Last week, I left you hanging halfway through Atul Gawande's new book, Being Mortal.  I was at that time hoping for a happy ending.  Well, no.  Not quite.  But sorta, in its own way.

The happy ending I was looking for may not exist. I would like a version in which we move through the aging process healthy, happy, fulfilled, and pain-free, passing across the great divide with a peaceful smile.  No, this book does not end that way.  Yes, the author shares some ideas that help, but they don't solve the dilemma.  Most of us will deal with pain, boredom, loneliness and helplessness as we age.  So, if it is not a really happy story, how does it end?

I walked away from this excellent read with two memorable messages:  1) Strive for the best possible day, today; and 2) have "the conversation" sooner than later. Then do it again.

Each day is a gift at 90, 80, 70 (or, in truth, at 40, 30, 20).  How would I approach this day if I knew it were my last?  What would I offer my loved ones now if I knew it were theirs?  Indulging simple pleasures, like my friend's mother who wanted a burger, a beer, and a cigarette for her 94^th.  Releasing resentments.  Choosing peace.  Appreciating beauty.  Laughing.  Another friend talks about helping her mom enjoy each day, knowing she won't remember it tomorrow.

Having "the conversation" is daunting.  Dr. Gawande describes the difficulty in his own family, even though his mother, father, and he were all doctors.  How do you understand your condition?  What are the treatment options and how much can they help? What quality-of-life tradeoffs are worth the shot at a few more weeks or months?  Doctors want to make things better.  They are reluctant to admit defeat and inclined to hold out hope, even when odds are long and costs high.

"The conversation" asks, what is most important to you if time is short?  Does the ability to communicate outweigh the value of a feeding tube? Does freedom from pain justify an addictive drug?  Is "comfort care" better than one more round of chemo?  "The conversation" introduces an element of choice when life spins out of control.  It provides the individual with information and honors the emotional impact of their circumstances. It listens, seeks to understand, and accepts.

Our system of caring for elderly, ailing, and dying humans is flawed.  Assisted living and nursing homes have room to improve.  Families could always do better.  Even more important, however, are the changes that lie within our grasp even when grappling with imperfect institutions.  Each of us can commit to having-and helping others to have-the best possible day today.  And each of us can strive for open conversation about what is happening, how it feels, the options, the implications, and the priorities to consider when decisions are made.