Atul Gawande, a renowned surgeon and writer, discusses the profound implications of mortality in healthcare. He explores the societal shift towards hospice care and the tensions created by medical technology in confronting death. Gawande emphasizes redefining medicine to prioritize well-being over mere survival. Personal stories illustrate the importance of meaningful conversations between patients and doctors. He also shares the transformative question that shaped his practice: 'What does a good day look like?' highlighting the value of living fully in the face of mortality.
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question_answer ANECDOTE
Importance of quality of life
Atul Gawande witnessed patients suffering when doctors prioritized extending life over quality of life.
One patient didn't wake up after a surgery and missed the opportunity for goodbyes, highlighting the need for conversations about mortality.
insights INSIGHT
Reframing end-of-life care
Doctors often frame end-of-life care as a binary choice between fighting and giving up.
The crucial question should be what patients are fighting for, focusing on their priorities and values.
question_answer ANECDOTE
Disney World wish
A dying woman's priority was taking her grandchildren to Disney World, which doctors overlooked.
This highlights the importance of understanding patients' individual goals beyond mere survival.
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Cixin Liu's 'The Three-Body Problem' is a critically acclaimed science fiction novel that blends hard science with compelling storytelling. The story follows a group of scientists who make contact with an alien civilization, leading to unforeseen consequences for humanity. Liu's intricate world-building and exploration of complex scientific and philosophical themes have earned him widespread recognition. The novel is known for its ambitious scope and its exploration of the potential challenges and dangers of encountering extraterrestrial life. It's a thought-provoking work that has captivated readers worldwide.
The Checklist Manifesto
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In 'The Checklist Manifesto', Atul Gawande explores the power of checklists in overcoming the complexities of modern professional work. He argues that despite advanced training and technology, professionals often fail due to the sheer volume and complexity of knowledge. Gawande illustrates how checklists, first introduced by the U.S. Air Force, have been successfully adopted in various fields, including medicine, to reduce errors and improve outcomes. He provides compelling examples, such as the reduction of fatalities in surgical procedures and the elimination of hospital infections, to demonstrate the effectiveness of checklists. The book emphasizes the importance of balancing autonomy and control, empowering frontline workers, and continuously improving checklists based on feedback and experience[1][3][5].
Being Mortal
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In *Being Mortal*, Atul Gawande explores the limitations and failures of modern medicine in dealing with aging and death. Through personal stories, case studies, and research, Gawande argues that the medical profession often prioritizes prolonging life over improving its quality. He highlights the need for greater communication and planning around end-of-life care, emphasizing the importance of autonomy, dignity, and individual preferences. The book encourages readers to rethink their approach to aging and dying, focusing on what makes life meaningful and fulfilling until the very end.
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How we die
Sherwin B. Nuland
In 'How We Die', Sherwin B. Nuland provides a detailed and honest account of how various diseases lead to death, focusing on conditions like heart disease, Alzheimer's, and cancer. The book emphasizes that understanding the process of dying can help individuals make informed decisions about end-of-life care and find dignity in living. It also explores the importance of living a meaningful life as a precursor to a 'good death'.
We are strange creatures. It is hard for us to speak about, or let in, the reality of frailty and death — the elemental fact of mortality itself. In this century, western medicine has gradually moved away from its understanding of death as a failure — where care stops with a terminal diagnosis. Hospice has moved, from something rare to something expected. And yet advances in technology have made it ever harder for physicians and patients to make a call to stop fighting death — often at the expense of the quality of this last time of life. Meanwhile, there is a new longevity industry which resists the very notion of decline, much less finitude.
Fascinatingly, the simple question which transformed the surgeon Atul Gawande’s life and practice of medicine is this: What does a good day look like? As he has come to see, standing reverently before our mortality is an exercise in more intricately inhabiting why we want to be alive. This conversation evokes both grief and hope, sadness at so many deaths — including our species-level losses to Covid — that have not allowed for this measure of care. Yet it also includes very actionable encouragement towards the agency that is there to claim in our mortal odysseys ahead.
Atul Gawande's writing for The New Yorker and his books have been read by millions, most famously Being Mortal: Medicine and What Matters in the End. He currently serves as Assistant Administrator for Global Health at the U.S. Agency for International Development. He previously practiced general and endocrine surgery at Brigham and Women’s Hospital in Boston and was a professor at both Harvard Medical School and the Harvard T.H. Chan School of Public Health.
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