What does a good day look like?

Atul Gawande has changed the way he thinks about his job, and that has made all the difference to his impact on the world. He has helped change the way we think about health care at the end of life.

The physician and author used to believe that a doctor’s obligation was to fight like hell for the life of the patient, to heroically beat back illness to make that life go on. But he has changed his mind about that. A physician’s brief, he now believes, is to “enable well-being.” Well-being involves “the reasons one wishes to be alive.”

Of all the questions a doctor can ask a patient poking their way down the back nine of life, one looms largest:

“What does a good day look like to you?”

That question is so important, in fact, that you don’t want to wait too long with it. “If you’re only asking that question at the very end of life, it’s almost too late.”

Gawande learned this the hard way.

In his book Being Mortal, he told the story of a patient who was dying of cancer. The day he finally thought to ask her that question, her reply was, “In my perfect day, I take my grandchildren to Disneyland.” At this point, that dream was off the table – this woman would die less than 48 hours later. “If we’d managed her late-stage care differently,” Gawande said, “she could have had that.”

The acute regret he felt shaped the way he practiced medicine for the next decade. He now privileged quality of life over quixotic medical intervention when odds of success are low (and the wages of the attempt, in terms of suffering and sacrifice, are high).

Gawande has been heavily influenced by the work of Laura Carstensen, the Stanford psychologist and geriatrician. Among the wise things Carstensen has said, this may be the wisest: “Well-being is really about having control of your own story.” Gawande took that to mean: Listen to these people. Find out what gives them the most pleasure and try to deliver it. Try to give them their good day.

The hospice movement—which has made huge strides in the past decade—concerns itself with the gift of good days at the end of life, through full-court-press palliative care. But the question is worth asking at any point in our lives:

What does a good day look like for you?

Something happens when we ask that question of ourselves. It shakes the tree of our life until our priorities fall out. It sharpens our definition of who we are. And sometimes rekindles the memory of who we used to be.

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I thought about all this while chatting over Zoom recently with my remarkable friend Verna, who has been through the trials of Job and emerged with her spirit somehow intact. (Her story is told here, and also in a forthcoming book she and I have collaborated on.) Before the tragedy that took all four of her limbs, Verna was an adventure hound – world traveler, adrenaline junkie. That lifestyle has obviously been seriously curtailed. But in her mind, a “good day” is the same as it ever ways. It’s one where the sense receptors are firing like lightning bugs in June. Where you feel life on planet Earth, acutely.

“Let me run something by you,” I said. “If I tried to arrange for us to go skydiving, would you be into that?”

In about a nanosecond, she replied: “Two hundred percent.”

Many parachuting schools offer “tandem jumps,” where you’re basically strapped to a professional. Together you tumble out of the plane. The jumpmaster does everything, including pulling the ripcord. Your only job is to absorb the thrill.

Both of the local dropzones were fully booked for the rest of the summer, so we made a date for next spring.

It’s gonna be a good day.