Quotes from Atul Gawande

But now he was adamant about doing "everything." David did not dare argue with him.

Wilson is still trying to work out how ordinary people can age without having to choose between neglect and institutionalization. It remains among the most uncomfortable questions we face.

daughter, if the parents survived into senescence. This was the lot of the poet Emily Dickinson, in Amherst, Massachusetts

I need to understand how much you're willing to go through to have a shot at being alive and what level of being alive is tolerable to you.

At times, they made her wonder if she had the right doctors

The nausea and the vomiting persisted, but she would not be defeated by them.

The effort and expense it took to keep him going were enormous

Making lives meaningful in old age is new. It therefore requires more imagination and invention than making them merely safe does.

One has to decide whether one's fears or one's hopes are what should matter most. *

Thirteen minutes after I took him off the ventilator

This simple but profound service—to grasp a fading man's need for everyday comforts, for companionship, for help achieving his modest aims—is the thing that is still so devastatingly lacking more than a century later.

Good checklists, on the other hand, are precise. They are efficient, to the point, and easy to use even in the most difficult situations.

Medical professionals concentrate on repair of health, not sustenance of the soul.

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 their final year of life, and most of that money goes for care in their last couple of months that is of little apparent benefit.

pay doctors to give chemotherapy and to do surgery but not to take the time required to sort out when to do so is unwise.

BILL THOMAS WANTED to remake the nursing home.

Above all, it was clear that he wanted to live. He would take any risk—even death—to live.

they provided assisted living, but no one seemed to think it was their job to actually assist him with living

But he did not hear us:

those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer.

Our responsibility, in medicine, is to deal with human beings as they are. People die only once.

an average of $94,000 during the last year of life with a metastatic breast cancer. Our medical system is excellent at trying to stave off death with $12,000-a-month chemotherapy, $4,000-a-day intensive care, $7,000-an-hour surgery. But, ultimately, death comes, and few are good at knowing when to stop.

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. The

An inherent tension exists between brevity and effectiveness. Cut too much and you won't have enough checks to improve care. Leave too much in and the list becomes too long to use. Furthermore