us
And the Bible didn’t mention us
The Bible didn’t mention us
Not even once

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