One American in seven has no coverage, and one in three younger than sixty-five will lose coverage at some point in the next two years. These are people who aren't poor or old enough to qualify for government programs but whose jobs aren't good enough to provide benefits either.

I am in a profession that has succeeded because of its ability to fix. If your problem is fixable, we know just what to do. But if it’s not? The fact that we have had no adequate answers to this question is troubling and has caused callousness, inhumanity, and extraordinary suffering.

People underestimate the importance of dilligence as a virtue. No doubt it has something to do with how supremely mundane it seems. It is defined as "the constant and earnest effort to accomplish what is undertaken."... Understood, however, as the prerequisite of great accomplishment, diligence stands as one of the most difficult challenges facing any group of people who take on tasks of risk and consequence. It sets a high, seemingly impossible, expectation for performance and human behavior.

Death, of course, is not a failure. Death is normal. Death may be the enemy, but it is also the natural order of things.

The pressure remains all in one direction, toward doing more, because the only mistake clinicians seem to fear is doing too little. Most have no appreciation that equally terrible mistakes are possible in the other direction—that doing too much could be no less devastating to a person's life.

Dressing somebody is easier than letting them dress themselves. It takes less time. It's less aggravation." So unless supporting people's capabilities is made a priority, the staff ends up dressing people like they're rag dolls. Gradually, that's how everything begins to go. The tasks come to matter more than the people.

Steps to become a positive deviant:1. Ask unscripted questions2. Don't complain3. Count something that interests you4. Write something... Anything5. Change yourself. Change something

Endings matter, not just for the person but, perhaps even more, for the ones left behind.

Our responsibility, in medicine, is to deal with human beings as they are. People die only once. They have no experience to draw on. They need doctors and nurses who are willing to have the hard discussions and say what they have seen, who will help people prepare for what is to come--and escape a warehoused oblivion that few really want.