The Fallacy of 'Giving Up'

At 30 years old, a person's brain weighs about three pounds. In its capaciousness it wears the skull like a well-tailored suit. So notes Harvard professor and surgeon Atul Gawande in his most recent book Being Mortal—only to contrast that with the fact that by age 70, there is usually about an inch of space between the brain and the skull. And that's not because the skull is expanding. From just a glance at a CT scan of a person's brain, a radiologist could venture a pretty good approximation of the person's age.

That's not to say that loss of brain volume means that most people don't retain enough grey matter to remain brilliant in old age. (Over the last 20,000 years, the average human brain has gotten smaller by about the size of a tennis ball, which doesn't mean we've gotten dumber.) Instead it's—like the recession of gums from teeth and the exhaustion of the stem cells that give hair its pigment—a vivid example of the normal aging of the human body.

Together these changes illustrate, Gawande writes, that the end process is often really not the body wearing down so much as gradually shutting down. It's a process that doctors are trained to resist and "fight," leading a patient into "battle" with disease. Though, the analogy falls apart in that a battle with death can't that old age is less a battle than a massacre. And, as Gawande notes, a good general is not one who leads an army to the point of total annihilation.