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An Amazon Best Book of the Month, October 2014: True or false: Modern medicine is a miracle that has transformed all of our lives.

If you said true, youd be right, of course, but thats a statement that demands an asterisk, a but. Weve been wrong about what our job is in medicine, writes Atul Gawande, a surgeon (at Brigham and Womens Hospital in Boston) and a writer (at the New Yorker). We think. . .[it] is to ensure health and survival. But really. . .it is to enable well-being. And well-being is about the reasons one wishes to be alive. Through interviews with doctors, stories from and about health care providers (such as the woman who pioneered the notion of assisted living for the elderly)and eventually, by way of the story of his own fathers dying, Gawande examines the cracks in the system of health care to the aged (i.e. 97 percent of medical students take no course in geriatrics) and to the seriously ill who might have different needs and expectations than the ones family members predict. (One striking example: the terminally ill former professor who told his daughter that quality of life for him meant the ongoing ability to enjoy chocolate ice cream and watch football on TV. If medical treatments might remove those pleasures, well, then, he wasnt sure he would submit to such treatments.) Doctors dont listen, Gawande suggestsor, more accurately, they dont know what to listen for. (Gawande includes examples of his own failings in this area.) Besides, theyve been trained to want to find cures, attack problemsto win. But victory doesnt look the same to everyone, he asserts. Yes, death is the enemy, he writes. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you dont want a general who fights to the point of total annihilation. You dont 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 cant. In his compassionate, learned way, Gawande shows all of usdoctors includedhow mortality must be faced, with both heart and mind. Sara Nelson

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