Quotes from Atul Gawande

Studdert and I both turned to her father to see what he might have to say.

It seems we've succumbed to a belief that, once you lose your physical independence, a life of worth and freedom is simply not possible. Nursing home staff like, and approve of, residents who are "fighters" and show "dignity and self-esteem"—until these traits interfere with the staff's priorities for them. Then they are "feisty.

Operations like that lap chole have taught me how easily error can occur, but they've also showed me something else: effort does matter; diligence and attention to the minutest details can save you." .

We know the patterns. We see the costs. It's time to try something else. Try a checklist.

Largely on their advice, Goodman's state medical board has given him permission to return to practice, although with restrictions.

He hesitated before going on.

We know the dance moves. You agree to become a patient, and I, the clinician, agree to try to fix you, whatever the improbability, the misery, the damage, or the cost. With this new way, in which we together try to figure out how to face mortality and preserve the fiber of a meaningful life, with its loyalties and individuality, we are plodding novices. We are going through a societal learning curve, one person

When to shift from pushing against limits to making the best of them is not often readily apparent. But it is clear that there are times when the cost of pushing exceeds its value.

but I began to have doubts about pulling out the screw.

We are all, whatever we do, in the hands of flawed human beings.

that. He had no regrets about the operation. It had given him his life back, he said.

Your competence gives you a secure sense of identity.

Medicine requires the fortitude to take what comes: your schedule may be packed, the hour late, your child waiting for you to pick him up after swimming practice; but if a problem arises you have to do what is necessary

it was clear that he still felt uneasy.

I left them to themselves.

and you will find that the larger, starker, and more painful difficulty is the still abundant uncertainty that exists over what should be done in many situations.

Every place has a deep-seated culture as to how things are done. Culture is the sum total of shared habits and expectations.

I excused myself and tracked down Dr. W, the senior surgeon on duty.

and led her out of the room.

In the absence of algorithms and evidence about what to do, you learn in medicine to make decisions by feel.

The pressure remains all in one direction, toward doing more, because the only mistake clinicians seem to fear is doing too little. Most have no appreciation that equally terrible mistakes are possible in the other direction—that doing too much could be no less devastating to a person's life.

Then she asked a series of questions, targeting issues that tend to arise in patients with terminal illness. Did Cox have pain? How was her appetite, thirst, sleeping? Any trouble with confusion, anxiety, or restlessness? Had her shortness of breath grown worse? Was there chest pain or heart palpitations? Abdominal discomfort? Trouble with constipation or urination or walking?

succumbed to a belief that, once you lose your physical independence, a life of worth and freedom is simply not possible.

Goodman and I went out for a meal together in town and then for a drive.