Being Mortal

Being Mortal, Atul Gawande

Gawande has written this sobering, honest, critical and yet hopeful book “about the modern experience of mortality - about what it’s like to be creatures who age and die, how medicine has changed the experience and how it hasn’t, where our ideas about how to deal with our finitude have got the reality wrong.” 

As he says:

“Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need."

He considers the medicalisation and institutionalisation of dying, and how it comes at cross purposes to what many want in their final days and years: choice over whether to remain in your own home, freedom over what you eat & drink, how we socialise (or not) with others, and the ability to make your own decisions about care, treatment and death.

He moves through topics considering how independent we are through most of life, but things start to fall apart as bodies decay and age naturally. We become creatures who need more help, and who become more dependent on others.

He consider what he terms the failure of the nursing home experiment, noting they were never designed for the purposes to which they have been put, with the three things that plague them: boredom, loneliness, helplessness:

“Our elderly are left with a controlled and supervised existence, a medically designed answer to unfixable problems, a life designed to be safe but empty of anything they care about.”

Gawande uses personal stories to illustrate many of his points, including very sad situations of people over-treated with increasingly painful and pointless procedures, and given false hope, who, along with their family, were never properly prepared for their inevitable death. He contrasts this with well done hospice care. He also weaves the story of his own father’s decline and death, and the choices they had to make along the way.

“Our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw on. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come - and escape a warehoused oblivion that few really want.”

He notes how hard it is for patients, family and doctors to have these hard conversations, but having them helps everyone to process the reality, and to be clear about when they want, can expect and what is possible. He suggests some of the things we should be talking about at this stage are:

• What do you want? (eg to be at home, to manage the pain, enjoy remaining days) 
• What are your biggest fears and concerns? (eg to not be able to go home, to be ventilated) 
• What goals are most important to you? (eg. being able to walk, care for yourself, eat, have autonomy over day) 
• What trade-offs are you willing to make, and which ones are you not? (this can help with risky surgery decisions, etc) 

Personally, I would have loved some consideration about how faith affects people’s view about these last days, but that was not where this book was headed.

He touches on assisted suicide, and in the end is not greatly supportive of it: “Our ultimate goal, after all, is not a good death but a good life to the very end.” As he notes, “assisted living is far harder that assisted death, but its possibilities are far greater, as well.”

I appreciated some of his final comments:

“Technological society has forgotten what scholars call the “dying role” and is important to people as life approaches its end. People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their legacies, make peace with God, and ensure that those who are left behind will be okay. They want to end their stories on their own terms …the way we deny people this role, out of obtuseness and neglect, is cause for everlasting shame. Over and over, we in medicine inflict deep gouges at the end of people’s lives and then stand oblivious to the harm done.”

“If to be human is to be limited, then the role of caring professionals and institutions - from surgeons to nursing homes - ought to be aiding people in their struggle with those limits”.

This is an excellent, thoughtful analysis that could help many start these important conversations with those they love.

God Made Me for Worship

God Made Me for Worship, Jared Kennedy 

This new volume in the God Made Me series helps young children to understand the purpose of church and what happens when we are there.

Like others in the series (God Made All of Me, God Made Me AND You, God made Boys and Girls, and God Made Me Unique) although all have different authors, they have a similar feel, both with way they have been collated, and with the eye-catching illustrations of Trish Mahoney.

It starts with a group of children talking to their pastor and wanting to understand why they do the things they do in church.

Then young readers are introduced to various parts of a worship service: the call to worship, praise and adoration, confession and lament, assurance, welcome (or passing the peace), ministry of the word (reading and preaching the bible), communion, giving, and the benediction. Variations between this expression and your church’s own would be easy to explain (eg. in our church no-one shouts out “That’s right! Amen!” during the preaching). And, of course, whether you have all these elements in your own church service will reflect your own churchmanship. Frankly, if some key parts are missing in your church, even parents should start to ask why. 

All of these are explained through the lens of the gospel, showing how what Christ has done for us is reflected in a worship service. My guess is, that this is a step many of us miss when we explain church to our children, for we may not have fully grasped it ourselves. 

I would have liked to see a bit more on prayer, because I hope a church would be praying more broadly that only in confession. I also felt bringing Isaiah 6 in was probably a bit more complicated than was necessary for this age group. I think this may be the first in the series with a parent that is not a believer, the father picks up the little girl and her mother after, and she is keen to tell him what she has learnt. That’s a helpful addition and reflects the reality of numerous families.

Another solid addition to the God Made Me series, aimed at those who are 4-8.

I received a pdf copy of this book in exchange for an honest review. 

Grace in the Desert

Grace in the Desert, Christine Dillon

Christine Dillon returns with the fourth book in her great series of Australian Christian fiction. I have not come across another author who so clearly explains the gospel, has strong Christian characters with real struggles and challenges, and has such relatable storylines.

In this volume the focus of the story returns to Rachel, and how she is managing with the changes life has presented to her in recent years. She is growing in her faith, but struggling with what forgiveness really means.

Pete also enters this story in more depth, who has suffered his own personal tragedy and is still coming to terms with loss. It is pleasing to see more strong Christian men in the later volumes.

Familiar characters from previous books are also still present: grandmother Noami, Blanche and William, the young man Josh with Down Syndrome who works at the nursery with Rachel and Pete, and Pete’s parents who were key in Rachel’s conversion.

Dillon writes very encouraging characters, who grow in sanctification, who are changed by God’s word, and who pour out their hearts to God in trusting prayer even in the midst of very challenging circumstances. She doesn’t shy away from the realities of life, the effects of sin, and the sadness that many live with. I found myself caught up in the characters’ lives and was moved to tears at numerous points.

My only concern is that for some it will feel like a high bar for comparison. There is almost no backsliding, no significant falling back into sin. While this is obviously the goal for us all as we continue to live faithfully in Christ - to be on an onward path of growth, I wonder if it may be disheartening for some who struggle to make such progress in their own lives. The challenges that beset many are not obviously present: be they laziness, struggles at church, finding it hard to love others, battles with addictions, or just persistent resistance to change. It’s also surprising that almost all of the characters are Christian, so there are much fewer evangelistic conversations than in previous books.

I suspect Dillon has chosen to have the focus more about what it means to continue to live in Christ, and that will be a help and encouragement to Christian readers. This book give us something to hope for and characters that we could model ourselves on. There is more practical theology and guidance for godly living here that in many non-Christian ‘how to’ books.

Again, my children (aged 17, 15 and 13) really appreciated it. Our Miss 13 has recently read all four for the first time and loved them. Compared to the light fluffy other ‘Christian’ fiction our children read, these are a wonderful way to explain the gospel again, to have characters that are real Christians living faithfully, and a way for them to consider their own growth in Christ. And they have been the same for me.