Quotes from Atul Gawande

He also found he made mistakes in handling complexity. A good decision requires looking at so many different features of companies in so many ways that, even without the cocaine brain, he was missing obvious patterns. His mental checklist wasn't good enough. "I am not Warren," he said. "I don't have a 300 IQ." He needed an approach that could work for someone with an ordinary IQ. So he devised a written checklist.

Loyalty, said Royce, "solves the paradox of our ordinary existence by showing us outside of ourselves the cause which is to be served, and inside of ourselves the will which delights to do this service, and which is not thwarted but enriched and expressed in such service.

In the end, people don't view their life as merely the average of all of its moments—which, after all, is mostly nothing much plus some sleep.

In other words, people who had substantive discussions with their doctor about their end-of-life preferences were far more likely to die at peace and in control of their situation and to spare their family anguish. A

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.

Whenever the elderly have had the financial means, they have chosen what social scientists have called "intimacy at a distance." Whereas in early-twentieth-century America 60 percent of those over age sixty-five resided with a child, by the 1960s the proportion had dropped to 25 percent. By 1975 it was below 15 percent. The pattern is a worldwide one.

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 result: those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer.

The anthropologist Lawrence Cohen describes conferences and conventions not so much as scholarly goings-on but as carnivals—"colossal events where academic proceedings are overshadowed by professional politics, ritual enactments of disciplinary boundaries, sexual liminality, tourism and trade, personal and national rivalries, the care and feeding of professional kinship, and the sheer enormity of discourse.

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. Medical science has given us remarkable power to push against these limits, and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be. We

Our reverence for independence takes no account of the reality of what happens in life: sooner or later, independence will become impossible. Serious illness or infirmity will strike . It is as inevitable as sunset. And then a new question arises: If independence is what we live for, what do we do when it can no longer be sustained?

As we medical students saw it, the failure of those around Ivan Ilyich to offer comfort or to acknowledge what is happening to him was a failure of character and culture.

as people's capacities wane, whether through age or ill health, making their lives better often requires curbing our purely medical imperatives—resisting the urge to fiddle and fix and control.

human beings fail the way all complex systems fail: randomly and gradually.

In the past, surviving into old age was uncommon, and those who did survive served a special purpose as guardians of tradition, knowledge, and history.

We stop the healthy from committing suicide because we recognize that their psychic suffering is often temporary. We believe that, with help, the remembering self will later see matters differently than the experiencing self—and indeed only a minority of people saved from suicide make a repeated attempt; the vast majority eventually report being glad to be alive. But for the terminally ill who face suffering that we know will increase, only the stonehearted can be unsympathetic.

New technology also creates new occupations and requires new expertise, which further undermines the value of long experience and seasoned judgment.

HOW DID WE wind up in a world where the only choices for the very old seem to be either going down with the volcano or yielding all control over our lives?

The battle of being mortal is the battle to maintain the integrity of one's life--to avoid becoming so diminished or dissipated or subjugated that who you are becomes disconnected from who you were or who you want to be.

The risk of a fatal car crash with a driver who's eighty-five or older is more than three times higher than it is with a teenage driver

A year on, Eleanor remained haunted by what happened to her. She still had no idea where the bacteria came from. Perhaps the foot soak and pedicure she had gotten at a small hair-and-nail shop the day before that wedding.

Medicine was just another a tool you could try, no different from a healing ritual or a family remedy and no more effective.

the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us. That

I do not come in saying, 'I'm so sorry.' Instead, it's: 'I'm the hospice nurse, and here's what I have to offer you to make your life better. And I know we don't have a lot of time to waste.