Quotes from Atul Gawande

He's too obese, I thought to myself.

The job of any doctor, Bludau later told me, is to support quality of life, by which he meant two things: as much freedom from the ravages of diseases as possible and the retention of enough function for active engagement in the world.

Although it had attracted wide interest across the country and had grown rapidly

after one or two bites I just don't want it.

The Dutch have been slower than others to develop palliative care programs that might provide for it. One reason, perhaps, is that their system of assisted death may have reinforced beliefs that reducing suffering and improving lives through other means is not feasible when one becomes debilitated or seriously ill.

In some way, it may be in the nature of surgery itself to want to come to grips with the uncertainties and dilemmas of practical medicine. Surgery has become as high tech as medicine gets, but the best surgeons retain a deep recognition of the limitations of both science and human skill. Yet still they must act decisively.

First drafts always fall apart, he said, and one needs to study how, make changes, and keep testing until the checklist works consistently

I handed her the needle and stepped aside.

It requires vigilance over nutrition, medications, and living situations. And it requires each of us to contemplate the unfixable in our life, the decline we will unavoidably face, in order to make the small changes necessary to reshape it. When the prevailing fantasy is that we can be ageless, the geriatrics uncomfortable demand is that we accept we are not.

He paused to consider.

Del Webb, an Arizona real estate developer, popularized the term "retirement community" in 1960 when he launched Sun City, a community in Phoenix that was among the first to limit its residents to retirees. It was a controversial idea at the time.

And having a place that genuinely feels like your home can seem as essential to a person as water to a fish.

The amount of freedom you have in your life is not the measure of the worth of your life.

He was immediately taken aback, recognizing that an empty stomach is what we require for patients going to surgery. I tried

Few people have these conversations, and there is good reason for anyone to dread them. They can unleash difficult emotions. People can become angry or overwhelmed. Handled poorly, the conversations can cost a person's trust. Handled well, they can take real time. I spoke to an oncologist who told me about a

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. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.

Our most cruel failure is in how we treat the sick and the aged is the failure to recognise that they have priorities beyond merely being safe and living longer; that the chance to shape one's story is essential to sustaining meaning in life.

By this point, Sara had undergone three rounds of chemotherapy with limited, if any, effect. Perhaps Marcoux could have discussed what she most wanted as death neared and how best to achieve those wishes.

The median income of people eighty and older is only about $15,000. More than half of the elderly living in long-term-care facilities run through their entire savings and have to go on government assistance-welfare-in order to afford it.

He was immediately taken aback, recognizing that an empty stomach is what we require for patients going to surgery. I tried to smooth matters over, saying that holding off was merely "routine procedure" until we had finished our evaluation.

Somehow, instead of holding on to the lifelong identity that was slipping away from him, he managed to redefine it. He moved his line in the sand. This is what it means to have autonomy—you may not control life's circumstances, but getting to be the author of your life means getting to control what you do with them. The

merely as struggling human beings.

It is a reality of medicine that choosing to not do something—to not order a test, to not give an antibiotic, to not take a patient to the operating room—is far harder than choosing to do it.

In the course of a normal lifetime, the muscles of the jaw lose about 40 percent of their mass and the bones of the mandible lose about 20 percent, becoming porous and weak.