Quotes from Atul Gawande

what is the course of action that best serves this understanding

We want autonomy for ourselves and safety for those we love." That remains the main problem and paradox for the frail. "Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self." She

we all require devotion to something more than ourselves for our lives to be endurable. Without it, we have only our desires to guide us, and they are fleeting, capricious, and insatiable. They provide, ultimately, only torment.

no matter how careful we might be, no matter how much thought we might put in, a checklist has to be tested in the real world, which is inevitably more complicated than expected. First drafts always fall apart, he said, and one needs to study how, make changes, and keep testing until the checklist works consistently.

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? And what is the course of action that best serves this understanding? The

Anyone who understands systems will know immediately that optimizing parts is not a good route to system excellence

From World War II onward, the picture shifted radically. Sulfa, penicillin, and then numerous other antibiotics became available for treating infections. Drugs to control blood pressure and treat hormonal imbalances were discovered. Breakthroughs in everything from heart surgery to artificial respirators to kidney transplantation became commonplace. Doctors became heroes, and the hospital transformed from a symbol of sickness and despondency to a place of hope and cure.

All we ask is to be allowed to remain the writers of our own story.

The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society. If you don't, mortality is only a horror.

A large part of the task is helping people negotiate the overwhelming anxiety—anxiety about death, anxiety about suffering, anxiety about loved ones, anxiety about finances," she explained. "There are many worries and real terrors." No one conversation can address them all. Arriving at an acceptance of one's mortality and a clear understanding of the limits and the possibilities of medicine is a process, not an epiphany.

Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone.

I asked Vince how his business was going. Not well, he said.

he had brought in no income since the previous August.

Neuroscientists have found that the prospect of making money stimulates the same primitive reward circuits in the brain that cocaine does.

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? And what is the course of action that best serves this understanding?

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?

So this is the way it unfolds. In the absence of what people like my grandfather could count on—a vast extended family constantly on hand to let him make his own choices—our elderly are left with a controlled and supervised institutional existence, a medically designed answer to unfixable problems, a life designed to be safe but empty of anything they care about.

Emanuels described a third type of doctor-patient relationship, which they called "interpretive." Here the doctor's role is to help patients determine what they want. Interpretive doctors ask, "What is most important to you? What are your worries?" Then, when they know your answers, they tell you about the red pill and the blue pill and which one would most help you achieve your priorities.

I did not say that the line was eight inches long and would go into his vena cava, the main blood vessel to his heart. Nor did I say how tricky the procedure would be.

The second type of failure the philosophers call ineptitude—because in these instances the knowledge exists, yet we fail to apply it correctly.

But as your horizons contract—when you see the future ahead of you as finite and uncertain—your focus shifts to the here and now, to everyday pleasures and the people closest to you. Carstensen gave her hypothesis the impenetrable name "socioemotional selectivity theory.

Ariadne Labs

I'd eat right through pain—even to the point of throwing up

But I said nothing of such things when I asked my patient's permission to do his line.