Gawande explains that tending to the needs of the dying and their loved ones seemed beside the point in medical school. Confronting mortality was simply outside the jurisdiction of what was taught. Instead, students were taught to diagnose and cure or treat disease, and to understand all the complex mechanisms of the body to repair injuries. It was not until he began to practice that he realized how unprepared he was for the realities of dying. He had no training to deal with mortality. As a junior surgical resident Gawande had a patient named Joseph Lazaroff who was suffering badly from an incurable cancer. After radiation failed to shrink the tumor, the only option left was surgery. Doctors were aware that even with surgery the