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.

Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.

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

I said there are at least two kinds of satisfaction, however, and the other has nothing to do with skill. It comes from human connection. It comes from making others happy, understanding them, loving them.

If we took away the ability to put defibrillators in people in their last years, people would be shouting in the streets.

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.

This was not guilt: guilt is what you feel when you have done something wrong. What I felt was shame: I was what was wrong.