Quotes by Surgeons - Page 2

We want progress in medicine to be clear and unequivocal, but of course it rarely is. Every new treatment has gaping unknowns - for both patients and society - and it can be hard to decide what do do about them.
Atul Gawande
If there is a credo in practical medicine, it is that the important thing is to be sensible.
Atul Gawande
In the community of living tissues, the uncontrolled mob of misfits that is cancer behaves like a gang of perpetually wilding adolescents. They are the juvenile delinquents of cellular society.
Sherwin B. Nuland
Though everyone may yearn for a tranquil death, the basic instinct to stay alive is a far more powerful force
Sherwin B. Nuland
Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.
Atul Gawande
There is a saying about surgeons, meant as a reproof: "Sometimes wrong; never in doubt." But this seemed to me their strength. Each day surgeons are faced with uncertainties. Information is inadequate; the science is ambiguous; one's knowledge and abilities are never perfect. Even with the simplest operation, it cannot be taken for granted that a patient will come through better off - or even alive. Standing at the table my first time, I wondered how the surgeon knew that he would do this patient good, that all the steps would go as planned, that the bleeding would be controlled and infection would not take hold and organs would not be injured. He didn't, of course. But still he cut.
Atul Gawande
The core predicament of medicine - the thing that makes being a patient so wrenching, being a doctor so difficult, and being a part of society that pays the bills they run up so vexing - is uncertainty. With all that we know nowadays about people and diseases and how to diagnose and treat them, it can be hard to see this, hard to grasp how deeply uncertainty runs. As a doctor, you come to find, however, that the struggle in caring for people is more often with what you do not know than what you do. Medicine's ground state is uncertainty. And wisdom - for both the patients and doctors - is defined by how one copes with it.
Atul Gawande
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 knew how to fight for territory when he could and how to surrender when he couldn't, someone who understood that the damage is greatest if all you do is fight to the bitter end.
Atul Gawande
...my patient needed a great deal of reassurance that there had been nothing unusual about the way her mother died, that she had not done something wrong to prevent her mother from experiencing that "spiritual" death with dignity that she had anticipated. All of her efforts and expectations had been in vain, and now this very intelligent woman was in despair. I tried to make clear to her that the belief in the probability of death with dignity is our, and society's, attempt to deal with the reality of what is all too frequently a series of destructive events that involve by their very nature the disintegration of the dying person's humanity. I have not often seen much dignity in the process by which we die.
Sherwin B. Nuland
What is troubling is not just being average but settling for it. Everyone knows that average-ness is, for most of us, our fate. And in certain matters—looks, money, tennis—we would do well to accept this. But in your surgeon, your child's pediatrician, your police department, your local high school? When the stakes are our lives and the lives of our children, we want no one to settle for average.
Atul Gawande
[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?
Atul Gawande
At least two kinds of courage are required in aging and sickness. The first is the courage to confront the reality of mortality- the courage to seek out the truth of what is to be feared and what is to be hoped. But even more daunting is the second kind of courage - the courage to act on the truth we find.
Atul Gawande
When our time is limited and we are uncertain about how best to serve our priorities, we are forced to deal with the fact that both the experiencing self and the remembering self matter. We do not want to endure long pain and short pleasure. Yet certain pleasures can make enduring suffering worthwhile. The peaks are important, and so is the ending.
Atul Gawande
Do what is right, and do it now.
Atul Gawande
Death with dignity" is our society's expression of the uni­versal yearning to achieve a graceful triumph over the stark and often repugnant finality of life's last sputterings. But the fact is, death is not a confrontation. It is simply an event in the sequence of nature's ongoing rhythms. Not death but disease is the real enemy, disease the malign force that requires confron­tation. Death is the surcease that comes when the exhausting bat­tle has been lost. Even the confrontation with disease should be approached with the realization that many of the sicknesses of our species are simply conveyances for the inexorable journey by which each of us is returned to the same state of physical, and perhaps spiritual, nonexistence from which we emerged at conception. Every triumph over some major pathology, no matter how ringing the victory, is only a reprieve from the inevitable end.
Sherwin B. Nuland
As pervasive as medicine has become in modern life, it remains mostly hidden and often misunderstood. We have taken it to be both more perfect than it is and less extraordinary than it can be.
Gawande Atul
In this work against sickness, we begin not with genetic or cellular interactions, but with human ones. They are what make medicine so complex and fascinating.
Atul Gawande
For years I had convinced myself that, as a doctor, I sacrificed moments with friends, family, and my husband for the greater good. The call to heal the sick and tend the injured superseded all else. The Lord heaped blessings upon me, and I hurled them back in the name of “service” to him.I’m a woman surgeon, I would snap. You made me this way. I have a legacy to carry on...The prospect of abandoning a secure position with excellent prospects for advancement terrified me. I spent many nights agonizing that, despite the Lord’s call, my decision to leave medicine was reckless or irresponsible. Such fears are normal and expected, but reflect our own limited understanding, rather than an enduring faith in the Lord. God is sovereign over our lives, and whatever doubts we have, we may trust that he knows the path and is in command over all.Christ has already overcome, and so we have nothing to fear. From Proverbs: “The heart of man plans his way, but the Lord establishes his steps” (Proverbs 16:9), and “trust in the Lord with all your heart, and do not lean on your own understanding. In all your ways acknowledge him, and he will make straight your paths” (Proverbs 3:5–6)...From 1 Thessalonians 1:3: We remember “before our God and Father your work of faith and labor of love and steadfastness of hope in our Lord Jesus Christ.” Christ died and rose victorious over death and sin to free us, so that we may have the hope and fulfillment that comes from living in him.
Kathryn Butler
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.
Atul Gawande
We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.
Atul Gawande
Love isn’t a choice. You fall for the person, not their chromosomes.
I.W. Gregorio
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 for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self.
Atul Gawande
Our reverence for independence takes no account of the reality of what happens in life: sooner or later, independence will become impossible. Serious illness or infirmity will strike. It is as inevitable as sunset. And then a new question arises: If independence is what we live for, what do we do when it can no longer be sustained?
Atul Gawande
The world is thinner in some places.
John Llewellyn Probert
I don't think I fully appreciated how relaxing it is having someone I can be really mean to. It's going to be so hard being nice all the time.
Fiona Wood
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.
Atul Gawande
This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong.
Atul Gawande
In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.
Atul Gawande
A study led by the Harvard researcher Nicholas Christakis asked the doctors of almost five hundred terminally ill patients to estimate how long they thought their patient would survive, and then followed the patients. Sixty-three per cent of doctors overestimated survival time. Just seventeen per cent underestimated it. The average estimate was five hundred and thirty per cent too high. And, the better the doctors knew their patients, the more likely they were to err.
Atul Gawande
Moths and flames, mankind and death--there is little difference.
Sherwin B. Nuland
Technological society has forgotten what scholars call the 'dying role' and its importance to people as life approaches its end. People want to share memories, pass on wisdoms and keepsakes, settle relationships, establish their legacies, make peace with God, and ensure that those who are left behind will be okay. They want to end their stories on their own terms. This role is, observers argue, among life's most important, for both the dying and those left behind. And if it is, the way we deny people this role, out of obtuseness and neglect, is cause for everlasting shame. Over and over, we in medicine inflict deep gouges at the end of people's lives and then stand oblivious to the harm done.
Atul Gawande
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?
Atul Gawande
My mother died of colon cancer one week after my eleventh birthday, and that fact has shaped my life. All that I have become and much that I have not become, I trace directly or indirectly to her death. ... In my professional and personal life, I have lived with the awareness of death's imminence for more than half a century, and labored in its constant presence for all but the first decade of that time.
Sherwin B. Nuland
All the same I fear what happens when we expand the terrain of medical practice to include actively assisting people with speeding their death. I am less worried about the abuse of these powers than I am about dependence on them.
Atul Gawande
I submit a body of facts which cannot be invalidated. My opinions may be doubted, denied, or approved, according as they conflict or agree with the opinions of each individual who may read them; but their worth will be best determined by the foundation on which they rest—the incontrovertible facts.
William Beaumont
Embrace each challenge in your life as an opportunity for self-transformation.
Bernie S. Siegel
We are besieged by simple problems.... Checklists can provide protection
Atul Gawande
With a DO-CONFIRM checklist, he said, team members perform their jobs from memory and experience, often separately. But then they stop. They pause to run the checklist and confirm that everything that was supposed to be done was done. With a READ-DO checklist, on the other hand, people carry out the tasks as they check them off--it's more like a recipe.
Atul Gawande
The instinct of the thief is most strongly marked in the Skua tribe, and I am afraid that the mere love of thieving alone actuates them on many occasions.
George Murray Levick
I have sometimes wondered why Jesus so frequently touched the people he healed, many of whom must have been unattractive, obviously diseased, unsanitary, smelly. With his power, he easily could have waved a magic wand. In fact, a wand would have reached more people than a touch. He could have divided the crowd into affinity groups and organized his miracles--paralyzed people over there, feverish people here, people with leprosy there--raising his hands to heal each group efficiently, en masse. But he chose not to. Jesus' mission was not chiefly a crusade against disease (if so, why did he leave so many unhealed in the world and tell followers to hush up details of healings?), but rather a ministry to individual people, some of whom happened to have a disease. He wanted those people, one by one, to feel his love and warmth and his full identification with them. Jesus knew he could not readily demonstrate love to a crowd, for love usually involves touching.
Paul Brand
You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. They are spent in institutions—nursing homes and intensive care units—where regimented, anonymous routines cut us off from all the things that matter to us in life. Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.
Atul Gawande
I am in a profession that has succeeded because of its ability to fix. If your problem is fixable, we know just what to do. But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity, and extraordinary suffering.
Atul Gawande
We recruit for attitude and train for skill,
Atul Gawande
REVISITING THE LIST1. Kiss EstelleOkay, at least I've met her. She thinks I'm a creep. And that's withought her knowing I've read her diaries. Unless we somehow fall over, exactly aligned, lip to lip, and gravity causes the pressure, or we find ourselves in a darkened room and through a series of Shakespearian ID muddles she thinks she's kissing someone else, I can't say how this is ever going to happen.
Fiona Wood
How many times do your feet have to press down on a path before they make an imprint, before pieces of soul start sticking?
Fiona Wood
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.
Atul Gawande
One American in seven has no coverage, and one in three younger than sixty-five will lose coverage at some point in the next two years. These are people who aren't poor or old enough to qualify for government programs but whose jobs aren't good enough to provide benefits either.
Atul Gawande
Look to the nervous system as the key to maximum health.
Galen
All involve risk, uncertainty, and complexity — and therefore steps that are worth committing to a checklist and testing in routine care. Good checklists could become as important as doctors and nurses as good stethoscopes (which, unlike checklist, have never been proved to make a difference in patient care). The hard question — still unanswered — is whether medical culture can seize the opportunity.
Atul Gawande
We are all plagued by failures - by missed subtleties, overlooked knowledge, and outright errors. For the most part, we have imagined that little can be done beyond working harder and harder to catch the problems clean up after them. We are not in the habit of thinking the way the army pilots did as they looked upon their shiny new Model 299 bomber — a machine so complex no one was sure human beings could try it.
Atul Gawande
Instead they choose to accept their fallibilities. They recognised the simplicity and power of using a checklist.
Atul Gawande
It is better to read a little and ponder a lot than to read a lot and ponder a little.
Denis Parsons Burkitt
We have to accept that any action we take might promote an equal and opposite reaction that we do not want. We have to realize that even the most noble actions or most obviously correct course can have its dark side that we cannot control or reason our way out of. The fighter of the "just war" must understand that her actions will result in the deaths of other humans; many of whom may be innocent. The pacifist who refuses all war must realize that his inaction might likewise result in the deaths of the innocent. There are no actions without contradiction—and yet we must act, for not to act is also a contradictory action with both positive and negative effects.
John Hunter
We combine our three packs of pasta for dinner – pesto. We tip the dried stuff into a pan, add water and simmer. We try it, looking at each other with disbelief as it hits the tastebuds. ‘It’s pesto, Jim, but not as we know it,’ I say.‘Fascinating,’ says Lou, unsmiling humouring my Star Trek reference, while wincing at the foul food. (And what made me say that? Is there such a thing as a dad-joke vacuum that needs to be filled, even in the wild?)
Fiona Wood
Of course, we often think we have to get sick literally in order to get the rest or pleasure we need in our lives. Bobbie and I therefore taught our children when they were younger that if they needed a day off from school, they should just say that and take a health day, not a sick day. That made them look at life differently. I think all of us need to rethink our attitudes toward health and sickness.
Bernie S. Siegel
The ability to overcome failure--to live through it and move on--is crucial. If we are not willing to face failure--if we don't have the skills to survive it--we have precluded any real creativity or risk. Failure may never become our friend, but if we are to do meaningful work, perhaps failure needs to be our companion.
John Hunter
This is when I became myself. The girl before this time is a shadow, like a soul who is practicing how not to become. She is the background, the hole in the fabric from which the real shape is cut.
Gabriel Weston
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 maybe empty. A seemingly difficult life may be devoted to a great cause. We have purposes larger than ourselves.
Atul Gawande
show me your eyes and i should tell who you are and what would your future
Mohamed Khadra
The common thread from all those stories was that talking helped, and listening, and time. One day I would find my own place. I couldn't run there, though, because it didn't exist yet; I had to build it myself, out of forgiveness, truth, and terrifying gestures of friendship.
I.W. Gregorio