Quotes from Atul Gawande

Taking care of a debilitated, elderly person in our medicalized era is an overwhelming combination of the technological and the custodial.

As you get older, the lordosis of your spine tips your head forward," he said to me. "So when you look straight ahead it's like looking up at the ceiling for anyone else. Try to swallow while looking up: you'll choke once in a while. The problem is common in the elderly. Listen." I realized that I could hear someone in the dining room choking on his food every minute or so.

They ask only to be permitted, insofar as possible, to keep shaping the story of their life in the world—to make choices and sustain connections to others according to their own priorities. In modern society, we have come to assume that debility and dependence rule out such autonomy.

Medicine's ground state is uncertainty. And wisdom—for both patients and doctors—is defined by how one copes with it. This

There was a succession of roommates, never chosen with her input and all with cognitive impairments. Some were quiet. One kept her up at night. She felt incarcerated, like she was in prison for being old. The

The job of any doctor, Bludau later told me, is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible and the retention of enough function for active engagement in the world. Most doctors treat disease and figure that the rest will take care of itself.

When, as the researchers put it, "life's fragility is primed," people's goals and motives in their everyday lives shift completely. It's perspective, not age, that matters most. Tolstoy

we all require devotion to something more than ourselves for our lives to be endurable.

What is troubling is not just being average but settling for it. Everyone knows that average-ness is, for most of us, our fate. And in certain matters—looks, money, tennis—we would do well to accept this. But in your surgeon, your child's pediatrician, your police department, your local high school? When the stakes are our lives and the lives of our children, we want no one to settle for average.

what living things provide. In place of boredom, they offer spontaneity. In place of loneliness, they offer companionship. In place of helplessness, they offer a chance to take care of another being.

The amount of freedom you have in your life is not the measure of the worth of your life. Just as safety is an empty and even self-defeating goal to live for, so ultimately is autonomy.

It is not death that the very old tell me they fear. It is what happens short of death—losing their hearing, their memory, their best friends, their way of life.

even children are permitted to take more risks than the elderly.

We want autonomy for ourselves and safety for those we love." That remains the main problem and paradox for the frail. "Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self.

When, as the researchers put it, "life's fragility is primed," people's goals and motives in their everyday lives shift completely. It's perspective, not age, that matters most.

The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society. If you don't, mortality is only a horror. But if you do, it is not.

Your chances of avoiding the nursing home are directly related to the number of children you have, and, according to what little research has been done, having at least one daughter seems to be crucial to the amount of help you will receive.

A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one's story is essential to sustaining meaning in life;

We want perfection without practice. Yet everyone is harmed if no one is trained for the future. So

Spending one's final days in an ICU because of terminal illness is for most people a kind of failure. You lie attached to a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said good-bye or "It's okay" or "I'm sorry" or "I love you.

That remains the main problem and paradox for the frail. "Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self.

Courage, Laches responds, "is a certain endurance of the soul.

I tried not to seem like a kid who'd just been offered a chance to go up to the front of the plane and see the cockpit. Sure, I said. That sounds neat.

Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days.