Quotes from Atul Gawande

There's no escaping the tragedy of life, which is that we are all aging from the day we are born. One may even come to understand and accept this fact.

Nursing homes have come a long way from the firetrap warehouses of neglect they used to be. But it seems we've succumbed to a belief that, once you lose your physical independence, a life of worth and freedom is simply not possible.

it had wide influence.

the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.

The lesson seems almost Zen: you live longer only when you stop trying to live longer. *

jump-start the heart

he didn't understand why I hadn't called him when there were clear signs of airway trouble developing.

about whether the person could safely be kept on the job, and about how things might be turned around.

what makes life worth living when we are old and frail and unable to care for ourselves?

I offered no excuses. I promised to be better prepared for such cases and to be quicker to ask for help.

So the night before the operation he did an unusual thing: he discussed the treatment options with her and let her choose.

not the difference between treating and doing nothing, she explained. The difference was in the priorities. In ordinary medicine, the goal is to extend life. We'll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, chaplains, and social workers to help people with a fatal illness have the fullest possible lives right now—

In the end, people don't view their life as merely the average of all its moments--which, after all, is mostly nothing much plus some sleep. For hum beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments, the ones where something happens.

I felt a sense of shame like a burning ulcer. This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong.

was willing to do what everyone else was extremely reluctant to do: to judge (or, as he prefers to say, to "assess") a fellow doctor.

which didn't do much of anything

She just had to hang in there, she told herself

I was willing to be rejected. That's what allows you to be a good salesperson. You have to be willing to be rejected.

Their story drew a heated response.

Paul O'Neill, the former secretary of the Treasury and CEO of the aluminum giant Alcoa, agreed to take over as head of a regional health care initiative in Pittsburgh, Pennsylvania. And he made solving the problem of hospital infections one of his top priorities.

decisions perhaps influenced by money, professional bias (for example, surgeons tend to favor surgery), and personal idiosyncrasy.

Most doctors, taking seriously the idea that patients should control their own fates, lay out the options and the risks involved.

end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes?

But in my grandfather's premodern world, how he wanted to live was his choice, and the family's role was to make it possible.