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.