What's Worth Living For? | Dr. Atul Gawande

A surprisingly uplifting conversation on aging, sickness, and death. Plus: why you get happier as you get older, hard-earned tips for handling tough diagnoses, and how to think about AI in your health care. Atul Gawande, MD, MPH, is a surgeon, author, and public health innovator. He holds the Fish Chair in Surgery at Brigham and Women's Hospital. He is the Samuel O. Thier Professor of the Practice of Surgery at Harvard Medical School and Professor of the Practice at Harvard T. H. Chan School of Public Health. Dr. Gawande was Assistant Administrator for Global Health at USAID from 2022-2025. He is a longtime writer for The New Yorker and has written four books: Complications, Better, The Checklist Manifesto, and Being Mortal. In this episode we talk about: Why the best doctors ask patients what matters before choosing treatment The simple question that reveals what makes life worth living Why patients who get less aggressive care sometimes live longer His father's answer to "what's worth living for" changed three times Why staying independent and staying safe often pull in different directions Research showing people get emotionally calmer, not sadder, as they age What happened when the U. S. shut down its global health aid programs Why he sees AI as a helpful second opinion, not a replacement, for doctors Get the 10% with Dan Harris app here https://app.danharris.com/membership Sign up for Dan's free newsletter here http://www.danharris.com/ Follow Dan on social: Instagram https://bit.ly/3tGigG5, TikTok https://bit.ly/3FOA84J Subscribe to our YouTube Channel https://bit.ly/3FybRzD Additional Resources: Being Mortal https://atulgawande.com/book/being-mortal/, the book Being Mortal https://www.pbs.org/wgbh/frontline/documentary/being-mortal/, the documentary This episode is sponsored by: Warby Parker: Buy one pair of glasses and get 20% off any additional pairs at WarbyParker.com/HAPPIER http://warbyparker.com/HAPPIER — and using our link helps support the show. #WarbyParker #ad BetterHelp: Sign up and get 10% off at BetterHelp.com/HAPPIER http://betterhelp.com/HAPPIER. Notion: Learn more about how Notion can support your business, at notion.com/happier http://notion.com/happier To advertise on the show, contact [email protected] or visit https://advertising.libsyn.com/10HappierwithDanHarris

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dan Harris?

  Hey everybody, welcome to the 10% happier podcast. I am your host, Dan Harris. As a Buddhist, I am simultaneously galvanized by and terrified by the unavoidable fact of death. Galvanized because being aware of your mortality can make life more vivid and vibrant in the present moment, terrified because like, who's not afraid of dying? Today, though, I'm talking to a very famous doctor who argues that we can make this process, which again is coming for all of us, much more humane. Dr. Atul Gawande is a renowned surgeon, a Harvard professor, a writer for The New Yorker, and the bestselling author of many, many books, including the one we're going to focus on today, which is called Being Mortal.

• 0:47Dan Harris?

  Now, you might be thinking, didn't Being Mortal come out in 2014? Yes, it did. But that was before I had a podcast, and I've been meaning to have Dr. Gawande on the show for a long time. And then I found an excuse because just a few months ago, The New York Times listed Being Mortal as one of the top five books that will lift you up in hard times, which reminded me that I wanted to have Dr. Gawande on. So here he is, Dr. Atul Gawande. Welcome to the show.

• 1:13Speaker 01

  Thanks for having me, Dan.

• 1:14Dan Harris?

  When my dad was still working, he was the head of radiation oncology at the Brigham and Women's Hospital in Boston, and he used to rave about this brilliant young surgeon who was writing articles for The New Yorker, and I should read those articles, and he was talking about you. So it's very nice to finally meet you.

• 1:34Speaker 01

  What's your dad's name?

• 1:35Dan Harris?

  Jay Harris.

• 1:37Speaker 01

  Oh, my God. Yes. I've shared patients with him. That's amazing. That's your dad.

• 1:42Dan Harris?

  He's in a very different situation than when you knew him. He's had a lot of health problems. He had a stroke and has a form of Parkinson's, so he's sometimes walking. Case study in impermanence.

• 1:55Speaker 01

  Tell him hello, but also you're going through what everybody goes through, dealing with a family member who's got significant challenges now.

• 2:05Dan Harris?

  Yes. So that brings us to your book. Again, Being Mortal, just one of many, many books you've written. One of the big through lines in the book was your experience with your father. Maybe let's start there.

• 2:20Speaker 01

  Yeah, my father was a surgeon who saw. So I'm a surgical oncologist at the Brigham and Dana Farber in Boston. My father was a urologist. My mother was a pediatrician there. I grew up in Athens, Ohio, and he developed a tumor in his brain stem and spinal cord that started causing him to have pain in his neck, and a scan revealed a tumor that was too large to actually remove. And that became our three and a half year, almost four year journey with struggling through the condition he had and the life he would

• 3:05Speaker 01

  be facing with it. There were things that could be done. There was operations, biopsies that could be offered, chemotherapy, radiation. He would take some of those choices. He would take, decide not to take other of those choices. But what struck me was, we had over 100 years of medical training between the three of us, and my sister coming in as well as a non-medical person. And, and we were no better equipped than anybody else to navigate it. And I started writing the book really because I had reached a point in my career

• 3:46Speaker 01

  when I was confident that if you had a problem I could fix, I could give you a great chance at fixing it. But come to me with a problem like the kind of problem my father had, and I didn't even, I was uncomfortable, and I didn't know even what it meant to be good at taking care of people, let alone actually being good at it. And getting to write was an excuse to start talking to people. It's strange to go as a doctor up to people and say things like, hey, can I come watch you, a geriatrician, in your office today? Or, you know, can I go follow you, a patient, as you navigate things at home? But when

• 4:30Speaker 01

  you're writing an article or then writing a book, you're allowed to do those things. And it was an amazing opportunity. I ultimately interviewed over 200 people, practitioners, patients, family members, as they all coped with these kinds of problems.

• 4:48Dan Harris?

  You talk about this in the book. Very few of us like to talk about death or to think about it. And yet, as I mentioned in the introduction, The New York Times listed Being Mortal as one of the top five books to read when, when you need to be lifted up in hard times. Why? Like, what is it about thinking about death in the right way that can be uplifting?

• 5:09Speaker 01

  So the surprise to me was the people who were best at managing these situations understood that it was not about death. It was about living to the very end, and what it meant to have a life worth living to the very end, or to help people, your family member, a patient, navigate coming to that space. It's shocking to me that it took me all of that time, 200 interviews, et cetera, to figure out the ultimate lessons. At the core of it is the fact that people have priorities besides just living longer. They

• 5:49Speaker 01

  have goals and purposes that are very meaningful to them, and they aren't just to control the disease. The most effective way to learn what people's priorities are is to ask them. But we don't ask. When we don't ask, the result is the care we provide as a family member, as a clinician, anybody trying to offer help, ends up being out of alignment with what matters most in their life. And the result of that is suffering. And I saw that now, grasping that, interviewing lots of folks, saw that through the lens of people

• 6:31Speaker 01

  living in senior retirement communities and nursing homes, people navigating tough conditions like your father is with Parkinson's disease and other things, my own father with his brain tumor. And it also gave clarity about how to approach, how to be good at taking care of folks. One of the people who I spoke to, a woman named Susan Block, who's a esteemed national expert palliative care clinician, she described to me taking care of her father, who had become ill with something very similar to my father facing

• 7:13Speaker 01

  a spinal cord problem. And, and she was the one who helped distill for me that the goal of a clinician is to identify what are your priorities, and there are questions that you can ask, like, what's your understanding of where you are with your health? What are your fears and hopes for the future if things worsen? What are you willing to endure and not willing to endure? What's the minimum quality of life you find acceptable? And when she asked her father this question, he said, hmm, minimum quality of life. Well, if I can eat chocolate ice cream and watch football on television, that'll be good enough

• 7:57Speaker 01

  for me. If I can't, let me go. And it was the best living will ever. He was telling you, not, do I want chest compressions? Do I want to be in an ICU? He was telling you, here's what's worth living for me, and if you can help provide it, you know, let me do it. If I can't, let me go. And, and then, you know, it became my favorite question to people, you know, I asked my dad. And his response was first, in the early days with the tumor, what matters to me is I want to stay a surgeon. I want to keep being able to go to the operating room. And so the goals were, could he keep working? Later, as he

• 8:38Speaker 01

  started to get paralyzed and have numbness and pain shooting down his hand, and he couldn't operate anymore, then he was despondent. It's like, I don't know what's worth living for. And then he realized what he missed most was not operating. It was helping people. And he ended up running for district governor of his Rotary Club in Ohio. And getting to do good through a service organization kept him going and motivated and happy and fulfilled for the next couple of years. And then when he became quadriplegic with it, it became food and family around the table. The answer changed over time.

• 9:22Dan Harris?

  How can we get better at having these conversations? And I think it's not just about having conversations with your loved ones, but also like having the conversation with yourself.

• 9:34Speaker 01

  Yeah, part of it is, it's more of a skill than I'd understood it to be. You can't simply ask someone, what matters to you? What's your priority? Like, what are you talking about? That understanding was distilled by Susan Block into something that we, that we actually took in our research center and turned into a set of questions that people could ask and started training clinicians and using them. And those became the questions I mentioned, asking things like, well, what's your understanding of where you are with your health? And then being able to progress through questions like, what are your hopes and fears? What are you willing to endure and not willing to endure? What are you willing

• 10:17Speaker 01

  to, what's the minimum quality of life you find acceptable? And those answers

• 10:24Speaker 01

  Help, first of all, that help the other person articulate for themselves what matters. They don't always come to those answers with clarity at the first time.

• 10:38Speaker 01

  But it opens the door and I found it changed. It almost physically changed my position with patients as I'm talking in the office. Because it suddenly felt like, you know, I'd face someone who has a terminal condition. They're deteriorating and they want something that's going to save them. They want to know that they're fighting and what they're fighting for. And a lot of times in these discussions, you can feel like you're in conflict. Same thing with a parent who's starting to have issues. You know, my mother, when she got older, started to have issues where we feared she was going to have a fall. And I care about, is she safe? She wants to know, can I live?

• 11:21Speaker 01

  And her answer is, well, what I want is to be able to remain independent in my apartment. And what I want is for her to not to fall. And those turn out to be the same things from a different perspective. And so now we could say, here's what we want. How do we pursue that? How do we give her her best chance to remain safe and doing well? We eventually navigated, it took time, not driving anymore. But she learned to use Uber and Lyft. Learned how to even, she started teaching people in her retirement community, how to navigate Uber and Lyft and find the cheapest ride.

• 12:01Speaker 01

  And also talk the delivery driver, the driver into carrying your groceries, you know, up into your apartment for you and things like that, you know? And then I found I'd called to go see her and, oh, she's gone into town. She's doing her thing. I found myself not in conflict with patients because we were having a discussion that was different in medical school. I was taught you lay out the options for people, the pros, the cons, the risks, the benefits of option A, B, C, D. But what I found in practice was people would always then follow up with a question. What would you do, doctor?

• 12:43Speaker 01

  And what I was taught in medical school and residency training is you answer that by saying, no, no, no. That's not for me to answer. Only you know what matters to you. So you tell me what your choice is. And they feel abandoned in that moment. And what this was teaching me was there's another way of being, and that's being a counselor. And a counselor understands your goals. So now if I understand your goal is to be independent in your apartment or to gather people around your dinner table and be able to enjoy that. I can then say, here's within the range of capability what we have to offer.

• 13:27Speaker 01

  And here's what I would recommend, based on my experience at getting you that goal you're looking at, or whether it's realistic to expect it at all. And we have to think about a change in goals.

• 13:40Dan Harris?

  You're talking about this, about having these conversations largely from the perspective of being a physician. Although you have, of course, referenced your parents. For the rest of us, do you have any guidelines that you think we should follow when we're, you know, inevitably thrust into these scenarios?

• 13:57Speaker 01

  Well, I'm imagining your conversation with your father.

• 14:00Dan Harris?

  We have had it.

• 14:01Speaker 01

  Well, and, you know, that conversation can start with a story. This guy we was talking to talked about a man who said, chocolate ice cream and football on television, and that's what really matters to him.

• 14:15Speaker 01

  What matters to you? Or you start it by saying, Dad, what are you willing to go through in order to achieve or to live the way you want to live? And that is a conversation I think any of us can have. And then the trick is honoring that. There are periods in time, whether it's my mom, my wife's parents, where I didn't love the choices they were making. And, you know, and sometimes you just know they're ultimately the one to take risks, not you. Sometimes you're paying for it.

• 14:54Speaker 01

  Sometimes there were periods in time when I thought, I'm just waiting for that crisis call to come.

• 15:03Speaker 01

  When there's a fall down the stairs that she shouldn't have been navigating in the first place. Or when my father continued to go to do surgery, even when, as his hand became paralyzed. And the nurses would actually help him. They'd help get his glove on. And he learned how to tie knots with one hand kind of stiff and unable to do it. Like that, that was a source of conflict, saying like, you know, we, this is, this is just going to be end in disaster. This is not good and needing to have that. But that's, you know, a counselor can do that. A counselor, when you're in that function, can advocate for and say, yeah, here's why you quit cigarettes.

• 15:48Speaker 01

  Here's why you shouldn't be in the operating room. And navigate it and it takes a few conversations, but we, we got there. Mostly it felt like a burden was off my back that they're living their life and trying things and going to navigate and give them some of that chance to do that.

• 16:10Dan Harris?

  There are so many times in my life, and I suspect this is true for you, where you just need a little reset, some little hack to get you out of a thought spiral or to help you fall back to sleep when you wake up at three in the morning or help you recover from some sort of temper tantrum. You know what I'm talking about? Which brings me to a little meditation challenge we're launching over on my app, 10% with Dan Harris. Starting on Monday, September 21st, we're kicking off a five day meditation challenge. It's called Reset, and it's all about getting back on solid ground when life throws you for a loop, which is inevitable in all of our lives. This challenge is guided by the amazing Diana Winston, who's a really legendary and fascinating and very nice meditation teacher.

• 16:55Dan Harris?

  And crucially, she has crafted each daily practice to be something you can actually do in a moment of suffering, when you're struggling in some way, large or small. These practices can literally help you reset. September 21st through the 25th, Reset with Diana and friends and me over on the 10% with Dan Harris app. You can sign up now at danharris.com. Most of us can remember being about 15 and feeling completely invisible, or worse, extremely visible, but for the wrong reasons. I remember one year when I was a teenager, I had a pimple in the crevice of my nose for the entire year. I didn't like that. Either way, even if we have painful memories of that age, most of us tend to soften it in memory.

• 17:39Dan Harris?

  And it was actually harder than we remember it now. That is the territory of Carrie, now streaming on Prime Video, the first ever television adaptation of Stephen King's Carrie. Eight episodes from Mike Flanagan with Stephen King as an executive producer. Flanagan had described this show as a tragedy. It's about a girl who doesn't feel seen by anyone and about how small, everyday acts of unkindness compound into something nobody meant to cause, which happens now at a speed and scale that would have been unimaginable not long ago. What I really appreciate about the show is that the show takes Carrie seriously as a person rather than as some sort of symbol. And the season keeps circling around one major question. Are you watching the making of a hero, a villain,

• 18:25Dan Harris?

  or something more complicated than either of those options? Carrie is now streaming on Prime Video.

• 18:39Dan Harris?

  You know this, but a lot of patients and perhaps this is even more true for the family members, want folks in medicine to do everything, you know, like, let's do everything we can. And yet there's, and you talk about this in the book, there's interesting data around moving into hospice or palliative care where you're just trying to treat the symptoms and keep people comfortable. I have a friend, this is anecdotal. I had a friend who was put into hospice and lived there for six years. Was told he had three days to live. Three days and he lived there for six years.

• 19:22Dan Harris?

  And so, yeah, I'd just be curious about your, your view on this.

• 19:26Speaker 01

  So one thing I'll start with before I get to the research is just saying, we talk about this as, you know, I want to do everything. And the debate is not, do we want to do everything or not? The question is, everything for what? Everything that we can do to accomplish what? Is it control of the disease at all costs? Is there anything you would not want to sacrifice in the course of your care? You know, my mother, she died just this past year.

• 19:55Dan Harris?

  Yeah, I'm sorry.

• 19:56Speaker 01

  Yeah, well, she was 89 though, and she had six years with stage four ovarian cancer. And she, you know, we had a clinician who asked her these questions. I knew which clinicians to go to, who'd gotten the training.

• 20:13Speaker 01

  And I went to one who did, and she was great. And, and so, you know, my mother, as I said, wanted to keep her independence in her living facility, but enjoyed her life and wanted to be able to do the things she did, from ping pong to taking walks at sunset. And, and so she did take the chemotherapy. But, you know, the oncologists also identified that one of the drugs caused a neuropathy, a loss of sensation in her feet that could cause a fall. And when she started to get that numbness, would stop that, that treatment.

• 20:56Speaker 01

  And that's what she did, that she got surgery to remove the tumor partially, and that she navigated a colostomy, understanding that that was something she was willing to navigate. All of those kinds of things, but then as the treatment started to take away things that were important to her, that after six years, she finally halted it. She got much longer with stage four ovarian cancer than anybody would have predicted. Now, one thing I'll say is that, so the research study was one that randomized people with incurable

• 21:38Speaker 01

  lung cancer, stage four incurable lung cancer, and randomized them to have their usual oncology care, or also see a palliative care clinician from the very beginning of their care. Often, people would say, used to say, hey, you know, it's not time to see the palliative care clinician, we still have options. It was thought of as like a last thing you do when you run out of medical options. And instead, they said, let's have people getting palliative care consultation right from the very beginning. And they found that the group who got those early palliative care discussions and plans focused on things like, how do I maximize

• 22:20Speaker 01

  your quality of life, as well as your quantity of life? Those people end up choosing to stop chemotherapy two months earlier than the group who were in the regular arm, just continue care as normal. They had much better control of symptoms and quality of life. They had lower costs. They were less likely to spend time in the hospital, and they lived 25% longer. Because when your answer to every question is, well, let me just find another treatment to give, let's get another operation, put you on the table, you're getting all the complications and none of the benefits, and losing the things that mattered to you

• 23:02Speaker 01

  in your life, when it's not planned in a way that's aligned with your goals. So it isn't a question of, do you get everything, or do you not get everything? It's, do you get to choose the assets and the options and the treatments and the capabilities that accomplish what's most important to you and your goals? And at a certain point, your quality of life starts to become more important than your quantity of life. And ironically, caring for that quality of life helps you live better and longer.

• 23:33Dan Harris?

  Another main focus for many of us, especially as we get older, is staying independent. But you have a whole chapter in the book that compares two grandparents, one of yours and I, what a grandparent-in-law, one who insisted on living on her own, and the other who just lived surrounded by his family. Yeah, can you tell the story? And also, what does it say about our thirst for independence?

• 24:02Speaker 01

  And they're both complicated cases, right? So one was my grandfather, who was in India, a farmer in a rural village, and living the way, you know, farming societies have lived for thousands of years. That you have an extended family, you know, your children would inherit the farm, and they'd become farmers. And that extended family would end up taking care of you into your old age. He continued, he died at the age of 108. He continued to be, you know, sit at the head of the table at dinner, and be the first

• 24:40Speaker 01

  one served. He was still continued to be largely with it. He would still walk us fields. He, you know, he died falling off of a bus when he was still wanting to do his thing. He was headed to the court to contest someone who'd failed to pay back a loan and hit his head. And, you know, that kind of society where family takes care of you, of you, and right to the end, and you remain the patriarch or the matriarch of the family, succeeded, but at the cost of the freedom of your child. In India, in this case, it's particularly

• 25:25Speaker 01

  the daughter-in-law, the one who marries your eldest son, becomes the person to take care of you. And then when, in this case, when they died, because he lived so long, you know, it'd be the next oldest daughter or daughter-in-law. And, and people, as economies improved, sought freedom for themselves. Young people wanted freedom. And we became, you know, nuclear, atomized families. And you had the rise that you see in India now, even of nursing homes and senior retirement communities and all of those things. The other story was of the life and ultimate death of my wife's grandmother, Alice Hobson.

• 26:09Speaker 01

  And Alice lived for years in a home on her own, valued that independence, but gradually became more and more isolated, started having some cognitive issues. Someone working as a landscaper took advantage of that and had her write multiple checks to him for the same services over and over again. And she had a car crash that went into the yard of her neighbor across the street. And that ultimately landed her in a, in a assisted living facility, in a place that was more like a hospital than a home. Whenever we'd

• 26:53Speaker 01

  come to see her, she'd always say, when am I getting to go home? And you'd say, you are home. This isn't home. And understanding, what does it mean to enable freedom for young people, lives that everybody wants to live? And the fact that even when, when adults even have their choices, older adults, they often prefer not to be in the home of a child, because now I'm under their rules. I'm, I'm, I'm living the way that they insist that I live. And so, you know, sociologists call it, the people prefer an intimate distance,

• 27:37Speaker 01

  that you live nearby, but just far away, that I also have my independence, and community, and education, and goals, and activities that go beyond bingo and watching television. Those kinds of places exist more and more.

• 27:56Dan Harris?

  My parents are in a place like that. And it's been very interesting to, you know, my mother has her cat with her, and is very, was not particularly social as a, as a, you know, in her prime, but is very, she's like the mayor of this assisted living facility. And, yeah, she's really thriving. At one point said, you know, this was the happiest period of her life. If you get it right, I mean, so many people, I know so many parents of my friends who, you know, if I bring up assisted living, you know, it strikes terror in their, in their soul. But, but if you get it right, and assisted living can be fantastic.

• 28:37Speaker 01

  Yes. The, there's these distinctions between senior living communities that have, in assisted living and nursing homes. And the best way to understand it is that the places that many people end up plugging into are ones where you can live in independent apartment, independent apartments. You can get services there. Some end up needing assisted living where you are at a higher level of services. And then some need full 24-hour day nursing home assistance. And enabling those in environments that don't feel like you're in a hospital. You know, I interviewed people being admitted for the first time

• 29:20Speaker 01

  to a assisted living or nursing home level facility. And they react, their experience was that it was like jail. They couldn't have their own furniture. They, you woke up and went to bed at the same time every day. You know, you'd wake up, you'd get changed by an orderly, you'd be, you'd get in the pill line, you'd go eat, you know, what you're told to eat. And that has evolved considerably, but not consistently. Many, many places are quite different from one another. My mother, for example, was in a senior retirement community located on a college campus. And she could take courses in the college with

• 30:03Speaker 01

  the students. And she was a former pediatrician, so she loved the connection to young people. The young people worked at their center. Sometimes, you know, some of them were learning, physical therapy students, some of them were staffing the cafeteria, some of them were involved in activities and vice versa. And she started a ping pong club every day. And I remember walking in one day to pick her up for lunch, and the group was all bursting out into tears laughing. Three of the four were at various stages of dementia, some cognitive, significant cognitive impairment. My mother had mild cognitive impairment,

• 30:46Speaker 01

  nothing, nothing near dementia. And, and she, I finally got, said, you know, what are you guys laughing about? And my mom said, none of us can keep the score. I'm the only one who can keep the score, but I can only keep the score if I call out the score every time at the end of every point. And I forgot to call out the score at the end of the last point, and now we're lost. And what it brought home to me, I, you know, if I answer the question, what, what, what are my priorities, you know, what's a minimum quality of life I'd find acceptable? I would have said, anything that would give me dementia is not an acceptable life. And here were, here, one of her best friends had significant dementia, but she

• 31:31Speaker 01

  was having joy in her life. She could enjoy and play ping pong, you know, enough to have fun, turned up every day, and had lots to talk about with my mom, didn't necessarily remember everything. And my mom loved her, and she loved my mom. And that was a extraordinary lesson to me. And she wasn't, you know, imprisoned. She was in a place she actually felt was her home.

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• 33:04Dan Harris?

  It's now been more than 12 years since you wrote your book, Being Mortal. Where are you in terms of processing your own mortality?

• 33:13Speaker 01

  I'm now past 60, so that was a different place than when I'd written the book in my mid-40s. And I would say, you know, when we looked for, we moved to DC for work in the, in the last administration, and we actually decided that we would look for a place that's on one floor, just in case we're staying long enough that we should age and want to, you know, make it, make it convenient. But I would say, I'm still, you know, at

• 33:51Speaker 01

  age 60, the average American who has access to healthcare, access to good public health as well, will live 90 years on average. So I'm aware on the one hand that I'm on the back end of the, of the age curve, but living my life still as the way you do when you think you have an infinite amount of time. I have plenty of things I'm ambitious about, trying for, et cetera. But Laura Carstensen, the Stanford researcher that I wrote about, has followed people as they age or as they became ill. She started her study in 1980s

• 34:31Speaker 01

  as the AIDS crisis hit, and it included people who suddenly became ill with HIV/AIDS at a time when there was no treatment available, and they had a death sentence. And what she saw was people who are older or facing their mortality behave differently than younger people who have a long time ahead of them. Younger people will prioritize spending time with going to a nightclub on a Friday night and hoping to meet new people, will focus on their job opportunities, acquisition of contacts, income, homes, you know, your

• 35:14Speaker 01

  status in the world. And as we get older, you think you're going to become unhappier, you're going to become depressed. In fact, as you get older, anxiety and depression decline. You develop capacity for a wider range of emotion, like there's a, the bittersweet sweet feeling of nostalgia, being able to live with, you know, a contradictory sense of things being bitter and sweet at the same time. And you tend to close your circles more. You focus more on family, the closer friends you have, relationships, and less

• 35:59Speaker 01

  on those other things. And the interesting thing was during this study, that's the pattern you saw even when young people became sick. It wasn't a brain development thing, it was a perspective. It's whether you had a perspective that you had a shorter amount of time, or essentially an infinite amount of time. And if you had less than 10 years, then you felt you had a shorter amount of time. If you had more than 20 years, you basically acted as if life was infinitely long. And you really fell into these two categories. But there would be moments that came during the study, 9/11 happened, and they were doing the study in Hong Kong, and the SARS epidemic happened. And at that moment,

• 36:42Speaker 01

  everybody reverted to a life is fragile approach. You, they wanted to go home instead of hanging out in the nightclub. They wanted to see family. They cared about pulling together and what really matters. And they were actually relieved of some of the anxiety, depression, things like that. And then, six months later, they were back to how we live. And so I'm in the, I'm still in the stage of trying to do stuff, going on a podcast with you.

• 37:20Speaker 01

  You know, I still have things that I'm excited about and interested in solving in the world and trying to address, and new things I want to try, and new people I want to meet. But I am, you know, transitioning to also nurturing these friendships that, that have gone on now for 40, 50 years of my life, and make time for staying close with them. Just came back from a week, summer holiday that we take with five other families where we've been gathering together for 40 years. And those things start to matter more and more, where I was kind of, you know, liable to blow it off a couple decades ago.

• 37:55Dan Harris?

  It's so interesting that you can write a whole book about mortality and still kind of in the back of your mind, even though you know it's irrational, feel like you're going to live forever.

• 38:11Speaker 01

  Because I don't have evidence every day of my mortality. I have things that, you know, they're different from my 40s. I'm aware that I'm having losses, that I'm not gaining things back. I'm not as fast as I used to be. I don't think as fast as I used to think. And finding ways to compensate for those things. I'm an avid tennis player, and I now having to change my game considerably at 60, where, you know, I was power and to some extent, speed, and now I have to be much smarter. And I think I actually play

• 38:51Speaker 01

  better than I used to. And I'm, I'm holding my game up at least by playing smarter.

• 38:58Dan Harris?

  It's such an interesting kind of bug in the human operating system that like, we know intellectually we're going to die, but we, we don't live like it. You know, I think there's a great line in the Indian epic, the Mahabharata, I think that's how you pronounce it. And the, the line is, one character asks the other, what's the most wondrous thing in the world? And the other person says that we're surrounded by aging, illness, and, and death, and yet we don't think it's going to happen to us. What do you think that's about?

• 39:32Speaker 01

  Well, I mean, the average lifespan of human beings, right into the beginning of the 20th century, was to your mid-40s. And the fact that we doubled the human lifespan worked against nature, and now we're living beyond our nature. And in that period, we have an extended range of being able to live with fragility. And our management systems, our internal biological management systems are made for expecting demise to occur fairly rapidly. Once you start having aches and pains and limitations and, and, you know,

• 40:16Speaker 01

  a cardiac condition or a lung condition. Whereas now, you can live decades with all of those things, and live a much higher quality of life than ever in history. And so we adjust our perspective based, you know, what really Laura Carstensen's work showed is that we tune our perspective based on the evidence of whether we're actually mortal and fragile. And when we don't have immediate evidence of our own mortality, when you're not waking up and every few weeks realizing your cancer is progressing, or your, your

• 40:59Speaker 01

  heart disease is bringing you to an end stage, then you have purpose and things that you do live for. And that's what, that's why those questions matter. One of the things I argue in the book is, everybody has a loyalty, something that they're willing to sacrifice themselves for, even die for, that, that matters to them. And that might be your kids. It might be an idea. It might be a project, an accomplishment. It might be beauty, religion, getting to serve, figure out those things and then serve them.

• 41:40Speaker 01

  Is what matters and can matter all the way to the very end. And I think in our, as we get older and get to live these long, much longer lives than human beings had, we get to serve purposes like that for much longer periods of time.

• 41:57Dan Harris?

  What are your purposes?

• 41:58Speaker 01

  You know, what would I really sacrifice myself for? My family for one, my children, my wife, my sibling, my sister. Number two, I would say is I've found purpose in trying to make the systems around health better. I've been fascinated for my whole career around the idea that we have learned how to double the human lifespan, but don't know how to deliver it affordably, effectively, give people these opportunities to achieve their loyalties. I'm interested both in the, the human experience and how we make our systems more effective at addressing those kinds of problems.

• 42:43Speaker 01

  And a lot of my work and jobs is sort of at, at that public level of making our systems better and more effective over time for solving these problems along the way. Those are my two big ones. For whatever reason, I get a lot of pleasure and joy out of whacking a little yellow tennis ball around a square box. And that, that also goes right in there as one of my priorities. I can't, I can't figure it out, but I'll, I'll do that for hours.

• 43:10Dan Harris?

  I buy it. Uh, I, I get tennis elbow, so I can't really do it, but I've, when I get a chance to do it, it's very fun and, uh, you're doing it with other people, you're moving the body, all those things feel good.

• 43:21Speaker 01

  I've been talking with my friends that there's ball people and non-ball people, I've decided. The, the ball people can't make any sense of people who want to go biking three hours up a mountain or, you know, endurance running or any of those things like runners. Put me 10 minutes, you know, down a road, I'm like, what the hell am I doing? Why, why am I doing this? This seems crazy. But, but then they say, the non-ball people say, why are you chasing a little yellow tennis ball around? Like what, what keeps you going for two and a half hours doing that? And the ball people just like throwing a ball in a basket or, or hitting one over a net. That, talk about strange wiring. Both of those are bizarre.

• 44:07Dan Harris?

  I'm non, non-binary in this regard. I like both.

• 44:10Speaker 01

  You do both. So there are people who are both, huh?

• 44:13Dan Harris?

  Yeah. I mean, I do much more of the non-ball stuff because I have so many injuries that prevent me from like playing tennis or doing other, other things, but I would, if left to my own devices, I would liberally do both. Speaking of aging.

• 44:32Dan Harris?

  After the book, you, uh, you moved to Washington, as you've mentioned, and you, uh, were running USAID, which is, for people who don't know it, one of the soft power wings of the, of the US government, where we spend money to, um, help people in other countries. And, uh, we've just lived through a time where the Trump administration, uh, gutted it. Uh, one study, uh, from the Lancet, I believe, um, said that this conservatively has probably led or will lead to tens, if not hundreds of thousands of unnecessary deaths. I'd just be curious what your, yeah, how you're processing all of this, what your thoughts are, how you think we should think about it.

• 45:17Speaker 01

  Yeah. And my role there wasn't leading the whole thing. I, I led the global health work of USAID, which is, um, uh, one of its biggest areas. My observations all stem from why I even took the job in the first place. Much of my work that I'm excited by, including this work around aging and the end of life, is around making, making it possible for people to get the benefits of everything we have discovered to enable a longer, better life. And one of those gaps comes from simply poverty in the world. The lowest income places in the world have half the survival rate of, of, um, of other places.

• 45:58Speaker 01

  And getting to USAID, and again, you'll lead its global health work, turned out to be the best job in medicine I've ever had, and likely the best job in medicine you've never heard of. I had 3,000 people in 65 countries and the, and Washington DC, deploying on the one hand, a lot, what seemed like a lot of money, $8 billion a year. On the other hand, it was about half of my hospital budget in Boston. $22 per American taxpayer out of $15,000 in the, in American tax bill. But with that, we were reaching hundreds of millions of people by strengthening systems for vaccination, for reducing deaths in childbirth, for addressing HIV, malaria, TB,

• 46:43Speaker 01

  for fighting outbreaks and preventing those outbreaks from reaching home. And the result of that was, has been documented to be, over the last 20 years, 90 million lives saved. In the countries where we worked, we cut the child mortality rate 32% and the overall mortality rate by 15%.

• 47:05Speaker 01

  It was great for the people we were serving and supporting. It strengthened countries to get onto their own feet. And I saw this from India, in India, where my parents grew up and where I would visit as a kid.

• 47:23Speaker 01

  That, you know, not only did we give food aid, but we provided the technology, scientific training and so on, for what's called the green revolution, where India went from a food recipient country, to the fourth largest exporter of food in the world, uh, feeding the rest of the world and not only itself. And, uh, and those kinds of accomplishments, uh, I got to build on. It was incredible as an experience. So to come out, the day that I left, noon on inauguration day, as the, the great American

• 48:03Speaker 01

  tradition, and the election changed the president and we peacefully handed over power and responsibility to the Trump administration. And then within hours, Trump had signed an order to freeze and halt all of the work of USAID.

• 48:23Speaker 01

  Like overnight, a complete dead stop. Food, aid left to rot in warehouses, medicines on the shelf, not allowed to be used, staff pulled out and sent home. I've been bearing witness to what has happened. It was on an argument that USAID was a criminal enterprise, was corrupt, didn't accomplish anything. And what's difficult is that was just a lie.

• 48:54Speaker 01

  The work immediately had consequences. And there have been now two different estimates that, that have, uh, put it in the ballpark of about 700,000 lives lost in 2025 from the shutdown of everything from HIV drug distribution to, um, TB programs, to outbreak prevention and, uh, and surveillance. So we are still in the bomb blast radius. There is more ongoing damage. There's some of the work that has come back. Then there's been a strong backlash, not only from liberals.

• 49:39Speaker 01

  This has been a longstanding bipartisan supported effort over 60 years since John F. Kennedy formed USAID. And, uh, and I don't think it's for nothing that, on the one hand, there's been a cut of $40 billion for overall assistance to countries, but a rise of half a trillion dollars in, in the war costs that we have because we've walked away from the idea that we offer a helping hand first before we show a fist of domination to how we approach the world. And it's not only unpopular abroad, it's unpopular at home. We see America as being a force for good in the world.

• 50:23Speaker 01

  USAID was one of the ways that did that. And people want to have those kinds of efforts continued. So the Republicans and Democrats came together to vote the, a budget that restored funds for foreign assistance and, uh, and keeping the shell of USAID intact. The administration is, you know, not necessarily going to spend that. They, they have, uh, held that funding back, but, um, we'll see what happens.

• 50:51Dan Harris?

  One last question from me before we get to our final segment. What's your take on AI in medicine and how we as patients should be interacting with AI, um, if at all, when it comes to our health?

• 51:07Speaker 01

  The best description I've heard is to say that AI is not going to replace your doctor, but doctors who use AI are going to replace doctors who don't use AI. And as if, as a intelligence at our side, I already see the ways that it can be dramatically useful. You know, most of, many clinicians have adopted AI. They call them ambient scribes that will record and do your note taking for you. And it's reduced the time that doctors require to write their medical notes and spend more time with patients.

• 51:47Speaker 01

  You'll see patients getting more, you know, people turning to AI can get better information and more clarity. Taking it as gospel is a bad idea. I often, when I'm asking questions of an AI bot.

• 52:07Speaker 01

  We'll ask multiple ones so that I'm triangulating among different sources. It might be Claude, it might be Gemini, it might be OpenAI. So I think there's important value that AI is bringing. I'm not seeing the signs that AI is different from other technology breakthroughs that have come before. We have had technology breakthroughs that gave us the GLP-1 drugs, for example, for controlling obesity that have replaced surgery for ulcers with a pill. And AI is going to be another one of those things. You know, it might be very soon the best reader of your mammogram.

• 52:45Speaker 01

  It may be the best initial diagnostic for some dermatologic conditions. But as a, but knowing which ones it's going to be the best for, which ones it's not, and what to do now based on what it's advising, how to deal with the risk of being wrong, et cetera. Those are still things that you want to have a co-pilot with. And I'd want a clinician who uses these capabilities alongside. And if I, and as a patient, I want to use this kind of information with people I trust as clinicians.

• 53:26Dan Harris?

  Lot of promise, lot of peril, lot to be figured out. Let's do this, we've been doing this, the closing segment, we're just a couple of weeks into trying this. It's called What's Good? And we just ask the guests, you know, what are you excited about? And it could be a book, movie, record. Don't say anything in tennis. You've already used up all of your tennis chits here. Could be just some little practice or habit you've, you've formed in your life. And then I'll give you one from mine.

• 53:52Speaker 01

  The first thing I thought of was the lunch I had today where my wife has showed me that if you put chimichurri on a ham and cheese sandwich, it's amazing. And it is amazing. So there's that.

• 54:09Dan Harris?

  That sounds disgusting. What are you talking about?

• 54:12Speaker 01

  It's absolutely, it's absolutely delicious. But, you know, life is good right now because I've finished my first draft of my next book. I've got a cool project we're working on to find new ways of addressing our shortage of mental health beds for people like this. You know, I just get, I just get excited by, I still get excited by things like that. And a little chimichurri.

• 54:39Dan Harris?

  What's the next book?

• 54:41Speaker 01

  The next book, and I haven't learned how to describe it really adequately, but the topic is how minds change. So how do people change their minds about things? We've, at a time when we feel kind of hopeless that anybody is going to change their minds, it is mining and understanding how did we do things like, we got, we got cigarettes out of bars and restaurants and airplanes. We have solved many problems and are in fact solving, continuing to solve many problems. And, and, and so, you know, it's understanding how people actually get things done in the face of resistance, including things that I've tried to get done.

• 55:25Speaker 01

  There's many failures I talk about along the way as well, but that's the next book.

• 55:30Dan Harris?

  That's fascinating. Will you come back on when the book comes out?

• 55:32Speaker 01

  Yes.

• 55:33Dan Harris?

  I'm going to hold you to that.

• 55:34Speaker 01

  It's not till, probably till the end of next year, but I do have the first draft done.

• 55:38Dan Harris?

  Great, congratulations. I, I'll give you one from my side. It's a TV show that I just started watching with my wife called Furious. It's on Hulu. It's written, it's incredibly well done. All of the performances are just incredibly powerful, but the, the writing and the, the subject matter are very powerful. It's really about female rage. It's about female rage. It's about a female serial killer and the female cop who chases her down. And in that, when I first heard the conceit, I was like, I don't know. But actually, it's extremely well done.

• 56:20Dan Harris?

  Not, again, not only just on the level of the performances, but on the issues it, it explores. Elizabeth Meriwether is the woman who created and wrote it. She wrote, she also wrote and created a show called The Dropout, which was about, what's the name of that woman who had that bullshit blood testing company?

• 56:44Speaker 01

  Oh, Elizabeth Holmes?

• 56:45Dan Harris?

  Yes, yes. So she, she did that when that won like all the awards a couple of years ago. Now she's back with Furious. And I, I'm annoying my wife because as we watch it, I just keep saying, this is so good. This is so good.

• 56:58Speaker 01

  That's amazing. Well, that's a great recommendation. I always end up watching these, you know, mainly cop shows, especially British cop shows. I'm watching this Irish, well, Northern Irish cop show called Blue Knights now, which is...

• 57:15Dan Harris?

  Blue Knights or Blue Lights?

• 57:17Speaker 01

  Blue Lights, you're right. Blue Lights.

• 57:19Dan Harris?

  I've been meaning to check that out.

• 57:20Speaker 01

  It's harrowing, but it is, I'm, I'm completely absorbed.

• 57:25Dan Harris?

  I might use that on a future What's Good segment after watching it. Such a pleasure to finally meet you again. I've heard about you decades ago and have read you in The New Yorker. And it's great to meet you and I really appreciate your time.

• 57:39Speaker 01

  Thanks for having me on. Look forward to it again.

• 57:42Dan Harris?

  One last thing before I let you go. If you want to listen to this show without ads, check out 10% Happier Plus, which is a subscription that is available right inside Apple Podcasts. If you become a subscriber, you'll get every episode ad-free. That's new episodes and all the episodes from our vast 10-year-plus archive. Look for 10% Happier Plus in Apple Podcasts and just hit subscribe. And a quick heads up, if you're already a subscriber to my app, 10% with Dan Harris, you've already got access to ad-free podcasts. Ad-free listening is baked right into your app subscription along with everything else, so please don't pay twice. You can check out the app at danharris.com and you can check out 10% Happier Plus inside Apple Podcasts.

• 58:26Dan Harris?

  Thank you very much for listening to the show. I deeply appreciate it. See you soon. Deuces. Thank you so much to everybody who worked so hard to make this show. 10% Happier is produced by Tara Anderson, Marissa Schneiderman, DJ Cashmere, David Hart, and Hayden Broome. Our recording and engineering is handled by the great folks over at Pod People. And Nick Thorburn of the indie rock band Islands wrote our theme. Thanks for listening. Peace.