Quotes from Atul Gawande

Compounding matters, we have no good metrics for a place's success in assisting people to live. By contrast, we have very precise ratings for health and safety. So you can guess what gets the attention from the people who run places for the elderly: whether Dad loses weight, skips his medications, or has a fall, not whether he's lonely.

Neff's philosophy is, as he put it, "hard on behavior but soft on the person.

But finding a good idea is apparently not all that hard. Finding an entrepreneur who can execute a good idea is a different matter entirely. One needs a person who can take an idea from proposal to reality, work the long hours, build a team, handle the pressures and setbacks, manage technical and people problems alike, and stick with the effort for years on end without getting distracted or going insane. Such people are rare and extremely hard to spot. Smart

their waiting lists are typically months long.

But in truth no single disease leads to the end; the culprit is just the accumulated crumbling of one's bodily systems while medicine carries out its maintenance measures and patch jobs.

In this work against sickness, we begin not with genetic or cellular interactions, but with human ones. They are what make medicine so complex and fascinating.

Even with the simplest operation, it cannot be taken for granted that a patient will come through better off—or even alive.

the fee can be as much as twenty thousand dollars):

Once a possibility has been put in your mind—especially one as horrible as necrotizing fasciitis—the possibility does not easily go away.

We're always trotting out some story of a ninety-seven-year-old who runs marathons, as if such cases were not miracles of biological luck but reasonable expectations for all. Then, when our bodies fail to live up to this fantasy, we feel as if we somehow have something to apologize for.

Practice is funny that way. For days and days, you make out only the fragments of what to do. And then one day you've got the thing whole. Conscious learning becomes unconscious knowledge, and you cannot say precisely how.

after pondering suicide, Goodman called Neff at his office.

Doctors may recommend the operation out of concern for their patients' health, but the stigma of obesity is clearly what drives many patients to the operating room.

There's no escaping the tragedy of life, which is that we are all aging from the day we are born.

1. Do you want to be resuscitated if your heart stops? 2. Do you want aggressive treatments such as intubation and mechanical ventilation? 3. Do you want antibiotics? 4. Do you want tube or intravenous feeding if you can't eat on your own?

Goodman made the trip the next day.

and it's no accident that seven times as many women as men have had the operation.

without a biopsy, we cannot rule it out." He paused for a moment to let her and her father absorb this.

People seemed to have two different selves—an experiencing self who endures every moment equally and a remembering self who gives almost all the weight of judgment afterward to two single points in time, the worst moment and the last one. The remembering

he has the potential for a full return to practice.

But is this really going to be effective and worthwhile over a forty-year span?

alone. "I think it is unlikely you have it

Some will be alarmed by the prospect of a doctor's writing about the inevitability of decline and death. For many, such talk, however carefully framed, raises the specter of a society readying itself to sacrifice its sick and aged. But what if the sick and aged are already being sacrificed—victims of our refusal to accept the inexorability of our life cycle?

At Neff's suggestion, Goodman