Despite what my name might suggest, I don’t consider myself a particularly macabre person. My interest in death as a concept always sneaks up on me and takes me by surprise. I think it’s largely been an existential interest, because I’ve long subscribed to the idea that living close to endings helps keep you honest. I make all my decisions in a way that helps me know I’d be proud if I never got to make another one. I call my family regularly and invest heavily in my loved ones because I know I won’t always have them. To quote the song Green Grass by Ellie Dixon: “Coffee goes cold, so you better drink all of it.”

Death is my friend, so to hear Gawande repeat multiple times that “death is the enemy” was jarring. What do you mean? Why make an enemy of something that equally never asked to exist? It is not Death’s fault that we have so much angst and dread about it that goes beyond simple animal fear. Humans are one of a handful of species who mourn their dead via ritual—among elephants, dolphins, some other primates, and (perhaps) corvids—and while that’s beautiful, it’s also atypical for an animal. We invent increasingly creative ways to solve medical problems that our ancestors would perhaps be equal parts amazed and horrified to behold, and I think speaking to that is the real strength of Being Mortal.

Through personal anecdote, case studies, and intimate editorializing, Gawande beautifully articulates the need for medical practitioners to take a hard look at their entire philosophy of practice, without forgetting that the majority of his audience will be the patients looking to them for answers. The question is deceptively simple: what happens if you admit some things can’t be fixed? He establishes quickly the typical training and viewpoints of medical practitioners, whose entire jobs seem to revolve around fixing things that are broken. When met with something that can’t be fixed, the two common responses are to drop it like a hot potato, or to continue forcing a solution to coalesce.

This is where suffering is created, because what is less fixable than aging? What more assured than death? And when death is the enemy, the lengths a person will go in the name of stealing even a few more days from such finality can be devastating to everything they hold dear. People are sold tickets to a lottery they have almost no hope of winning because we struggle to have hard conversations about the reality of existence: that nothing lasts forever. Gawande’s primary advocacy is not to stop trying to beat the odds, but to make sure we give people the tools to decide what’s worth it to them. To create a space where it’s safe to contemplate what happens when we eventually, inevitably fail. To recognize when the hard decisions we have to make in medicine no longer align with the minimum quality of life we want for ourselves.

This book make me cry so many times, ranging from “who’s cutting onions?” to full-blown head back, tears streaming, completely bereft as he describes patients and their stories in ways that feel both informative and personal. You can feel the care he has for the people he speaks about, especially when he talks about the death of his own father. He implicates himself as being part of the problem he names, and he ends by illustrating the solution, even if the solution means peaceful surrender. There is so much we can do before that point, though. We talk about healthcare outcomes for marginalized communities, and I pray that more people can live long lives, but the elderhood that awaits so many of us needs improvements. The end of life care that reduces suffering for the terminally ill needs to be advocated for. In the end, death doesn’t have to be scary, if we’re willing to have the hard conversations before they become impossible ones.

I’m going to end my thoughts with a quote from Twitter I kept thinking about as I read this book:

i hope death is like being carried to your bedroom when you were a child & fell asleep on the couch during a family party. i hope you can hear the laughter from the next room