We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.

People who reach certain levels of frailty, more important than getting their mammogram, more important than getting their blood pressure tweaked, they're at high risk of falling. If they fall and break their hip, they not only die sooner, they die miserably.

I learned about a lot of things in medical school, but mortality wasn't one of them.

There are times when you have sharp elbows, and people are trying to muscle you out of certain meetings - because then people could leak to the press that you had a role in certain decisions. I, at twenty-six, was very impatient and didn't know how to keep my powder dry. I was running a team of seventy-five people when I had never been a boss. I was the worst boss ever.

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

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.

I chose surgery because I thought that perhaps this would make me more like the kind of person I wanted to be.