Being Mortal: Medicine and What Matters in the End

by Atul Gawande

In the main, the family has remained the primary alternative. Your chances of avoiding the nursing home are directly related to the number of children you have, and, according to what little research has been done, having at least one daughter seems to be crucial to the amount of help you will receive. But our greater longevity has coincided with the increased dependence of families on dual incomes, with results that are painful and unhappy for all involved. Lou Sanders was eighty-eight years old

how we seek to spend our time may depend on how much time we perceive ourselves to have. When you are young and healthy, you believe you will live forever. You do not worry about losing any of your capabilities. People tell you “the world is your oyster,” “the sky is the limit,” and so on. And you are willing to delay gratification—to invest years, for example, in gaining skills and

Carstensen gave her hypothesis the impenetrable name “socioemotional selectivity theory.” The simpler way to say it is that perspective matters. She produced a series of experiments to test the idea. In one, she and her team studied a group of adult men ages twenty-three to sixty-six. Some of the men were healthy. But some were terminally ill with HIV/AIDS. The subjects were given a deck of cards with descriptions of people they might know, ranging in emotional closeness from family members to the author of a book they’d read, and they were asked to sort the cards according to how they would feel about spending half an hour with them. In general, the younger the subjects were, the less they valued time with people they were emotionally close to and the more they valued time with people who were potential sources of information or new friendship. However, among the ill, the age differences disappeared. The preferences of a young person with AIDS were the same as those of an old person. Carstensen tried to find holes in her theory. In another

When, as the researchers put it, “life’s fragility is primed,” people’s goals and motives in their everyday lives shift completely. It’s perspective, not age, that matters most. Tolstoy recognized this. As Ivan Ilyich’s health fades and he realizes

Gerasim did it all easily, willingly, simply, and with a good nature that touched Ivan Ilyich. Health, strength, and vitality in other people were offensive to him, but Gerasim’s strength and vitality did not mortify but soothed him. This simple but profound service—to grasp a fading man’s need for everyday comforts, for companionship, for help achieving his modest aims—is

But, she said, “It’s the rare child who is able to think, ‘Is this place what Mom would want or like or need?’ It’s more like they’re seeing it through their own lens.” The child asks, “Is this a place I would be comfortable leaving Mom?” Lou had not been in the assisted

The lesson seems almost Zen: you live longer only when you stop trying to live longer.

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