Atul Gawande’s latest book, Being Mortal, is about end of life care, how we get it wrong and what we can do about it. But, primarily, it is a discussion about what the function of medicine really is. The traditional view is that medicine exists to preserve life; death is the enemy and doctors are “the generals who march the soldiers onward, saying all the while, ‘You let me know when you want to stop.’” But in a war you cannot win, 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.”
Across a series of studies, Gawande shows that by simply talking about the end of life, we get more of it. Patients who saw a palliative care specialist trained in end-of-life conversations spent less time in the hospital, suffered less, and lived 25 percent longer compared to patients who had the same condition but did not have such conversations. We should discuss what makes life worth living, whether it’s eating ice cream or playing bridge or being able to recognize family. Once we can’t do these things, it might be better to forego that fourth round of chemo, or that third surgery.
As I read Being Mortal, it occurred to me that young professionals make a similar conceptual mistake. We chase status and money without first outlining our priorities. Our goals should be concrete (pitch an article to the New Yorker) and not grandiose and abstract (become a famous writer). We should avoid the idea that income is a means to a better life, just like patients should avoid the delusion that the fourth round of chemo will allow them to be happy. This equation may sound simple, but as graduation nears and the dread of unemployment looms, seniors will get it backwards.
There is, to be sure, a difference between naively chasing a dream and making time for the activities that give people a sense of fulfillment. I’m not suggesting that graduates should cancel the interview with Goldman Sachs and move to L.A. to pursue their passion for acting. That would be foolish. Like a palliative care specialist, career center counselors should ask students what activities, interests, or hobbies make their life worth living. What could you not do without? What will happen if you cannot do what you like? Tailor the job search around those priorities. If you love to write, the entry-level job at Goldman Sachs could be a great fit. The point is not to find the dream job but a job that allows people to do what they enjoy—even if it’s for a few hours each weekend.
Yet even graduates who pledge to spend their free time wisely can be naïve about how much life could change. In Young Money: Inside the Hidden World of Wall Street’s Post-Crash Recruits, Kevin Roose writes about recent graduates who, with the ink on their diplomas still drying, begin working one hundred hours a week and ten hours each weekend day. These spry recruits do not actively work during every moment of these grueling stretches. They idle for hours a day waiting for a senior banker to assign work. That’s how their livelihood gets depleted. The “drop-offs” typically arrive late in the day when the senior banker is headed home, leaving the analyst a “graveyard’s shift worth of work” before he can go home and sleep. As one first-year analyst put it, “It’s not the hours that kill you—it’s the lack of control of the hours… my life doesn’t belong to me anymore.”
Gawande writes that palliative care specialists ask patients if they understand what their condition is, how their body could react to subsequent drugs and surgeries, and how those physical changes may shift their priorities. Most young analysts on Wall Street don’t have analogous conversations. Usually, it’s take a few years of exhausting work, a relentless boss, and maybe a romantic breakup or a fallout with close friends for them to have honest discussions about what they value—and how a full time job could undermine those values. A third year salary of $150,000 looks appealing, but at that point, swaths of employees wonder how much it’s actually worth.
I’m picking on Wall Street but graduates in other industries (consulting comes to mind) follow a similar trajectory. One reason is perspective—young people, regardless of generation, lack it. Gawande reports studies showing that the elderly prefer to spend time with friends and family. They live in the present instead of dwelling on the past or future. Young people, by contrast, are the opposite. We seek novelty, dream about the future, and make new friends. Young, terminally ill patients, by comparison, have preferences similar to the elderly. “How we seek to spend our time may depend on how much time we perceive ourselves to have,” Gawande writes.
One piece of wisdom I took from Being Mortal is that when the chances of survival slip from very small to zero, we must switch from fighting for survival to fighting for the things we value. But I wonder: do we need to wait until we’re approaching the end of life to examine it?