Quotes from Atul Gawande

MODERN SCIENTIFIC CAPABILITY has profoundly altered the course of human life. 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.

Doctors quickly learn that how much they make has little to do with how good they are. It largely depends on how they handle the business side of their practice. Many

This experiment of making mortality a medical experience is just decades old. It is young. And the evidence is it is failing.

People with serious illness have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars.

But death is not a subject that his doctors, friends, or family can countenance. That is what causes him his most profound pain.

As we age, it's as if the calcium seeps out of our skeletons and into our tissues.

Tears wet my eyes. I'm a surgeon. I like solving things. But how do I solve this?

Studies find that as people grow older they interact with fewer people and concentrate more on spending time with family and established friends. They focus on being rather than doing and on the present more than the future. Understanding

Arriving at meaningful solutions is an inevitably slow and difficult process. Nonetheless, what I saw was: better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes willingness to try.

The investigators at Johns Hopkins and elsewhere had also observed that when nurses were given a chance to say their names and mention concerns at the beginning of a case, they were more likely to note problems and offer solutions. The researchers called it an "activation phenomenon." Giving people a chance to say something at the start seemed to activate their sense of participation and responsibility and their willingness to speak up. These

The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all.

Well, if I'm able to eat chocolate ice cream and watch football on TV, then I'm willing to stay alive.

But even more daunting is the second kind of courage—the courage to act on the truth we find.

We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right - one after the other, no slipups, no goofs, everyone pitching in. We are used to thinking of doctoring as a solitary, intellectual task. But making the medicine go right is less often like making a difficult diagnosis than like making sure everyone washes their hands.

In 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. Patients

Asl?nda insanlar?n baÄŸl?l??a ihtiyac? olduÄŸunu savundu. BaÄŸl?l?k ille de mutluluk getirmez ve hatta ac? verici olabilir ancak hepimiz hayatlar?m?z? tahammül edilebilir k?lmak için kendimizin d???nda bir ÅŸeye adanm??l??a ihtiyaç duyar?z. Bu olmadan bize yaln?zca arzular?m?z rehberlik eder ki onlar da geçici, kaprisli ve doyumsuzdur.

Whatever the limits and travails we face, we want to retain the autonomy—the freedom—to be the authors of our lives.

We are besieged by simple problems.... Checklists can provide protection

But we have at last entered an era in which an increasing number of them believe their job is not to confine people's choices, in the name of safety, but to expand them, in the name of living a worthwhile life.

Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers. I wrote this book in

As fewer of us are struck dead out of the blue, most of us will spend significant periods of our lives too reduced and debilitated to live independently.

When someone has come to you for your expertise and your expertise has failed, what do you have left? You have only your character to fall back upon—and sometimes it's only your pride that comes through.

Hope is not a plan, but hope is our plan.

People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their legacies, make peace with God, and ensure that those who are left behind will be okay.