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482. The Butchering Art: Joseph Lister’s Quest to Transform the Grisly World of Victorian Medicine

Rating:  ☆☆☆

Recommended by:  Ben and Drue Emerson

Author:   Lindsey Fitzharris

Genre:   Non Fiction, Biography, Science, Medicine, Health

304 pages, published October 31, 2017

Reading Format:  Book

Summary

The Butchering Art tells the story of Joseph Lister, a Quaker surgeon in nineteenth-century England and Scotland who solved the riddle of post operative infections.  Drawing from the work of friend Louis Pasteur and his own tireless experimentation, Lister proved germ theory and changed the practice of medicine and saving countless lives.

Quotes 

“The adoption of Lister’s antiseptic system was the most prominent outward sign of the medical community’s acceptance of a germ theory, and it marked the epochal moment when medicine and science merged.”

 

“From the moment he looked through the lens of his father’s microscope to the day he was knighted by Queen Victoria, his life was shaped and influenced by his circumstances and the people around him. Like all of us, he saw his world through the prism of opinions held by those whom he admired most:”

 

“Lister understood that being in a hospital could be a terrifying experience and followed his own golden rule: “Every patient, even the most degraded, should be treated with the same care and regard as though he were the Prince of Wales himself.”

 

“The best that can be said about Victorian hospitals is that they were a slight improvement over their Georgian predecessors. That’s hardly a ringing endorsement when one considers that a hospital’s “Chief Bug-Catcher”—whose job it was to rid the mattresses of lice—was paid more than its surgeons.”

 

“If Lister had nursed any hope that his diligence and reasoned argument concerning his antiseptic system would convert the American audience, he would be sorely disappointed. One attendee accused him of being mentally unhinged and having a “grasshopper in the head.”

 

“Erysipelas was one of four major infections that plagued hospitals in the nineteenth century. The other three were hospital gangrene (ulcers that lead to decay of flesh, muscle, and bone), septicemia (blood poisoning), and pyemia (development of pus-filled abscesses).”

 

“When a distinguished but elderly scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is almost certainly wrong. —ARTHUR C. CLARKE”

 

“The symptoms syphilis engendered worsened over time. In addition to the unsightly skin ulcers that pockmarked the body in the later stages of the disease, many victims endured paralysis, blindness, dementia, and “saddle nose,” a grotesque deformity that occurs when the bridge of the nose caves into the face. (Syphilis was so common that “no nose clubs” sprang up all over London. One newspaper reported that “an eccentric gentleman, having taken a fancy to see a large party of noseless persons, invited every one thus afflicted, whom he met in the streets, to dine on a certain day at a tavern, where he formed them into a brotherhood.” The man, who assumed the alias of Mr. Crampton for these clandestine parties, entertained his noseless friends every month for a year until his death, at which time the group “unhappily dissolved.”)”

 

“Let us not overlook the further great fact, that not only does science underlie sculpture, painting, music, poetry, but that science is itself poetic.… Those engaged in scientific researches constantly show us that they realize not less vividly, but more vividly, than others, the poetry of their subjects. —HERBERT SPENCER”

 

My Take

I learned a lot about history and medicine from The Butchering Art which focuses on the story of surgeon Joseph Lister and how he demonstrated the role played by germs in causing infections.  Prior to Lister, surgery was a gruesome affair with unsanitary hospitals and many post-operative infections.  We all owe a debt of gratitude to Lister and all of the scientists who were courageous enough to challenge the status quo.

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473. Better

Rating:  ☆☆☆☆

Recommended by:

Author:  Atul Gawande

Genre:   Non Fiction, Health, Medicine, Science, Memoir, Essays

273 pages, published April 3, 2007

Reading Format:  Audiobook on Overdrive

Summary

In Better, surgeon and author Atul Gawande explores different aspects of medical care (hygiene, obstetrics, medical malpractice, battlefield surgical tents in Iraq, doctor assisted administration of the death penalty, the treatment of polio in India) and explores how to bring improvements to different systems.

Quotes 

“Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.”

 

“People underestimate the importance of dilligence as a virtue. No doubt it has something to do with how supremely mundane it seems. It is defined as “the constant and earnest effort to accomplish what is undertaken.”… Understood, however, as the prerequisite of great accomplishment, diligence stands as one of the most difficult challenges facing any group of people who take on tasks of risk and consequence. It sets a high, seemingly impossible, expectation for performance and human behavior.”

 

“The seemingly easiest and most sensible rule for a doctor to follow is: Always Fight. Always look for what more you could do.”

 

“We are used to thinking of doctoring as a solitary, intellectual task. But making medicine go right is less often like making a difficult diagnosis than like making sure everyone washes their hands.”

 

“The hardest question for anyone who takes responsibility for what he or she does is, What if I turn out to be average?”

 

“Doctors quickly learn that how much they make has little to do with how good they are. It largely depends on how they handle the business side of their practice.”

 

“Indeed, the scientific effort to improve performance in medicine—an effort that at present gets only a miniscule portion of scientific budgets—can arguably save more lives in the next decade than bench science, more lives than research on the genome, stem cell therapy, cancer vaccines, and all the other laboratory work we hear about in the news.”

 

“Ingenuity is often misunderstood. It is not a matter of superior intelligence but of character. It demands more than anything a willingness to recognize failure, to not paper over the cracks, and to change. It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions.”

“We always hope for the easy fix: the one simple change that will erase a problem in a stroke. But few things in life work this way. Instead, success requires making a hundred small steps go right – one after the other, no slipups, no goofs, everyone pitching in.”

 

“Human birth…is a solution to an evolutionary problem: how a mammal can walk upright, which requires a small, fixed, bony pelvis, and also possess a large brain, which entails a baby whose head is too big to fit through that small pelvis…in a sense, all human mothers give birth prematurely. Other mammals are born mature enough to walk and seek food within hours; our newborns are small and helpless for months.”

 

“Betterment is perpetual labor. The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality. To complicate matters, we in medicine are also only human ourselves. We are distractible, weak, and given to our own concerns. Yet still, to live as a doctor is to live so that one’s life is bound up in others’ and in science and in the messy, complicated connection between the two It is to live a life of responsibility. The question then, is not whether one accepts the responsibility. Just by doing this work, one has. The question is, having accepted the responsibility, how one does such work well.”

 

My Take

I always think the mark of a good non fiction book is how much I learned from reading it.  Well, I learned a lot about modern medicine after reading Better.   It also didn’t hurt that Atul Gawande (author of Being Mortal) is a talented writer with something to say.

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401. The Tennis Partner

Rating:  ☆☆☆1/2

Recommended by:

Author:   Abraham Verghese

Genre:    Nonfiction, Memoir, Medicine

368 pages, published 1998

Reading Format:  Book

Summary

The Tennis Partner is a memoir by Abraham Verghese, the author of the bestselling book Cutting for Stone.  Verghese writes about a time earlier in his medical career when he befriended David Smith, an Australian medical student recovering from drug addiction and former professional tennis player.   Verghese and Smith share a love for tennis and start playing on a regular basis.  Verghese writes with poignancy about this time period when he separated from his wife and David slid back into addiction.

Quotes 

It made one a perpetual student, a posture that I respected more than the posture of absolute mastery.

 

My Take

While The Tennis Partner is well written, it didn’t resonate with me nearly as much as  Cutting for Stone, a beautifully written book and author Abraham Verghese’s masterpiece.  However, The Tennis Partner still has a lot to recommend it.  In a similar vein as Beautiful Boy, which I highly recommend, it is a moving account of the helplessness of watching someone you care for continuously slip back into addiction.  Tough reading at times, but I still recommend it.

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236. Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, A Man Who Would Cure the World

Rating:  ☆☆☆☆1/2

Recommended by:

Author:  Tracy Kidder

Genre:  Non-Fiction, Biography, Medicine, Public Policy

333 pages, published August 31, 2004

Reading Format:  e-Book on Overdrive

 

Summary

Mountains Beyond Mountains is a biography of Dr. Paul Farmer, a Harvard educated doctor whose life’s mission is a quest to improve the health of the world’s impoverished people, with is the destitute plateau region of Haiti as his primary place of work.  Farmer has also worked in Peru, Cuba, and Russia.  In addition to humanitarian work, Farmer is a Harvard professor, renowned infectious-disease specialist, anthropologist, the recipient of a MacArthur “genius” grant, modern day Robin Hood.  Farmer and his compatriots focus on diagnosing and curing infectious diseases and bringing the lifesaving tools of modern medicine to those who need them most.

 

Quotes 

“And I can imagine Farmer saying he doesn’t care if no one else is willing to follow their example. He’s still going to make these hikes, he’d insist, because if you say that seven hours is too long to walk for two families of patients, you’re saying that their lives matter less than some others’, and the idea that some lives matter less is the root of all that’s wrong with the world.”

 

“That’s when I feel most alive, he told me once on an airplane, when I’m helping people.”

 

“WL’s [White Liberals] think all the world’s problems can be fixed without any cost to themselves. We don’t believe that. There’s a lot to be said for sacrifice, remorse, even pity. It’s what separates us from roaches.”

 

“Paul’s face grew serious. ‘I think whenever a people has enormous resources, it is easy for them to call themselves democratic. I think of myself more as a physician than an American. We belong to the nation of those who care for the sick. Americans are lazy democrats, and it is my belief, as someone who shares the same nationality as [a Russian doctor], I think the rich can always call themselves democratic, but the sick people are not among the rich […] I’m very proud to be an American. I have many opportunities because I’m American. I can travel freely through the world, I can start projects, but that’s called privilege, not democracy.”

 

“The goofiness of radicals thinking they have to dress in Guatemalan peasant clothes. The poor don’t want you to look like them. They want you to dress in a suit and go get them food and water. Comma.”

 

“I think Farmer taps into a universal anxiety and also into a fundamental place in some troubled consciences, into what he calls “ambivalence,” the often unacknowledged uneasiness that some of the fortunate feel about their place in the world, the thing he once told me he designed his life to avoid.”

 

“One time I listened to Farmer give a talk on HIV to a class at the Harvard School of Public Health, and in the midst of reciting data, he mentioned the Haitian phrase “looking for life, destroying life,” Then he explained, “It’s an expression Haitians use if a poor woman selling mangoes falls off a truck and dies.” I felt as if for that moment I could see a little way into his mind, It seemed like a place of hyperconnectivity, At moments like that, I thought that what he wanted was to erase both time and geography, connecting all parts of his life and tying them instrumentally to a world in which he saw intimate, inescapable connections between the gleaming corporate offices of Paris and New York and a legless man lying on the mud floor of a hut in the remotest part of remote Haiti. Of all the world’s errors, he seemed to feel, the most fundamental was the “erasing” of people, the “hiding away” of suffering. “My big struggle is how people cannot care, erase, not remember.”

 

“It is the curse of humanity that it learns to tolerate even the most horrible situations by habituation.” “Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.” “The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.”

 

“I have fought the long defeat and brought other people on to fight the long defeat, and I’m not going to stop because we keep losing. Now I actually think sometimes we may win. I don’t dislike victory. … You know, people from our background-like you, like most PIH-ers, like me-we’re used to being on a victory team, and actually what we’re really trying to do in PIH is to make common cause with the losers. Those are two very different things. We want to be on the winning team, but at the risk of turning our backs on the losers, no, it’s not worth it. So you fight the long defeat.”

 

My Take

Mountains Beyond Mountains is a powerful book written by the very talented Tracy Kidder (a winner of the Pulitzer Prize for a different book) about the difference that one person can make with their life.  The title comes from the Haitian proverb “Beyond mountains there are mountains”: as you solve one problem, another problem presents itself, and so you go on and try to solve that one too.  That, in a nutshell, is the philosophy of Dr. Paul Farmer and it was very inspiring to see how it has played out in his life.

 

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212. Pandemic

Rating:  ☆☆☆1/2

Recommended by:  Scott Nelson

Author:  Sonia Shah

Genre:  Non-Fiction, Science, Health, Medicine, History, Public Policy

288 pages, published February 16, 2016

Reading Format:  Book

 

Summary

Pandemic recounts the history of pandemics in the world with particular focus on the nature and spread of cholera, Ebola, SARS and AIDS.  It then explores the decline in animal species and spread of animals to all corners of the world and how that can lead to increased risk for human populations, what types of pathogens are likely to cause a global pandemic in the near future and what we can do to prevent it.

 

Quotes 

“In the nineteenth century, cholera struck the most modern, prosperous cities in the world, killing rich and poor alike, from Paris and London to New York City and New Orleans. In 1836, it felled King Charles X in Italy; in 1849, President James Polk in New Orleans; in 1893, the composer Pyotr Ilyich Tchaikovsky in St. Petersburg.”

 

“But far from being a harmless source of fertilizer, dog feces is both an environmental contaminant (and is classified as such by the Environmental Protection Agency) and a source of pathogens that can infect people. Like human excreta, dog poo teems with pathogenic microbes, such as strains of E. coli, roundworms, and other parasites. One of the most common parasitic infections in Americans is the result of their exposure to dog feces. The dog roundworm Toxocara canis is common in dogs and, because of the ubiquity of dog feces, widespread in the environment. It can contaminate soil and water for years.”

 

“the global bonfire of fossil fuels will heighten the likelihood of pandemics on its own, in a way that is likely to be even more consequential than all of its contributing factors put together.”

 

“Globally, 12 percent of bird species, 23 percent of mammals, and 32 percent of amphibians are at risk of extinction. Since 1970, global populations of these creatures have declined by nearly 30 percent. Just how these losses will shift the distribution of microbes between and across species, pushing some over the threshold, remains to be seen.”

 

“As avian diversity declined in the United States, specialist species like woodpeckers and rails disappeared, while generalist species like American robins and crows boomed. (Populations of American robins have grown by 50 to 100 percent over the past twenty-five years.)48 This reordering of the composition of the local bird population steadily increased the chances that the virus would reach a high enough concentration to spill over into humans.”

 

“a single opossum, through grooming, destroyed nearly six thousand ticks a week.”

 

My Take

Pandemic is a fascinating, but chilling, read.  While human beings have largely conquered many ravaging diseases of the past (small pox, typhus, polio), we are still at risk from old and new diseases, especially in our global age where air travel can quickly spread a disease from its point of origin to all corners of the globe.  I also found the discussion of animal sources of disease to be intriguing.  Another reason not to have a dog or cat!

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175. Polio: An American Story

Rating:  ☆☆☆☆

Recommended by:  Sue Deans and Darla Schueth

Author:   David M. Oshinsky

Genre:  Non-Fiction, History, Science, Medicine, Public Policy

342 pages, published September 1, 2006

Reading Format:  Book

 

Summary

In Polio:  An American Story, Historian David Oshinsky tells the gripping story of a world terrorized by polio and the intense effort to find a cure, from the March of Dimes to the discovery of the Salk and Sabin vaccines.  Drawing on newly available papers of Jonas Salk, Albert Sabin and other key players, Oshinsky paints a suspenseful portrait of the race for the cure, weaving a dramatic tale centered on the furious rivalry between Salk and Sabin. We also get an inside look at the National Foundation for Infantile Paralysis which was founded in the 1930s by FDR and Basil O’Connor and which revolutionized fundraising and the perception of disease in America.

 

 

My Take

For the past five years, I have been a member of the Boulder Rotary Club.  From my first meeting, I became aware that eradicating polio from the face of the earth has been a long time mission of all Rotarians throughout the world and indeed, Rotarians have contributed mightily to making that happen.  Our Rotary Club just launched a book group for our club (how could I not join) and given Rotary’s history, it was no surprise that our first selection was Polio:  An American Story.  What was surprising was how much I enjoyed this book.  A well-deserved Winner of the Pulitzer Prize for History (2006) and the Herbert Hoover Book Award (2005),   Oshinsky takes a potentially dry subject and breaths fascinating life into it.  Through the lens of polio, we see how the scientific, cultural, sociological and historical shifts in our nation as we progressed through the twentieth century.  Both a gripping scientific suspense story and a provocative social and cultural history, Polio:  An American Story provides fresh insight into post World War II era America.

 

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146. Stiff: The Curious Lives of Human Cadavers

Rating:  ☆☆☆

Recommended by:   Boulder Librarian

Author:   Mary Roach

Genre:  Non-Fiction, Science, Medicine

320 pages, published 2003

Reading Format:  Audio Book

 

Summary

I learned a lot from reading Stiff about a subject I didn’t even know would be interesting:  the use of the dead for cadavers and as test subjects (think crash test dummies) and the brain dead for organ donation.  For over two thousand years, cadavers have been involved in advancing the cause of science.  In this unique book, Mary Roach explores what happens to our bodies postmortem and it is a fascinating tale.

 

Quotes

 “The way I see it, being dead is not terribly far off from being on a cruise ship. Most of your time is spent lying on your back. The brain has shut down. The flesh begins to soften.  Nothing much new happens, and nothing is expected of you.”

 

“You are a person and then you cease to be a person, and a cadaver takes your place.”

 

“One young woman’s tribute describes unwrapping her cadaver’s hands and being brought up short by the realization that the nails were painted pink. “The pictures in the anatomy atlas did not show nail polish”, she wrote. “Did you choose the color? Did you think that I would see it? I wanted to tell you about the inside of your hands. I want you to know you are always there when I see patients. When I palpate an abdomen, yours are the organs I imagine. When I listen to a heart, I recall holding your heart.”

 

“It is astounding to me, and achingly sad, that with eighty thousand people on the waiting list for donated hearts and livers and kidneys, with sixteen a day dying there on that list, that more then half of the people in the position H’s family was in will say no, will choose to burn those organs or let them rot. We abide the surgeon’s scalpel to save our own lives, out loved ones’ lives, but not to save a stranger’s life. H has no heart, but heartless is the last thing you’d call her.”

 

“We are biology. We are reminded of this at the beginning and the end, at birth and at death. In between we do what we can to forget.”

 

“The human head is of the same approximate size and weight as a roaster chicken. I have never before had occasion to make the comparison, for never before today have I seen a head in a roasting pan.”

 

“It’s the reason we say “pork” and “beef” instead of “pig” and “cow.” Dissection and surgical instruction, like meat-eating, require a carefully maintained set of illusions and denial.”

 

“Here is the secret to surviving one of these [airplane] crashes: Be male. In a 1970 Civil Aeromedical institute study of three crashes involving emergency evacuations, the most prominent factor influencing survival was gender (followed closely by proximity to exit). Adult males were by far the most likely to get out alive. Why? Presumably because they pushed everyone else out of the way.”

 

“Sharing a room with a cadaver is only mildly different from being in a room alone.

They are the same sort of company as people across from you on subways or in airport lounges, there but not there. Your eyes keep going back to them, for lack of anything more interesting to look at, and then you feel bad for staring.”

 

“Here’s the other thing I think about. It makes little sense to try to control what happens to your remains when you are no longer around to reap the joys or benefits of that control. People who make elaborate requests concerning disposition of their bodies are probably people who have trouble with the concept of not existing. […] I imagine it is a symptom of the fear, the dread, of being gone, of the refusal to accept that you no longer control, or even participate in, anything that happens on earth. I spoke about this with funeral director Kevin McCabe, who believes that decisions concerning the disposition of a body should be mad by the survivors, not the dead. “It’s non of their business what happens to them whey the die,” he said to me. While I wouldn’t go that far, I do understand what he was getting at: that the survivors shouldn’t have to do something they’re uncomfortable with or ethically opposed to. Mourning and moving on are hard enough. Why add to the burden? If someone wants to arrange a balloon launch of the deceased’s ashes into inner space, that’s fine. But if it is burdensome or troubling for any reason, then perhaps they shouldn’t have to.”

 

My Take

I always like learning about new things and I really learned about something new while reading Stiff.  Roach’s book gave me an appreciation for how important the use of human cadavers has been to understanding how the human body and disease work, as well as how to build better transportation options to protect the living.  We all owe a debt to those who came before us and donated their body to science and those who generously signed organ donation cards.

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65. Being Mortal: Medicine and What Matters in the End

Rating:  ☆☆☆1/2

Recommended by:

Author:   Atul Gawande

Genre:  Non-Fiction, Medicine, Health, Public Policy

282 pages, published October 7, 2014

Reading Format:  Audio Book

Summary 

In Being Mortal, Gawande, a practicing surgeon, tackles the difficult issue of how medicine can not only improve life but also death.  While modern medicine has made amazing advances in the past few decades, it is still challenged when dealing with end of life issues where the interests of human spirit and dignity are often inadequately considered.  Nursing homes, preoccupied with safety, pin patients into railed beds and wheelchairs. Doctors, committed to extending life, often impose devastating procedures that may extend the quantity of life, but also severely impact the quality.  Gawande argues that quality of life is the desired goal for patients and families and offers examples of better models for assisting the infirm and dependent elderly.  He also explores hospice and shows that a person’s last weeks or months may be rich and dignified.

Quotes

“In the end, people don’t view their life as merely the average of all 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 difficult life may be devoted to a great cause. We have purposes larger than ourselves.  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. That is profoundly affected by how things ultimately turn out. Why would a football fan let a few flubbed minutes at the end of the game ruin three hours of bliss?  Because a football game is a story.  And in stories, endings matter.”

“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.”

 

“Our ultimate goal, after all, is not a good death but a good life to the very end.”

 

“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.”

 

“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.”

 

“Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits, and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be. We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. 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?”

 

“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 which is not thwarted but enriched and expressed in such service.” In more recent times, psychologists have used the term “transcendence” for a version of this idea. 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.”

 

“You may not control life’s circumstances, but getting to be the author of your life means getting to control what you do with them.”

 

“We’re always trotting out some story of a ninety-seven-year-old who runs marathons, as if such cases were not miracles of biological luck but reasonable expectations for all. Then, when our bodies fail to live up to this fantasy, we feel as if we somehow have something to apologize for.”

 

“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.”

 

“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.”

 

“Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it the good we do can be breathtaking.”

 

“People with serious illness have priorities besides simply prolonging their lives. Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete.”

 

“Your chances of avoiding the nursing home are directly related to the number of children you have.”

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