It is really difficult to try to write a coherent review of such a dense and difficult book as this. I suspect that for me as a senior citizen, its impact is quite different than it would be for younger readers, and of course I had had this title on my wish list for quite some time, as I inch closer and closer to the reality of knowing that my mortality becomes more obvious with each health issue and each new year absorbed. I dread, as most people probably do, the thought of a slow and painful end. Atul Gawande is making a plea for the world of medecine to revamp its attitudes in the end of life stages.... where prolonging life is often more painful and demeaning that trying to find the best way to keep a life meaningful and worth living. As he so aptly concludes: "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 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?' I loved the whole presentation of newfangled assisted living situations where animals are brought in my the hundreds and gardens are maintained to keep residents engaged in a useful life.... if you have every moment of your existence regulated, you are being incarcerated, and Gawande is calling for a whole new way of looking at how to deal with the inevitable such that people can maintain that sense of being of use. Not for the faint of heart, and a bit difficult for me right at this moment, but still, a book I much liked reading. I marked more than a dozen good passages, but obviously I cannot share them all! Perhaps this remark to finish then: "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 somehow we have something to apologize for." As a rational humanist, this rings very true to me. But who knows? The fantasy keeps us going..... we just need to continue insofar as possible to be the authors of our own lives.

on the bench near the entrances