Book summary “Being Mortal”: summary

Introduction

Modern medical training prepares you to fight disease and prolong biological survival at all costs. Yet medical schools teach almost nothing about the inevitable realities of aging, frailty, and dying. You enter the medical system expecting healing, but you often find a bureaucratic apparatus focused on technical fixes while ignoring what makes life worth living.

Death used to be a familiar event that happened at home surrounded by family. Over the past century, medicalization shifted the dying process into sterile hospitals and institutional nursing homes. This transition promised safety and prolonged existence, but it extracted a devastating toll on human autonomy and emotional well-being.

Modern medicine fails the aging and terminally ill by prioritizing biological survival over a meaningful quality of life.

You face a profound modern dilemma when your body begins to fail. Society treats aging as a technical problem to be solved rather than a natural stage of life to be navigated. When you can no longer care for yourself, you must choose between unsafe independence and safe institutional control. Both options demand unacceptable sacrifices of your dignity and personal freedom.

The author Atul Gawande explores how medicine got aging and dying wrong through historical analysis, medical studies, and personal stories of patients and family members. The book examines how modernization changed the life cycle, how medical institutions strip away autonomy, and how palliative care offers a better path. You will discover how to approach hard conversations about decline and find the courage required to face mortality.

You must confront several difficult questions as you navigate the final chapters of life:

• How can you maintain dignity and control when your body breaks down?
• What compromises between safety and autonomy actually work in old age?
• How do you balance the fight for time with the desire for quality of life?
• What conversations must you have with your loved ones before it is too late?

1. The Independent Self

Modernization gave generations the liberty to live independently, but modern medicine lacks answers for when physical decline makes that autonomy impossible.

You live in a society that values autonomy above all else. Historically, older individuals commanded property and authority, leading demographers to document age heaping where people exaggerated their years. Today, less than 2 percent of the US population was 65 or older in 1790, while 14 percent of the US population is 65 or older today. In Germany, Italy, and Japan, that elderly proportion exceeds 20 percent, and 100 million elderly people currently live in China.

Multigenerational traditions

Traditional societies relied on multigenerational households. Gawande's grandfather Sitaram lived to nearly 110 in an Indian village 300 miles inland from Mumbai where Uti is located. Sitaram remained the head of the household and made key decisions about his land because his large family absorbed the burden of his physical care. Sitaram lived in the village of Uti, continuing to inspect his farm fields on horseback into his hundreds until he suffered a fatal fall from a bus.

Modernization did not strip the elderly of their status. It demoted the traditional family system by giving both young and old the liberty to live independent lives. Economic development created jobs away from ancestral lands, turning shared households into a struggle for control over property and lifestyle. Gawande's father left his ancestral village in India to pursue professional opportunities in the United States, making a traditional shared household impossible.

The rise of retirement communities

Older generations embraced this shift by choosing independent leisure over living as dependents under their children's roofs. Real estate developers recognized this desire, leading to the rapid global growth of specialized retirement towns. Del Webb launched Sun City in Phoenix in 1960 as a pioneering retirement community featuring a golf course, a shopping arcade, and a recreation center.

Modern Western elders often choose to live completely independently in their own homes for decades after the death of a spouse. Alice Hobson lived alone in her Arlington house on Greencastle Street for twenty years after her husband Richmond died of a heart attack at age sixty. Alice was widowed when she was 56 years old, and Richmond Hobson died of a heart attack at age sixty in 1985 when Gawande met her. Pensions, savings, and stable housing allowed Alice to manage household chores, drive vehicles, and run community activities without living with her children.

The inevitability of decline

The modern reverence for independence fails to account for the reality that serious illness and physical infirmity will eventually make independence impossible. When independent older adults finally experience declining physical strength, memory loss, or dangerous falls, families and conventional medical practitioners are left without answers.

Health professionals use standardized frameworks to assess whether an elderly person retains the capacity for basic physical independence or safe living:

• 8 Activities of Daily Living used to measure basic physical independence;
• 8 Independent Activities of Daily Living used to measure the capacity to live safely alone.

When Alice Hobson reached age eighty-four in 1992 and began experiencing memory lapses and severe falls down her basement stairs, her family doctor could not offer guidance on what to expect or how to manage her failing independence. Medical and social systems evaluate older adults using two specific categories. The first consists of eight basic physical functions required for independence, and the second consists of eight more complex activities required to live safely alone.

2. Things Fall Apart

Medical progress has altered the trajectory of aging from sudden fatal drops to either prolonged chronic decline or a long, slow fade of accumulated bodily system failures.

Aging follows biological wear and tear rather than single programmed genes, and geriatric specialists add immense value by preserving function.

The biology of aging

You watch physical aging happen through the gradual softening of bones and teeth alongside the hardening and calcification of blood vessels, soft tissues, and organs. Jaw muscles and bones lose mass, teeth wear away, and calcium seeps from the skeleton into soft tissues.

By age eighty, people lose a quarter to half of their muscle weight. The hand shows speckles of calcification in arteries, bone translucency, and osteoarthritis in its twenty-nine joints.

Inheritance has little influence on human longevity. Only 3 percent of lifespan is explained by parents' longevity. Complex biological systems age through random and gradual failure of their components much like engineered complex machines.

The role of geriatrics

Mainstream doctors often avoid treating elderly patients due to complex overlapping complaints and unfixable chronic issues. Geriatricians provide immense value by simplifying medications, ensuring proper nutrition, and assessing fall risks.

Each year, 350,000 Americans fall and break a hip. About 40 percent of hip fracture patients end up in a nursing home, and 20 percent never walk again.

Researchers at the University of Minnesota identified 568 high-risk adults over seventy and found that those seeing geriatric teams were a quarter less likely to become disabled. They were also half as likely to develop depression and 40 percent less likely to require home health services.

Living through old age

Expert geriatricians face the same personal declines of aging, requiring active strategies, purpose, and support systems to maintain independence.

Felix Silverstone, a prominent senior geriatrician, retired from medical practice at eighty-two. He experienced severe cardiac events, hearing loss, and cognitive slowing in his eighties.

He moved with his blind wife Bella to Orchard Cove, a retirement community where he derived his primary self-worth and purpose from being her caregiver.

3. Dependence

Old age brings a continuous series of losses. Physical and mental debilities accumulate until daily requirements exceed your capacities, forcing a period of dependence.

Historical poorhouses morphed into total institutional nursing homes that strip away personal control to manage safety and clear hospital beds.

Before modern social safety nets, elderly people who became too frail to work and lacked family support were forced into grim poorhouses. An Illinois State Charities Commission report from 1912 described a county poorhouse as unfit for animals, overrun with rats and mice, and lacking bathtubs.

In developing countries where extended families break down before economic affluence arrives, charity-run old age homes resemble historical poorhouses. At the Guru Vishram Vridh ashram in New Delhi, a converted warehouse housed over a hundred disabled elderly people on cots pushed closely together. The youngest resident was sixty, while the oldest was over a hundred.

History of care

Some elderly individuals fiercely resist moving to safer, managed environments because giving up their home means giving up their life and control. When Mount Saint Helens erupted in 1980, eighty-three-year-old Harry Truman refused to evacuate his lodge on Spirit Lake. He had owned the property for fifty years, cared for sixteen cats across fifty-four acres, and stated that losing his home would kill him in a week.

Modern nursing homes developed largely by accident as a medical solution to clear out hospital beds. Following the Hill-Burton Act of 1946 for hospital construction, lawmakers provided funding to build separate hospital recovery units in 1954, and Medicare legislation arrived in 1965. The bureaucratic concept of substantial compliance allowed thousands of substandard facilities to open, leading to an explosion of thirteen thousand nursing homes by 1970.

Total institutions

Sociologist Erving Goffman noted the likeness between prisons and nursing homes in Asylums fifty years ago. These total institutions strip away personal privacy, control, and autonomy to enforce rigid schedules and centralized authority.

Alice Hobson felt incarcerated like she was in prison after a hip fracture forced her into a skilled nursing unit. She lost control over her clothes, wake-up times, meals, and roommates.

Residents in nursing homes often resist institutional control through noncooperation, which staff members dismiss pejoratively as being feisty. You can observe daily battles where residents:

• sneak food that violates dietary restrictions;
• take unauthorized walks;
• refuse scheduled activities;
• decline prescribed medications.

4. Assistance

Assisted living was designed to preserve autonomy, but corporate safety priorities clash with human psychological shifts toward present emotional well-being.

Relying solely on family to care for aging, frail relatives places an unsustainable burden on working-age children, particularly daughters. Increased longevity combined with dual-income families creates painful and unhappy results for everyone involved. Caregivers often act as round-the-clock concierges, chauffeurs, and medical troubleshooters while trying to maintain their own jobs and households.

Lou Sanders lived with his daughter Shelley and her husband Tom in a Boston suburb, where Shelley had to manage his frequent falls, medication, night terrors, and daily bathing while working and raising teenagers.

During a 1 year timeframe, Lou had four ambulance rides to the emergency room due to postural hypotension. Lou reached ninety-two when he finally entered an assisted living facility.

Assisted living evolution

Keren Brown Wilson created the assisted living concept in the 1980s based on her experience with her mother Jessie's unhappy institutionalization. The goal was to build a home where residents could control their schedule, visitors, pets, and rules while receiving necessary help.

Wilson and her husband built the first assisted living facility called Park Place in Portland, Oregon, opening in 1983 with 112 units for tenants rather than patients.

Assisted living eventually mutated from a radical alternative into a watered-down version driven by safety regulations, liability fears, and corporate profits. Developers and board members pushed for bigger buildings and stricter rules, turning assisted living into a mere layover before a nursing home. Facilities frequently prioritized institutional safety over resident autonomy, stripping away personal freedoms to protect against lawsuits.

Psychology of aging

Human priorities shift fundamentally as people age, moving away from future-oriented achievement and toward present-focused emotional and social satisfaction. Stanford psychologist Laura Carstensen formulated socioemotional selectivity theory, demonstrating that perspective on time dictates motivation. When horizons are perceived as finite, people prioritize everyday pleasures and close relationships over expanding networks of information.

Carstensen tested this theory across age groups and found that individuals with terminal illnesses or those facing extreme external uncertainty consistently mirrored the social preferences of older adults.

The shift in human goals from achievement to emotional well-being is driven by a person's perceived time horizon rather than chronological age itself. Experimental studies showed that when healthy young people are asked to imagine moving far away or experiencing an extended life span, their social and goal preferences shift to match those of different age groups, proving perspective is all that matters.

The safety paradox

Society and family members consistently prioritize safety and survival for the elderly, often at the direct expense of their autonomy, happiness, and personal freedom. While individuals demand autonomy and personal choice for themselves, they demand absolute safety for their loved ones. This paradox leads children and institutions to place frail seniors into secure environments that strip away everything they care about.

5. A Better Life

Traditional nursing home plagues of boredom and helplessness can be cured through animals, plants, and the Green House model of care.

Dr. Bill Thomas recognized that institutional care prioritized safety and routine over actual living. This medicalized approach stripped elderly residents of their independence and reduced their existence to a holding pattern.

The Eden alternative

You find that nursing homes traditionally suffer from three fundamental plagues that destroy the human spirit:

• boredom;
• loneliness;
• helplessness.

At Chase Memorial Nursing Home, Dr. Thomas sought to cure these conditions by introducing living elements into the facility. The staff brought in a greyhound, a lapdog, four cats, and 100 parakeets delivered and integrated into the facility. They also added indoor plants, a garden, and child care to transform the sterile environment into a real home.

This intervention produced startling clinical results compared to a control home. Residents achieved a 50 percent reduction in prescriptions required per resident, total drug costs dropped to 38 percent of the comparison facility, and deaths fell by 15 percent.

Authorship and autonomy

Philosopher Josiah Royce argued that mere physical survival feels empty. You need devotion to something larger than self-interest to make your mortality endurable. Mr. L., a depressed resident who lost his wife and gave up walking, transformed and eventually moved home after being given a pair of parakeets to care for.

Philosopher Ronald Dworkin noted that the real value of autonomy lies in personal responsibility for shaping your own life story. Even when faced with severe debility and dependence, you want to retain choices consistent with your personal identity. Residents like Rhoda Makover and Anne Braveman valued the ability to make simple, personal decisions, such as walking to the bathroom themselves or going to the movies.

The Green House model

The Green House model reimagines nursing care by replacing large, sterile corridors with small, communal households. Developed by Bill Thomas, these homes group no more than 12 residents per home in private rooms around a central kitchen and living area. Caregivers act as generalists who cook, clean, and provide companionship, reversing rigid departmental silos.

Over 150 Green Houses have been built across 25 states. Lou Sanders thrived at the Leonard Florence Center for Living, a Green House where he had a private room, could set his own schedule, and enjoyed human contact and independent routines.

6. Letting Go

As people's capacities wane, making their lives better often requires curbing purely medical imperatives and resisting the urge to fix and control. Modern medicine excels at trying to stave off death with expensive procedures and drugs, but it struggles to know when to stop.

Hospice care shifts the priority from extending life at all costs to ensuring the fullest possible life and freedom from discomfort in the present.

Unlike ordinary medical care that sacrifices current quality of existence for the chance of gaining time later, hospice deploys a multidisciplinary team to focus on objectives like pain relief, mental awareness, and family time. You are required to have a six months life expectancy to certify eligibility for hospice. Patients often enter hospice reluctantly, hoping to beat their fatal illness, but structured support helps them manage symptoms at home.

Lee Cox, a seventy-two-year-old with pulmonary fibrosis and heart failure, moved in with her niece and received hospice care, which helped her manage her symptoms and enjoy brief outings before her health declined.

The medical imperative trap

Purely medical imperatives lead to patients spending their final days in intensive care units hooked up to machines. This deprives you of a peaceful end and leaves caregivers three times as likely to suffer major depression. A critical care physician described her ICU as a warehouse for the dying, mentioning an eighty-year-old woman with heart failure who was tubed in most natural and artificial orifices. Another elderly woman had a family who insisted on permanent tracheostomy and dialysis despite her prior wishes.

• 25 percent of all Medicare spending goes for the 5 percent of patients in their final year of life;
• 12,000-a-month chemotherapy;
• 4,000-a-day intensive care;
• 7,000-an-hour surgery;
• 94,000 average cost during the last year of life with metastatic breast cancer.

Palliative care benefits

Early integration of palliative care specialists for terminal patients not only reduces suffering and curtails futile treatments but can actually lengthen life. When you face advanced incurable illnesses and discuss your goals with palliative specialists, you tend to stop aggressive chemotherapy sooner and enter hospice earlier. A 2010 Massachusetts General Hospital study of 151 patients randomly assigned stage IV lung cancer patients to usual care or usual care plus palliative visits. Those seeing a palliative specialist lived 25 percent longer.

Systematic discussions

Doctors consistently and heavily overestimate the survival time of their terminally ill patients, which hinders realistic end-of-life planning. A study led by sociologist Nicholas Christakis asked doctors of terminally ill patients to estimate survival times. It found that 63 percent of doctors overestimated survival, with average estimates 530 percent too high, while 17 percent underestimated it. Furthermore, 40 percent of oncologists admit to offering treatments they believe are unlikely to work.

Systematic community-wide discussions about end-of-life wishes dramatically lower hospital utilization and align care with patient values. In La Crosse, Wisconsin, local medical leaders launched a campaign in 1991 to institutionalize end-of-life discussions. By 1996, 85 percent of dying residents had a written advanced directive, up from 15 percent. This resulted in half as many days spent in the hospital during the last six months compared to the national average and one year higher life expectancy than the national mean.

7. Hard Conversations

Effective clinicians use interpretive communication models and express personal worries to help patients navigate terminal illness and second-order desires.

Doctor-patient relationships evolve through three distinct forms:

• paternalistic relationship where the doctor decides;
• informative relationship that acts as a retail transaction of facts;
• interpretive relationship of collaborative discovery.

Traditional paternalism dictates care, while the informative model treats you as a consumer choosing options. Neither satisfies the human need for guidance. The interpretive model uses shared decision-making to help you determine what matters most and match treatments to those personal priorities.

Advanced modern illnesses often follow a trajectory of mounting, unpredictable crises that medicine can only temporarily rescue. This pattern is dubbed One Damn Thing After Another, or the ODTAN syndrome. As diseases progress, you experience a compounding cascade of complications such as pulmonary emboli, bowel obstructions, and severe side effects from multiple interventions.

Jewel Douglass suffered a series of crises including failed chemotherapy regimens, pulmonary emboli, and recurring bowel obstructions from metastatic ovarian cancer.

Conveying meaning

When communicating severe prognoses, doctors should convey meaning and empathy rather than merely cold facts by explicitly stating their personal worries. Palliative care experts emphasize that you seek meaning behind clinical data. Physicians make mistakes by focusing solely on cognitive information. Expressing personal concern using simple phrases communicates seriousness while simultaneously signaling that the physician is allied with you and navigating uncertainties alongside you.

Atul Gawande told patient Jewel Douglass that he was worried about her recurring bowel obstruction. This changed the emotional climate of the room and opened the door for honest prognostic discussions.

Second-order desires

Because human wants are fickle and driven by primitive fears, effective clinicians must occasionally challenge short-term desires to help you align with deeper, second-order goals. You possess second-order desires, which are wishes to be healthier or more faithful to larger life goals rather than controlled by immediate fear or impulse. Doctors who listen only to momentary first-order preferences may fail you. Consequently, clinicians must deliberate on larger goals and push back against shortsighted choices.

True autonomy in the face of decline means getting to be the author of your life by deciding how to utilize remaining capabilities rather than merely controlling circumstance. When individuals confront the finitude of their time and the loss of physical independence, their focus narrows and priorities shift toward relational and meaningful goals. Redefining identity allows you to adapt to physical losses and retain control over your remaining days.

Atmaram Gawande retired from surgery as his tumor progressed, dropped to 132 pounds following radiation therapy, redirected his purpose into serving as district governor of Rotary International aiming to visit 59 clubs twice, and later chose targeted hospice care over aggressive radiation.

8. Courage

Facing aging and serious sickness requires two distinct forms of courage: first, the courage to confront the reality of mortality, and second, the courage to act on that truth based on personal priorities. Seeking out the truth of what to fear and hope for is difficult, but deciding to act on that truth is even more daunting.

Facing mortality requires the courage to confront reality and act on that truth so that you can embrace the dying role and preserve well-being.

The human mind evaluates past experiences through the remembering self rather than the experiencing self, adhering to the peak-end rule that judges an experience entirely by its most intense moment and its end. Daniel Kahneman and Donald Redelmeier demonstrated that patients' retrospective ratings of pain ignore duration and are instead dictated by the single worst moment and the final moments of a procedure.

In experiments studying 287 patients undergoing colonoscopy and kidney stone procedures, a short period without pain at the end dramatically reduced patients' overall pain ratings despite prolonged discomfort.

When patients face terminal illness, surgical and medical interventions are only justified if they prioritize immediate well-being and align with specific goals rather than merely prolonging life. Surgeons can perform palliative operations aimed strictly at making a patient feel better immediately rather than attempting high-risk curative surgeries that gamble with the final chapter of life.

Jewel Douglass chose to undergo a palliative operation with strict conditions of no risky chances, resulting in drainage tubes that relieved 90 percent of her nausea and pain, allowing her to spend her final weeks at home.

While legalizing assisted death provides reassurance and control for some terminally ill patients, it risks diverting societal attention and resources away from improving comprehensive palliative and assisted living care. In the Netherlands, where assisted suicide has existed for decades, one in thirty-five people sought assisted death by 2012, reflecting a slower development of palliative care programs.

The dying role is essential for both patients and their families. It allows you to share memories, pass on wisdom, settle relationships, and end your story on your own terms. Modern technological society often neglects this vital psychosocial phase, instead inflicting aggressive medical interventions that damage the final period of life.

Peg Bachelder, a 62-year-old piano teacher diagnosed with a sarcoma, utilized hospice care to manage her symptoms and successfully resume teaching her students and saying good-byes for six full weeks before her death.

The fundamental job of medicine is not merely to ensure health and survival, but to enable well-being and preserve the reasons you wish to be alive. Cultural and religious rituals surrounding death help connect individuals and families to a historical chain of generations, offering peace and closure. Following his father's death, the author and his family traveled to Varanasi, a city dating to the 12th century BC, to scatter his father's ashes in the Ganges River according to Hindu tradition.

9. Introduction

Medical education trains physicians to fix problems and save lives while completely ignoring the realities of aging, frailty, and dying. During medical school, students dissect corpses solely to learn anatomy and are taught that the purpose of medicine is to stop pathologies rather than tend to human demise. The only discussion of mortality in Gawande's medical school was an hour spent analyzing Tolstoy's novella The Death of Ivan Ilyich.

Aggressive surgical and technological interventions for terminal patients often result in a prolonged, painful death rather than restoring a meaningful life.

Joseph Lazaroff, a sixty-something city administrator with metastatic prostate cancer, chose a major, dangerous surgery involving opening his chest and collapsing a lung, which led to a painful and prolonged death. Faced with an incurable and metastatic cancer compressing the spinal cord, a surgical team offered a high-risk operation that did not stand a chance of returning the patient to his previous life. The technical surgery succeeded, but the patient suffered severe complications, respiratory failure, and ultimately died in the intensive care unit after more than fifty pounds of weight loss, eight and a half hours of surgery, and his fourteenth day in intensive care before stopping life support.

Medical school omission

Doctors learn technical competence and problem-solving, which creates an identity threatened by unfixable conditions. Encountering patient deaths and seeing medicine fail to save individuals can deeply shock young clinicians and induce feelings of professional failure. Gawande experienced recurring nightmares during his training in which he tried to smuggle patient corpses back into the hospital in the trunk of his car to avoid getting caught.

Joseph Lazaroff case

Mr. Lazaroff's oncologists, radiation therapists, and surgeons maintained months of treatments for an incurable problem without ever discussing the ultimate limits of their capabilities or what mattered most to him. Medical professionals focus exclusively on explaining specific treatment dangers while avoiding the larger truth about disease progression and the ultimate limits of medical intervention, effectively participating in a collective delusion alongside the patient.

While scientific advances have allowed people to live longer and better, they have also turned aging and dying into medicalized experiences managed by health care professionals rather than natural events occurring at home. By 1945, most deaths occurred in the home, but by the 1980s, just 17 percent of deaths occurred in the home. Treating mortality purely as a medical experience to be managed by technology is a young experiment that is currently failing patients.

Conclusion

Modern medical systems often fail you when physical decline and terminal illness strip away independence. You face a culture built on the promise of biological fixability, which treats aging and dying as technical failures rather than natural human stages. When you or your family members confront institutional nursing homes, you witness how safety and operational efficiency routinely override personal autonomy, treating you like a patient rather than a person.

The central insight is that survival is not your ultimate goal when life is coming to a close. You want autonomy, a sense of home, meaningful social contact, and protection of your second-order desires. When you shift the medical objective from fighting death to preserving the quality of daily life, you transform the entire experience of aging and dying. You can navigate this shift by adopting specific rules for managing late-stage decline:

1. Prioritize your functional capacity and daily autonomy above pure biological survival metrics.
2. Select living arrangements like assisted living or the Green House model that preserve personal control over schedule and environment.
3. Involve geriatric specialists early to manage physical wear and tear systematically.
4. Transition to palliative care and hospice the moment aggressive interventions no longer serve your ultimate priorities.
5. Initiate hard conversations with your family and clinicians long before a crisis forces your hand.
6. Express your deepest personal worries and values so that your caregivers know what matters most to you.
7. Demand an interpretive communication model from your physicians rather than mere technical information delivery.
8. Cultivate the courage to accept the reality of decline and embrace the roles that remain available to you.

You have the power to reshape how you age by acknowledging your mortality and planning for dependence with intention. When you align your medical care with your core human values, you ensure that your final chapter remains rich, purposeful, and entirely your own.

10 Key Ideas

1. Modernization gave generations the liberty to live independently, but modern medicine lacks answers for when physical decline makes that autonomy impossible.
2. Aging follows biological wear and tear rather than single programmed genes, and geriatric specialists add immense value by preserving function.
3. Historical poorhouses morphed into total institutional nursing homes that strip away personal control to manage safety and clear hospital beds.
4. Assisted living was designed to preserve autonomy, but corporate safety priorities clash with human psychological shifts toward present emotional well-being.
5. Traditional nursing home plagues of boredom and loneliness can be cured through animals, plants, and the Green House model of care.
6. Hospice care shifts the priority from extending life at all costs to ensuring the fullest possible life and freedom from discomfort in the present.
7. Effective clinicians use interpretive communication models and express personal worries to help patients navigate terminal illness and second-order desires.
8. Facing mortality requires the courage to confront reality and act on that truth so that you can embrace the dying role and preserve well-being.
9. Aggressive surgical and technological interventions for terminal patients often result in a prolonged, painful death rather than restoring a meaningful life.
10. The fundamental job of medicine is not merely to ensure health and survival, but to enable well-being and preserve the reasons you wish to be alive.