Quotes from Atul Gawande

where they had control--their skills, for example--these doctors sought betterment. They understood themselves to be part of a larger world of medical knowledge and accomplishment. Moreover, they believed they could measure up in it...partly...a function of...camaraderie as a group.

The body's decline creeps like a vine. Day to day, the changes can be imperceptible. You adapt. Then something happens that finally makes it clear that things are no longer the same.

Human birth...is a solution to an evolutionary problem: how a mammal can walk upright, which requires a small, fixed, bony pelvis, and also possess a large brain, which entails a baby whose head is too big to fit through that small pelvis...in a sense, all human mothers give birth prematurely. Other mammals are born mature enough to walk and seek food within hours; our newborns are small and helpless for months.

You want people to make sure to get the stupid stuff right. Yet you also want to leave room for craft and judgment and the ability to respond to unexpected difficulties that arise along the way.

One American in seven has no coverage, and one in three younger than sixty-five will lose coverage at some point in the next two years. These are people who aren't poor or old enough to qualify for government programs but whose jobs aren't good enough to provide benefits either.

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; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone's lives.

Assisted living most often became a mere layover on the way from independent living to a nursing home.

We've divided the world into us versus them—an ever-shrinking population of good people against bad ones. But it's not a dichotomy. People can be doers of good in many circumstances. And they can be doers of bad in others. It's true of all of us. We are not sufficiently described by the best thing we have ever done, nor are we sufficiently described by the worst thing we have ever done. We are all of it.

I never expected that among the most meaningful experiences I'd have as a doctor—and, really, as a human being—would come from helping others deal with what medicine cannot do as well as what it can. But it's proved true, whether with a patient like Jewel Douglass, a friend like Peg Bachelder, or someone I loved as much as my father.

We are running up against the difficulty of maintaining a coherent philosophical distinction between giving people the right to stop external or artificial processes that prolong their lives and giving them the right to stop the natural, internal processes that do so. At root, the debate is about what mistakes we fear most—the mistake of prolonging suffering or the mistake of shortening valued life.

The problem is that the wise course is so frequently unclear. For a long while, I thought that this was simply because of uncertainty. When it is hard to know what will happen, it is hard to know what to do. But the challenge, I've come to see, is more fundamental than that. One has to decide whether one's fears or one's hopes are what should matter most.

There is one difference in medicine, though: it is people we practice upon.

He wanted no careless errors; the stakes were too high.

Technological society has forgotten what scholars call the "dying role" and its importance to people as life approaches its end.

So when my turn came up again, I put my name down for duty that night.

I'm in dread of what would happen if she becomes too hard for me to care for," he said. "I try not to think too far ahead. I don't think about next year. It's too depressing. I just think about next week." It's the route people the world over take, and that is understandable. But it tends to backfire. Eventually, the crisis they dreaded arrived

She was starting to grasp that this is what the closing phase of a modern life often looks like—a mounting series of crises from which medicine can offer only brief and temporary rescue. She was experiencing what I have come to think of as the ODTAA syndrome: the syndrome of One Damn Thing After Another.

Human judgment, even expert human judgment, falls well short of certainty.

I laughed and dismissed the idea.

That left only one possibility:

Bludau needed to triage by zeroing in on either the most potentially life-threatening problem or the problem that bothered her the most. But this was evidently not what he thought. He asked almost nothing about either issue. Instead, he spent much of the exam looking at her feet. The single most serious threat she faced was [...] falling. The three primary risk factors for falling are poor balance, taking more than four prescription medications, and muscle weakness.

And for a moment—only a moment, mind you—I felt my confidence slip.

however, the doubts really set in.

by incorporating feedback from each success and each failure to improve their guesswork.