"Being Mortal" by Atul Gawande & Spinach Mana’eesh
As a medical student, I was curious to read Dr. Atul Gawande’s latest book, Being Mortal. I had heard of him often, especially as a writer and future doctor, but had not yet read any of his work. What intrigued me most about his latest book was the fact that he was writing about aging and death, a topic so rarely discussed pragmatically and head-on in medicine, or even in daily life.
I was pleased to find that Dr. Gawande is forthcoming in his perceptions of the way our current culture has approached caring for the elderly. Through his experiences, research and conversations with individuals across the globe, Gawande finds consistent threads of change that have reduced the quality of old age and the experience of dying in America.
What I found fascinating about Gawande’s comparisons was the way that he delves into cultural differences between America and other societies. The value placed on the elderly is itself quite different, and as a result the process of aging and death is too. In many societies, the elderly are revered and valued for their wisdom, knowledge of tradition, and skills. As a result, they are well taken care of by family and rarely age alone, unlike much of our elderly population in the United States.
I was surprised to read about the implication this has on the way in which people die. As I continued to read, however, it made more sense. The family unit has changed drastically in many societies, and with the advent of technology reducing our need for bearers of tradition, the elderly are seen more and more as a burden. Thus, they are often left to age on their own and eventually sent to facilities of care by their families or their own inclination. This, of course, is a far cry from other cultures where the elderly continue to live with their multigenerational families until their last days.
Gawande examines the facets of life, from the evolving family unit to modern medical practice, that have led from what is still perceived as an idyllic way of aging and dying -— having autonomy and living a fulfilling life and dying comfortably without being in a medical facility — to our current conditions where the elderly are often relegated to nursing homes, hospice facilities, and hospitals as they near their final moments.
The problem is, in part, due to medical culture.
Too often, because of the capabilities technology has allowed, we expect that medicine will return us to our full faculties, that in spite of ailments that continue to cause our decline, we can still survive as we had once been. The reality, unfortunately, is that modern medicine, while powerful, is still limited, buying time and keeping diseases only at bay.
Our expectations then do not align with reality. While we hope for this idyllic form of dying, we are often also believe that choosing not to take all drastic medical measures means that we are not strong individuals. This struck a chord with me. In a busy world filled with countless opportunities, giving in to the inevitable has become a sign of weakness. That seems true on many levels, whether social or professional. So how can it be surprising that it would seep into our experience with illness and ultimately death?
Gawande makes a compelling argument for the way that medicine should change, for the principles that should guide our society as we handle the very nature of death. What we need is acceptance of the limitations of medicine and of the ever changing social landscape in order to truly allow ourselves to die comfortably, rather than suffering through procedures that can only keep us clinically alive without truly living.
I found myself agreeing with Gawande on many fronts, eager to see such change blossom. As I think forward about my future as a clinician, I can only hope that with time we can greatly improve the process of aging, dying, and providing medical care to a vulnerable subset of our population.
While I think this book was extremely valuable to me as a health professional, I can also say that it is a must-read for anyone given the breadth and implications that aging and dying have for society.
This traditional Arab bakery item is a delicious and healthy addition to your cuisine. While reading Being Mortal, I thought of these little appetizers because of their history and tradition. Like many Arab dishes, the technique and taste varies between bakers and families. Its recipe is often handed down for generations. As we age, we carry these traditions forward as emblems of our family structures, even as the family unit itself transforms.
For the dough
- 1/2 stick butter
- 3-4 cups all-purpose flour (start with 3 and add up to a cup more if dough feels runny)
- 1/4 teaspoon salt
- 1 cup milk
- 1 egg
- 2 teaspoons yeast
- 1 tsp sugar
- 1/2 cup warm water (for every 2 tsp. yeast)
- A large bag of spinach
- ½ an onion
- Garlic powder
Preheat oven to 350ºF.
In the meantime, heat butter until it is half melted. Separately, heat milk until it is lukewarm. In another bowl, mix the lukewarm water with 1 teaspoon sugar. Add the yeast and let it rise a bit. If it rises, go ahead and use it.
In a separate bowl, beat eggs, milk, and butter together.
Next, beat in the yeast-water mixture.
Combine the salt and flour in a separate bowl. Then, gradually add this mixture to the bowl with the other ingredients. When you're done adding the flour and the dough comes together, knead it for some time so that the dough feels well-formed and elastic.
After the dough is kneaded, put it in a bowl and cover. Then, let rise for 20 to 30 minutes.
In the meantime, as the dough rises, gently saute the spinach and onion with salt, pepper, and garlic powder to taste. This will be the filling.
After the dough rises, take a small handful of dough and press it into a very thin square (about ¼-inch
Place a tablespoon of filling in the center of the square. Fold the corners of the dough into the center and pinch closed. The result should be a small pouch in the shape of a triangle (but any shape is fine, really).
Place on a greased baking sheet.
Repeat the process of creating little squares, stuffing, and folding them until you have the desired number of mana’eesh.
Bake for 20 to 30 minutes.
TIP: You can use all of the dough, or you can use some and store the remaining unbaked dough in a zip-top bag in the fridge or freezer until the next time you’d like to use it.