Atul Gawande Quotes

When the prevailing fantasy is that we can be ageless, the geriatrician’s uncomfortable demand is that we accept we are not.

The terror of sickness and old age is not merely the terror of the losses one is forced to endure but also the terror of the isolation. As people become aware of the finitude of their life, they do not ask for much. They do not seek more riches. They do not seek more power. They ask only to be permitted, insofar as possible, to keep shaping the story of their life in the world — to make choices and sustain connections to others according to their own priorities.

The simple view is that medicine exists to fight death and disease, and that is, of course, its most basic task. 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.

human beings need loyalty. It does not necessarily produce happiness, and can even be painful, but we all require devotion to something more than ourselves for our lives to be endurable. Without it, we have only our desires to guide us, and they are fleeting, capricious, and insatiable. They provide, ultimately, only torment.

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

It is not death that the very old tell me they fear. It is what happens short of death — losing their hearing, their memory, their best friends, their way of life. As Felix put it to me, “Old age is a continuous series of losses.” Philip Roth put it more bitterly in his novel Everyman: “Old age is not a battle. Old age is a massacre.

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

we usually have only vague indicators to rely upon.

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.

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.

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.

We recruit for attitude and train for skill,

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.

So Pabrai added the following checkpoint to his list: when analysing a company, stop and confirm that you’ve asked yourself whether the revenues might be overstated or understated due to boom or bust conditions.

Endings matter, not just for the person but, perhaps even more, for the ones left behind.