Outsiders tend to be the first to recognize the inadequacies of our social institutions. But, precisely because they are outsiders, they are usually in a poor position to fix them.

Life is choices, and they are relentless. No sooner have you made one choice than another is upon you.

As economists have often pointed out, we pay doctors for quantity, not quality. As they point out less often, we also pay them as individuals, rather than as members of a team working together for their patients. Both practices have made for serious problems.

Are doctors who make mistakes villains? No, because then we all are.

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

I talked to over two hundred patients and family members about their experiences with aging, serious illnesses, and the big unfixables. But I also spoke with scores of physicians, and especially geriatricians, palliative care doctors, hospice nurses, and nursing home workers. The biggest thing I found was that when these clinicians were at their best, they were recognizing that people had priorities besides merely living longer. The most important and reliable way that we can understand what people's priorities are, besides just living longer, is to simply ask. And we don't ask.

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