We have medicalized aging, and that experiment is failing us.

This is the reality of intensive care: at any point, we are as apt to harm as we are to heal.

Arriving at an acceptance of one's mortality is a process, not an epiphany.

My own son has a congenital heart condition, where his life was saved by a cardiac surgeon stepping in at 11 days of life to save his life. But he is now 21 years old because of constant monitoring and working with him with a primary care physician. that's the only reason now that he's getting to live a long and healthy life. That's what we're not rewarding. They don't have the kind of resources and commitment that we are giving to people like me. I have millions of dollars of equipment available to me when I go to work every day in an operating room.

Culture matters. Of course, if physicians are rewarded or penalized for their service and results, the culture will change. But the key values we doctors are being pressed to embrace are humility, teamwork, and discipline.

What is needed, however, isn't just that people working together be nice to each other. It is discipline. Discipline is hard--harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can't even keep from snacking between meals. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.

When [disease] can't be stopped, that's where we become lost.