Chapters 3 and 4 “Old age is not a battle. Old age is a massacre,” says Philip Roth in Everyman. True or not? Do we fear age and dying more than we fear death? Why? Why not? Gawande asks, p. 68, “How did we wind up in a world where the only choices for the very old seem to be either going down with the volcano or yielding all control over our lives?” Since he wrote that question, what, if anything, has changed? Do we have more choices now? What allows us choice? On nursing homes, p. 71, “describing the history of nursing homes from the perspective of the elderly ‘is like describing the opening of the American West from the perspective of the mules; they were certainly there, and the epochal events were certainly critical to the mules, but hardly anyone was paying very much attention to them at the time.’” Is this comparison true in our own experience? Why or why not? Why is a mule a particularly apt and unpleasant comparison? Does anyone here want to be another mule? What can we do? Why must nursing homes remove all control from the individual? Note the comparison between nursing homes and prisons at top of p. 74. Too extreme? How do we make life worth living in nursing homes? See bottom of p. 85, part of the story of Lou and daughter Shelley. How far are we already into this “overwhelming combination of the technological and the custodial”? Are there any other options? Such as? How can we differentiate nursing-home life and assisted-living life and independent life—still maintaining some desired quality of life? When and why does “safety” become less essential than something else, something more important to make “life worth living”? How do we help younger persons and medical personnel understand our shift in values? See middle of p. 97: “how we seek to spend our time may depend on how much time we perceive ourselves to have.” How have we already begun that shift? When did we become aware of it? What matters most now? See middle of p. 99, Gawande’s assessment of Ivan Ilyich and the changes in what Ivan values. What does Gawande mean—here quoting a story from Wilson—on p. 106, middle: “’We want autonomy for ourselves and safety for those we love.’ That remains the main problem and paradox for the frail. ‘Many of the things that we want for those we care about are things that we would adamantly oppose for ourselves because they would infringe upon our sense of self’”? What things? Why? Reread the last paragraph of the chapter, pp. 108-109. The Death of Ivan Ilyich How does the opening, with its third-person narrative, told mainly through the consciousness of Peter Ivanovich, prepare us to appreciate Ivan Ilyich’s life and death? What is the relationship between Peter Ivanovich and Ivan Ilyich? How does Tolstoy keep us at a distance from Ivan Ilyich during this introduction? During the wake and funeral, what are the main concerns of Peter Ivanovich? Of Schwartz? Of Praskovya Fedorovna? What is important about the pink-cretonne pouffe? In the introduction, what specifics do we learn about Ivan Ilyich’s career, family, and household? Early in his life, what does Ivan Ilyich value? Desire? Achieve? How do we know Ivan Ilyich is fastidious? And why should we know that? Why does he marry? Why does he marry this particular woman? Why does he move to St. Petersburg? When Tolstoy describes Ivan Ilyich’s care in decorating the new house, what does he reveal to us about Ivan Ilyich? How does Tolstoy gradually move us toward Ivan Ilyich? How closely do we enter Ivan Ilyich’s consciousness? Why does Tolstoy use this device of changing points of view? How effectively? What causes Ivan Ilyich’s pain, so far as we ever know? What causes his death? What do the doctors tell Ivan Ilyich about his illness? Why does he despise them? Why does Ivan Ilyich come to despise his wife, friends, colleagues, daughter? How does his son, Ilya, differ from the other family members? How and why does Gerasim look after Ivan Ilyich? Before he can get into and through the black sack—what is the black sack, by the way?—what must Ivan Ilyich do? How does Ivan Ilyich re-enact the basic Christian story? What symbols, comments, situations best illustrate that story? What do we learn from Ivan Ilyich about living? about dying? about compassion? about “ultimate concerns”?