We want autonomy for ourselves and safety for those we love. That remains the main problem and paradox for the frail. Many of the things that we want… - Atul Gawande

We want autonomy for ourselves and safety for those we love.

What geriatricians do — bolster our resilience in old age, our capacity to weather what comes — is both difficult and unappealingly limited. It requires attention to the body and its alterations. It requires vigilance over nutrition, medications, and living situations. And it requires each of us to contemplate the unfixables in our life, the decline we will unavoidably face, in order to make the small changes necessary to reshape it. When the prevailing fantasy is that we can be ageless, the geriatrician’s uncomfortable demand is that we accept we are not.

Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?

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 difficult life may be devoted to a great cause. We have purposes larger than ourselves. Unlike your experiencing self — which is absorbed in the moment — your remembering self is attempting to recognize not only the peaks of joy and valleys of misery but also how the story works out as a whole.