...a disgruntled reflection on my own life as a sort of desperate improvisation in which I was constantly trying to make something coherent from conflicting elements to fit rapidly changing settings.

Rarely is it possible to study all of the instructions to a game before beginning to play, or to memorize the manual before turning on the computer. The excitement of improvisation lies not only in the risk of being involved but in the new ideas, as heady as the adrenaline of performance, that seems to come from nowhere.

There are few things as toxic as a bad metaphor. You can't think without metaphors.

The timing of death, like the ending of a story, gives a changed meaning to what preceded it.

Solutions to problems often depend upon how they're defined.

The critical question about regret is whether experience led to growth and new learning. Some people seem to keep on making the same mistakes, while others at least make new ones. Regret and remorse can be either paralyzing or inspiring. [p. 199]

A suprising number of physicians manage to continue to care about persons even after the rigors of medical training.