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

Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need.

What about regular professionals, who just want to do what they do as well as they can?

We've created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets - and have only the rudiments of a system to prepare patients for the near certainty that those tickets will not win. Hope is not a plan, but hope is our plan.

At times, in medicine, you feel you are inside a colossal and impossibly complex machine whose gears will turn for you only according to their own arbitrary rhythm. The notion that human caring, the effort to do better for people, might make a difference can seem hopelessly naive. But it isn't.

We yearn for frictionless, technological solutions. But people talking to people is still the way norms and standards change.

You may not control life's circumstances, but getting to be the author of your life means getting to control what you do with them.