Essential Truths About Aging and Death

Last year (2024) I reached my goal of reading one hundred books — works ranging from science, medicine, psychology, and the arts to social science, literature, and investing. Among them were many outstanding titles. To keep this recommendation list from growing unwieldy, I have chosen only the finest: every book below earned at least four, and often five, stars in my personal ledger.

Why these particular books? Some expanded my vision and sharpened my thinking; others offered knowledge of genuine practical value; still others moved me so deeply that I felt both joy and sorrow. All of them are volumes I will revisit — proof enough, I hope, of their worth.

---

First on the list

Title: Being Mortal: Medicine and What Matters in the End
Author: Atul Gawande

---

Most of you who are reading this newsletter are still far from old age, and the realities of decline and death may feel both remote and frightening. Yet every life reaches the same terminus. What will we face when that time comes?

What physical and emotional journeys lie ahead? What can we do to prepare — and how must medicine itself change to meet those needs? To dispel fear, we must first dispel ignorance.

In Being Mortal, surgeon and public-health professor Atul Gawande addresses many of the most pressing questions about aging and death. He examines modern medicine's current stance — and its limitations — arguing persuasively that the traditional goal of "curing disease" is often ill-suited to the elderly.

The book explores nursing homes, in-home care, hospice, and more: Why do we grow old? How does aging alter each part of the body (a healthy sixty-year-old's retinas, for instance, receive only one-third the light of a young adult's)? Is remaining at home truly better than moving to a facility? How can we accept aging with grace and find courage before death? What, finally, is the meaning of life — and what should the aims of end-of-life care be?

Gawande combines scientific rigor with profound humanism. Real cases abound, including the moving account of his own father's final illness. Below are a few insights that struck me most forcefully.

• The will to live is stubborn. Many young people blithely declare, "If I'm ever bedridden or terminally ill, I'll end my life on my own terms." Yet when the moment arrives, that resolve often melts. One patient in the book once told his son he would never die "full of tubes" as his late wife had. But when confronted with a life-or-death operation, he begged: "Don't give up on me — try everything."
• Healthy habits slow aging but do not halt it. Mainstream medicine is not designed for older patients; physicians treat symptoms, expecting the patient to regain vigor unaided. The elderly, lacking that resilience, often suffer greater pain from identical interventions. Thus geriatrics emerged — medicine that considers not only disease but also a patient's daily life and mental health, reducing depression and disability. Sadly, geriatrics still receives scant attention and funding.
• Japan's quiet lessons. Living in Japan, the world's oldest society, I see daily how thoughtfully the country adapts. Slower escalators, flawless barrier-free design, "mild-cool" subway cars, and traditional services such as cash payments or postal forms ensure seniors are not stranded in a digital world. Even rented apartments include bathroom handrails and non-slip floors; New Year dishes like ebi kakiage (shrimp tempura) and toshikoshi soba carry long-life symbolism. These details, woven through every aspect of life, deserve study by any nation confronting demographic change.

Aging and death await us all. Understanding them grants us courage: we need not fear tomorrow, but can instead devote ourselves to becoming our best selves today, cherishing the vigor of youth while offering deeper empathy and care as our parents grow old.