Atul Gawande Quotes

An audience is a community. The published word is a declaration of membership in that community and also of a willingness to contribute something meaningful to it.
So choose your audience. Write something.

we need practice to get good at what we do. There is one difference in medicine, though: it is people we practice upon.

We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.

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 disease as possible and the retention of enough function for active engagement in the world.

What tormented Ivan Ilyich most,” Tolstoy writes, “was the deception, the lie, which for some reason they all accepted, that he was not dying but was simply ill, and he only need keep quiet and undergo a treatment and then something very good would result.” Ivan Ilyich has flashes of hope that maybe things will turn around, but as he grows weaker and more emaciated he knows what is happening. He lives in mounting anguish and fear of death. But death is not a subject that his doctors, friends, or family can countenance. That is what causes him his most profound pain.

The core predicament of medicine - the thing that makes being a patient so wrenching, being a doctor so difficult, and being a part of society that pays the bills they run up so vexing - is uncertainty. With all that we know nowadays about people and diseases and how to diagnose and treat them, it can be hard to see this, hard to grasp how deeply uncertainty runs. As a doctor, you come to find, however, that the struggle in caring for people is more often with what you do not know than what you do. Medicine's ground state is uncertainty. And wisdom - for both the patients and doctors - is defined by how one copes with it.

Three Plagues of nursing home existence: boredom, loneliness, and helplessness.

Consider the fact that we care deeply about what happens to the world after we die. If self-interests were the primary source of meaning in life, then it wouldn’t matter to people if an hour after their death everyone they know were to be wiped from the face of the earth. Yet, it matters greatly to most people. We feel that such an occurrence would make our lives meaningless. The only way death is not meaningless is to see yourself as part of something greater; a family, a community, a society. If you don’t, mortality is only a horror, but if you do, it is not. 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 is not thwarted, but enriched and expressed in such service… Above the level of self-actualization in Maslow’s hierarchy of needs, they suggest the existence in people of a transcendent desire to see and help other beings achieve their potential.
As our time winds down, we all seek comfort in simple pleasures; companionship, everyday routines, the taste of good food, the warmth of sunlight on our faces. We become less interested in the awards of achieving and accumulating and more interested in the rewards of simply being. Yet, while we may feel less ambitious, we also have become concerned for our legacy, and we have a deep need to identify purposes outside ourselves that make living feel meaningful and worthwhile.

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. For human beings, life is meaningful because it is a story. A story has a sense of a whole, and its arc is determined by the significant moments; the ones where something happens. Measurements of people’s minute by minute levels of pleasure and pain miss this fundamental aspect of human existence. A seemingly happy life may be empty. A seemingly diffic

Death, of course, is not a failure. Death is normal. Death may be the enemy, but it is also the natural order of things.

You know, there’s this phase of people’s lives in which they can’t really cope on their own, and we ought to find a way to make it manageable.

Good checklists, on the other hand, are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not try to spell out everything — a checklist cannot fly a plane. Instead, they provide reminders of only the most critical and important steps — the ones that even the highly skilled professionals using them could miss. Good checklists are, above all, practical.

Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.

Courage, Laches responds, “is a certain endurance of the soul.

Are doctors who make mistakes villains? No, because then we all are.

Modernization did not demote the elderly. It demoted the family. It gave people — the young and the old — a way of life with more liberty and control, including the liberty to be less beholden to other generations. The veneration of elders may be gone, but not because it has been replaced by veneration of youth. It’s been replaced by veneration of the independent self. * * *