Quotes from Atul Gawande

Was money part of the problem?

The birds were drawing him out. For Thomas, it was the perfect demonstration of his theory about 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 reason has to be that doctors remain at least partly motivated by the hope of doing meaningful and respected work for people and society.

he told them of the dire condition she was in when she arrived

It is still not apparent to me what the clues were that I was registering when I first saw Eleanor's leg. Likewise, it is not obvious what the signs were that we could get by without an amputation.

Josiah Royce wrote a book with the title The Philosophy of Loyalty.

what he has found is a stubborn, overwhelming, and embarrassing degree of inconsistency in what we do.

there was nothing for them to do but wait.

When life's fragility is primed peoples goals and motives in their every day lives shift completely. It's perspective not age that matters most.

The question therefore is... how can we build a health care system that will actually help people achieve what's most important to them at the end of their lives

How can this be justified?

The single most serious threat she faced was not the lung nodule or the back pain. It was falling. Each year, about 350,000 Americans fall and break a hip. Of those, 40 percent end up in a nursing home, and 20 percent are never able to walk again. The three primary risk factors for falling are poor balance, taking more than four prescription medications, and muscle weakness.

But, she said, "It's the rare child who is able to think, 'Is this place what Mom would want or like or need?' It's more like they're seeing it through their own lens." The child asks, "Is this a place I would be comfortable leaving Mom?

How could anyone who makes a mistake of that magnitude be allowed to practice medicine?

The soaring cost of health care has become the greatest threat to the long-term solvency of most advanced nations, and the incurable account for a lot of it. In the United States, 25 percent of all Medicare spending is for the 5 percent of patients who are in the final year of life, and most of that money goes for care in their last couple of months that is of little apparent benefit

She envied the confidence and poise of the women she saw behind the desk.

Eleanor Bratton, without question, would have been treated completely differently depending on where she went, who she saw, or even just when she saw me

The answer, he believed, is that we all seek a cause beyond ourselves. This was, to him, an intrinsic human need. The cause could be large (family, country, principle) or small (a building project, the care of a pet). The important thing was that, in ascribing value to the cause and seeing it as worth making sacrifices for, we give our lives meaning.

Thomas laid out the thinking behind his proposal. The aim, he said, was to attack what he termed the Three Plagues of nursing home existence: boredom, loneliness, and helplessness. To attack the Three Plagues they needed to bring in some life. They'd put green plants in every room. They'd tear up the lawn and create a vegetable and flower garden. And they'd bring in animals.

Medicine has become the art of managing extreme complexity.

We want to see them punished.

the encounter somehow made the goal seem attainable.

Everyone understands, though, that a great deal of uncertainty about what to do for people will always remain.

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.