As recently as 1945, most deaths occurred in the home. By the 1980s, just 17 percent did. Those who somehow did die at home likely died too suddenly to make it to the hospital -- say, from a massive heart attack, stroke, or violent injury -- or were too isolated to get somewhere that could provide help. Across not just the United States but also the entire industrialized world, the experience of advanced aging and death has shifted to hospitals and nursing homes.
For most of our hundred-thousand-year existence -- all but the past couple of hundred years -- the average life span of human beings has been thirty years or less. (Research suggests that subjects of the Roman Empire had an average life expectancy of twenty-eight years.)
The risk of a fatal car crash with a driver who's eighty-five or older is more than three times higher than it is with a teenage driver.
In 1954 lawmakers provided funding to enable them to build separate custodial units for patients needing an extended period of "recovery." That was the beginning of the modern nursing home. They were never created to help people facing dependency in old age. They were created to clear out hospital beds -- which is why they were called "nursing" homes.
This is the consequence of a society that faces the final phase of the human life cycle by trying not to think about it. We end up with institutions that address any number of societal goals -- from freeing up hospital beds to taking burdens off families' hands to coping with poverty among the elderly -- but never the goal that matters to the people who reside in them: how to make life worth living when we're weak and frail and can't fend for ourselves anymore.
Your chances of avoiding the nursing home are directly related to the number of children you have, and, according to what little research has been done, having at least one daughter seems to be crucial to the amount of help you will receive.
Their attitude seemed to result from incomprehension rather than cruelty, but, as Tolstoy would have said, what's the difference in the end?
So this is the way it unfolds. In the absence of what people like my grandfather could count on -- a vast extended family constantly on hand to let him make his own choices -- our elderly are left with a controlled and supervised institutional existence, a medically designed answer to unfixable problems, a life designed to be safe but empty of anything they care about.
The inhabitants of Chase Memorial Nursing Home now included one hundred parakeets, four dogs, two cats, plus a colony of rabbits and a flock of laying hens. There were also hundreds of indoor plants and a thriving vegetable and flower garden. The home had on-site child care for the staff and a new after-school program. Researchers studied the effects of this program over two years, comparing a variety of measures for Chase's residents with those of residents at another nursing home nearby. Their study found that the number of prescriptions required per resident fell to half that of the control nursing home. Psychotropic drugs for agitation, like Haldol, decreased in particular. The total drug costs fell to just 38 percent of the comparison facility. Deaths fell 15 percent.
In 1908, a Harvard philosopher named Josiah Royce wrote a book with the title The Philosophy of Loyalty. Royce was not concerned with the trials of aging. But he was concerned with a puzzle that is fundamental to anyone contemplating his or her mortality. Royce wanted to understand why simply existing -- why being housed and fed and safe and alive -- seems empty and meaningless to us. What more is it that we need in order to feel that life is worthwhile? The answer, he believed, is that we all seek a cause beyond ourselves. This was, to him, an intrinsic human need. The cause could be large (family, country, principle) or small (a building project, the care of a pet). The important thing was that, in ascribing value to the cause and seeing it as worth making sacrifices for, we give our lives meaning...Royce called this dedication to a cause beyond oneself loyalty. He regarded it as the opposite of individualism. The individualist puts self-interest first, seeing his own pain, pleasure, and existence as his greatest concern. For an individualist, loyalty to causes that have nothing to do with self-interest is strange. When such loyalty encourages self-sacrifice, it can even be alarming -- a mistaken and irrational tendency that leaves people open to the exploitation of tyrants.
The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society.
As our time winds down, we all seek comfort in simple pleasures -- companionship, everyday routines, the taste of good food, the warmth of sunlight in our faces. We become less interested in the rewards of achieving and accumulating, and more interested in the rewards of simply being.
Those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives -- and they lived 25 percent longer. In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality.
The brain gives us two ways to evaluate experiences like suffering -- there is how we apprehend such experiences in the moment and how we look at them afterward -- and the two ways are deeply contradictory.
Everyone knows the experience of watching sports when a team, having performed beautifully for nearly the entire game, blows it in the end. We feel that the ending ruins the whole experience. Yet there's a contradiction at the root of that judgment. The experiencing self had whole hours of pleasure and just a moment of displeasure, but the remembering self sees no pleasure at all...Why would a football fan let a few flubbed minutes at the end of the game ruin three hours of bliss? Because a football game is a story. And in stories, endings matter.
No one ever really has control. Physics and biology and accident ultimately have their way in our lives. But the point is that we are not helpless either. Courage is the strength to recognize both realities. We have room to act, to shape our stories, though as time goes on it is within narrower and narrower confines.
Assisted living is far harder than assisted death, but its possibilities are far greater, as well.
The core principles it takes to achieve excellence in Special Operations are the same fundamental principles it takes to accomplish great things in business. Or for that matter in life.
Front sight focus is that state of intense concentration in which all your resources and abilities are brought to bear on a singular intention.
If you can't pour yourself 100 percent into an idea when you start it, then you're starting it half-assed, and you'll never have more than a half-baked plan. When you have a half-baked plan, you can't expect any more than a half-baked outcome.
This is job #1: Stay on task. Stay on target. Stay focused.
My parents used to say, if you're going to do something, make the effort to do it right the first time.
Based on the performance practices of Olympic athletes and world-class shooters, the program focused on developing the two traits common to every one of these top performers: complete and total confidence ("I will win no matter what"), combined with rigorous, consistent, meticulous mental rehearsal ("and this is exactly what it will look like and feel like").
We trained our instructors to teach and reinforce with positive language rather than negative, reminding students what to do and how to do it right rather than cautioning what not to do and castigating them for what they did wrong. And we trained our students in how to talk to themselves.
Outstanding success starts in your mind, and so does failure.
With every meeting, every email, every phone call, I have a question going in the back of my mind: "Is there purpose to this conversation? Do I want to build a relationship with this person of this company? Is there purpose behind this meeting that aligns with my life and business strategy?" If the answer is no, then I pass, every time.
Whatever attitudes, assumptions, beliefs, and opinions you have about money, you need to drop them. Lose them. Right here, right now.
I can always make more money. I can't make more time.
People who don't have money suffer for it. They eat cheap processed food and get heart disease and cancer at higher rates. They don't take care of themselves, because they can't afford to. They have more stress in their lives because they're so freaking stretched. They can't afford the best, and it hurts. It's just the facticity of life.
All that crap about rich people being egocentric, or corrupt, or uncaring, is complete and total nonsense, concocted to help people who don't have money feel more virtuous and better about their lives.
The only way you can successfully and consistently focus on your business is if you maintain your health, your family, your relationships, and all the rest of what makes you a human being in a healthy state of balance.
It's a matter of balance, and balance is a matter of doing one thing at a time -- and being very, very clear on exactly what that one thing is.
Next time you're out walking around in public, ask yourself, if someone suddenly mounted an armed attack, where would it most likely come from? What would be your best escape route? Now ask those same questions about your business.
The more you sweat in training the less you bleed in battle.
Just enough is never enough, not even close to enough.
Conventional wisdom is not always wrong -- but it's always suspect.
You can't manage what you don't understand.
We don't accept industry norms. (Remember: norm = average = mediocre.)
There's a phrase from psychology that people sometimes use in business: "a bias for action." That describes perfectly the SEAL mentality. Given the choice to do something or sit there, we'll always favor taking action.
My time in the SEAL teams expanded my view of what is possible. In the teams, you quickly realize that most people have preset limits on what they believe is normal and possible and that most are capable of at least three to four times the output they think they are.
If I look through your bedroom and poke around your kitchen, I don't need to see your financials, because I already have a pretty good idea of what kind of shape your business is in. The Buddhists have an expression, "How you do anything is how you do everything." How you manage the smallest mundane details of your life will add up to your success -- or failure -- on the largest scale.
Money, or lack of money, is never the problem. It's what people use as an excuse to avoid facing the real problem, which is unwillingness to take action.
People often think of Spec Ops guys as people with a ton of attitude. You know: swagger, overconfidence. But that's the movies, not the reality. In the real world of combat, swagger gets you killed, and probably a bunch of your buddies with you. In business, you may not get physically blown up, but you will get fiscally blown up.
You want to plan for as many contingency outcomes as you can think of so you'll know what to do when it all goes sideways. Because if you have to stop and think about it when it happens, you're screwed.
Often failure, crises, and setbacks are the only way you gain that invaluable insight you need to anticipate future problems and design the right contingencies. Which is another reason an imperfect plan executed now is so vastly superior to a perfect plan executes sometime in the vague future.
Whatever it is that you do, you are making a stand, either for excellence or for mediocrity.
Excellence lies at the heart of greatness.
Excellence, more that anything else, is a decision, a choice, a commitment. A state of mind.
Strong leaders never ask their teams to do anything they aren't willing to do themselves. The corollary is also true, as a strong leader, you need to hold your team to the same standard of excellence you hold yourself.
Under pressure, you don't rise to the occasion; you sink to the level of your training. That's why we train so hard.
Change has to start in you before you can expect it in others. And then, expect it in them.
Excellence matters in everything you do, not only in fitness, but in everything. The food you eat, the clothes you wear, the music you listen to. The shows and films you watch. The words and sentences you speak. The quality of your relationships. You should be a connoisseur of greatness.
Successful people don't waste their time trying to tear down others -- but they are often the targets of others who do.
A genuine commitment to excellence is impossible without a deep appreciation of pain and failure.
The day you stop getting criticism is the day you should start to worry. When people don't tell you what you're doing wrong, it means they've given up on you.
Take it all one piece at a time. If you look at everything coming at you all at once, it can seem overwhelming. But if you break it down into small pieces and take it a piece at a time, it eventually gets manageable.
Esprit de corps and a solid team ethos are too precious to let anything threaten them. A team with average ability but great chemistry will win out over a team with extreme talent but lousy chemistry. Character counts more than talent, and attitude counts more than skill.
The best place to be, when you're part of an organization, is to be irreplaceable.
I've had more than a few people, some of whom I placed a lot of trust in, try to get back into my inner circle after a break in loyalty, and I've compassionately turned each of them away. Hold true to your own core values and make no exceptions. People will respect you more for it.
You have to earn your title every day.
It's such a simple thing: talk to your people, share the plan with them so they know where you're all heading and the purpose behind what you're doing. Engage your crew; have a dialogue; let them know that you know they exist and that they're part of what you're all doing together. Don't leave your people in a vacuum.
[Peter] Drucker said an effective mission statement should be short and so clearly focused that it would fit easily on a t-shirt.
If you don't have a crystal clear and compelling mission, and communicate it clearly and effectively to everyone on your team, you're going to be like a batter at the plate swinging with his eyes closed. Sure, you might hit one of the balls pitched your way, but the odds aren't good.
The moment you start trying to be a hero, you're not a warrior anymore.
This is what happens when you're an entrepreneur. One day you're wiping down the counters at a diner, and the next you're opening a chain of restaurants up and down the coast. It's a natural progression: total focus --> excellence --> leadership.
It is not some special talent or skill, some inborn ability or exceptional capacity that makes you a leader. It certainly isn't an expensive education, high station, or family name that makes you a leader. It isn't even necessarily past accomplishments. What makes you a leader, more than anything else, is that you dare to plant your flag in the ground and do something nobody has done or is willing to do. A leader goes first. A leader charts the uncharted.
What does you vision or ideal scenario look like? If there's one thing I've learned about targets, it's that you're never going to hit yours if you don't what what -- or where -- it is.
There will be three themes that you'll see recur throughout this book: avoid debt like the plague, live below your means, and embrace the thrifty lifestyle.
After spending freely, eventually you'll have to pay back what you've borrowed. This will have to be done with money that could better be spent on today's needs rather than yesterday's desires.
Grapes and bananas usually last a week. Once they're gone we move on to other fruits. Pears, lettuce, cucumbers, and peppers can last two weeks. Apples, cabbage, radishes, oranges, and celery can last a month.
In our lives, we view the lack of money as a sign that the answer is No, or at least not right now.
The average car requires $1000-$1500 per year for maintenance.
We recommend that your house payment, insurance, taxes, maintenance, and utilities exceed no more than 40% of your monthly net spendable income -- less is always better.
In a letter that public relations expert Robert L. Dilenschneider sent out to his clients, he encouraged them to have a more accepting and understanding view of people with different perspectives. His numbers illustrate that we continue to have an abundance of the world's resources at our beck and call. If we could shrink the whole earth's population to a village of precisely 100 people, with all the existing human ratios remaining the same, it would look like this: 59% of the wealth would be in the hands of only 6 people and all 6 would be citizens of the United States. 80 would live in substandard housing. 70 would be unable to read. 50 would suffer from malnutrition. 1 would be near death. 1 would be near birth. 1 would have a college education. 1 would own a computer.
Contentment is important and that knowing when enough is enough not only is going to allow us to enjoy our lives but most likely will allow us to share our excess with others in need.
Learning to live with less brings more to relationships.
You have at your disposal one of the most powerful tools available to mankind: the power of choice. You can choose to be defeated and give up, or you can choose to become a victor.
