Quotes from Atul Gawande

The options overwhelmed her. They all sounded terrifying. She didn't know what to do. I realized, with shame, that I'd reverted to being Dr. Informative—here are the facts and figures; what do you want to do? So I stepped back and asked the questions I'd asked my father: What were her biggest fears and concerns? What goals were most important to her? What trade-offs was she willing to make, and what ones was she not? Not

the reason for the delay is not usually laziness or unwillingness. The reason is more often that the necessary knowledge has not been translated into a simple, usable, and systematic form.

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.

defrailulation specialists

expectations about their

The key word in her mind was home. Home is the one place where your own priorities hold sway. At home, you decide how you spend your time, how you share your space, and how you manage your possessions. Away from home, you don't. This loss of freedom was what people like Lou Sanders and Wilson's mother, Jessie, dreaded.

People live longer and better than at any other time in history. But scientific advances have turned the processes of aging and dying into medical experiences, matters to be managed by health care professionals. And we in the medical world have proved alarmingly unprepared for it.

The veneration of elders may be gone, but not because it has been replaced by veneration of youth. It's been replaced by veneration of the independent self.

Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person's life.

At one time, we might have turned to an old-timer to explain the world. Now we consult Google, and if we have any trouble with the computer we ask a teenager

Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.

In each case the results were consistent. 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.

so the smaller the patient (and his or her blood supply) the greater the effect. Members

But now the problem we face is ineptitude, or maybe it's "eptitude"—making sure we apply the knowledge we have consistently and correctly.

The burdens for today's caregiver have actually increased from what they would have been a century ago.

The necessity of nature's final victory was expected and accepted in generations before our own. Doctors were far more willing to recognize the signs of defeat and far less arrogant about denying them.

According to Block, about two-thirds of patients are willing to undergo therapies they don't want if that is what their loved ones want. The

In the end, a checklist is only an aid. If it doesn't aid, it's not right. But if it does, we must be ready to embrace the possibility.

Medicine has become the art of managing extreme complexity—and a test of whether such complexity can, in fact, be humanly mastered.

medically dominated culture of care for the elderly.

This is why the betrayals of body and mind that threaten to erase our character and memory remain among our most awful tortures. The battle of being mortal is the battle to maintain the integrity of one's life—to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be. Sickness and old age make the struggle hard enough. The professionals and institutions we turn to should not make it worse.

What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make?

Obstetrics went about improving the same way Toyota and General Electric went about improving: on the fly, but always paying attention to the results and trying to better them. And

other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality. If end-of-life discussions were an experimental drug, the FDA would approve it.