Medical opinion: Atul Gawande's prose is as sharp as his scalpel. Photo: Erik Jacobs/NYT/Redux/Eyevine
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Rock doc: surgeon and writer Atul Gawande on old age and dying

What should doctors do when the drugs won’t work? Often it’s easier to push one more treatment than to acknowledge that “people have priorities other than living longer”.

Choosing a soundtrack for the operating theatre is not easy. “It has to be the kind of music that the nurses and the other doctors go along with,” the American surgeon Atul Gawande explains. “Country tends to be out, and most hip-hop, too.” He usually goes for indie. A journalist once told him that his problem was that he was too old for his iPod (he’s 49), which amused him. Gawande, sharply suited and drinking orange juice in a London café, lists his current surgery favourites: Alt J, the National and Weezer.

His musical taste is just one way in which Gawande defies convention as a surgeon. He is also a bestselling author who has been a staff writer for the New Yorker since 1998, and he’ll be giving this year’s Reith Lectures. He has a knack for identifying grand themes – how checklists can save millions of lives lost through medical mistakes, why some ideas (such as anaesthetic) catch on quickly and others (such as antiseptic) don’t, what hospitals can learn from the fast-food industry – and exploring these ideas through the stories of the patients he has treated. His writing is often moving – sometimes in a stomach-churning way: his account of the woman with an unstoppable itch who scratched all the way through to her brain is, perhaps regrettably, unforgettable.

Gawande’s latest book, Being Mortal, explores how the medical profession, and modern society, approach the end of life. What should doctors do when the drugs won’t work? Often it’s easier to push one more treatment – an operation, another round of chemo – than to acknowledge that “people have priorities other than living longer”.

This is a book about the “good life” and even though often sad, it is uplifting, too. We are wrong to assume that in order to be happy you need to be independent and healthy: elderly people dependent on help often report higher levels of happiness than the rest of us. As we age, we care less about wealth and public recognition, valuing close friends and family more.

Gawande admires those thinking imaginatively about geriatric care: the man who introduced cats, dogs and birds into a nursing home, or the staff who make sure an 85-year-old dementia patient can go out drinking margaritas every Friday. “I have nothing against the tech entrepreneur who wants to discover the immortality pill,” he says, but adds that it is wrong “that we don’t think there can be innovation in what happens in the last five years of your life that can make it incredibly better”.

The tenderest passages are those in which Gawande writes about his father’s death from cancer. Atmaram Gawande died before the book was published, but Atul’s research helped him support his father better. Both were surgeons, but initially they “couldn’t even wrap [their] minds around how to talk about the tumour that was advancing”.

For Atmaram Gawande, medicine was a path out of poverty. He grew up in India and decided to become a doctor – although he’d never met one – after his mother died of malaria. He met Gawande’s mother in the US and settled in rural Ohio, where Atul grew up. “I’m the son of two Indian immigrant physicians. Which means you practically have ‘You are going to be a doctor’ stamped on your head at birth,” Gawande jokes. He initially resisted this pressure: starting a rock band, winning a Rhodes scholarship to study philosophy, politics and economics at Oxford, working in the Clinton administration and for Al Gore’s presidential campaign. But then he realised he was “good at certain things in medicine, better than I was as a philosopher”. He seems pretty successful at both. 

Sophie McBain is a freelance writer based in Cairo. She was previously an assistant editor at the New Statesman.

This article first appeared in the 20 November 2014 issue of the New Statesman, The deep roots of Isis

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Supreme Court gives MPs a vote on Brexit – but who are the real winners?

The Supreme Court ruled that Parliament must have a say in starting the process of Brexit. But this may be a hollow victory for Labour. 

The Supreme Court has ruled by a majority of 8 to 3 that the government cannot trigger Article 50 without an Act of Parliament, as leaving the European Union represents a change of a source of UK law, and a loss of rights by UK citizens, which can only be authorised by the legislature, not the executive. (You can read the full judgement here).

But crucially, they have unanimously ruled that the devolved parliaments do not need to vote before the government triggers Article 50.

Which as far as Brexit is concerned, doesn't change very much. There is a comfortable majority to trigger Article 50 in both Houses of Parliament. It will highlight Labour's agonies over just how to navigate the Brexit vote and to keep its coalition together, but as long as Brexit is top of the agenda, that will be the case.

And don't think that Brexit will vanish any time soon. As one senior Liberal Democrat pointed out, "it took Greenland three years to leave - and all they had to talk about was fish". We will be disentangling ourselves from the European Union for years, and very possibly for decades. Labour's Brexit problem has a long  way yet to run.

While the devolved legislatures in Scotland, Northern Ireland and Wales will not be able to stop or delay Brexit, that their rights have been unanimously ruled against will be a boon to Sinn Féin in the elections in March, and a longterm asset to the SNP as well. The most important part of all this: that the ruling will be seen in some parts of Northern Ireland as an unpicking of the Good Friday Agreement. That issue hasn't gone away, you know. 

But it's Theresa May who today's judgement really tells you something about. She could very easily have shrugged off the High Court's judgement as one of those things and passed Article 50 through the Houses of Parliament by now. (Not least because the High Court judgement didn't weaken the powers of the executive or require the devolved legislatures, both of which she risked by carrying on the fight.)

If you take one thing from that, take this: the narrative that the PM is indecisive or cautious has more than a few holes in it. Just ask George Osborne, Michael Gove, Nicky Morgan and Ed Vaizey: most party leaders would have refrained from purging an entire faction overnight, but not May.

Far from being risk-averse, the PM is prone to a fight. And in this case, she's merely suffered delay, rather than disaster. But it may be that far from being undone by caution, it will be her hotblooded streak that brings about the end of Theresa May.

Stephen Bush is special correspondent at the New Statesman. His daily briefing, Morning Call, provides a quick and essential guide to British politics.