Patient Care Quotes

The art of medicine consists of amusing the patient while nature cures the disease.

Owls are wise. They are careful and patient. Wisdom precludes boldness. That is why owls make poor heroes.

The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease. ~

Do not do what someone else could do as well as you. Do not say, do not write what someone else could say, could write as well as you. Care for nothing in yourself but what you feel exists nowhere else. And, out of yourself create, impatiently or patiently, the most irreplaceable of beings.

Take care of him, Soteria. And remember it takes great courage and heart for a man who knows no kindness to show it to another. Even the wildest of beasts can be tamed by a patient and gentle hand. (Takeshi)

I know I messed up but I’m here for real now. We’re going to do this and I promise I’ll take care of you as best I can. You’re going to have to be patient with me because I’m flying blind.

Be patient. Your skin took a while to deteriorate. Give it some time to reflect a calmer inner state. As one of my friends states on his Facebook profile: "The true Losers in Life, are not those who Try and Fail, but those who Fail to Try.

Dr. Fortunato," Kristine shot back at Laurie, her resentment undisguised. "You don't know how we do things in Wright. Dr. Parrish doesn't care about hospital hierarchy. He's very accessible and he'd never let his ego get in the way of patient care. Maybe you do things differently where you work-

Ladies and gentlemen of the class of '97: Wear sunscreen. If I could offer you only one tip for the future, sunscreen would be it. The long-term benefits of sunscreen have been proved by scientists, whereas the rest of my advice has no basis more reliable than my own meandering experience. I will dispense this advice now. Enjoy the power and beauty of your youth. Oh, never mind. You will not understand the power and beauty of your youth until they've faded. But trust me, in 20 years, you'll look back at photos of yourself and recall in a way you can't grasp now how much possibility lay before you and how fabulous you really looked. You are not as fat as you imagine. Don't worry about the future. Or worry, but know that worrying is as effective as trying to solve an algebra equation by chewing bubble gum. The real troubles in your life are apt to be things that never crossed your worried mind, the kind that blindside you at 4 pm on some idle Tuesday. Do one thing everyday that scares you. Sing. Don't be reckless with other people's hearts. Don't put up with people who are reckless with yours. Floss. Don't waste your time on jealousy. Sometimes you're ahead, sometimes you're behind. The race is long and, in the end, it's only with yourself. Remember compliments you receive. Forget the insults. If you succeed in doing this, tell me how. Keep your old love letters. Throw away your old bank statements. Stretch. Don't feel guilty if you don't know what you want to do with your life. The most interesting people I know didn't know at 22 what they wanted to do with their lives. Some of the most interesting 40-year-olds I know still don't. Get plenty of calcium. Be kind to your knees. You'll miss them when they're gone. Maybe you'll marry, maybe you won't. Maybe you'll have children, maybe you won't. Maybe you'll divorce at 40, maybe you'll dance the funky chicken on your 75th wedding anniversary. Whatever you do, don't congratulate yourself too much, or berate yourself either. Your choices are half chance. So are everybody else's. Enjoy your body. Use it every way you can. Don't be afraid of it or of what other people think of it. It's the greatest instrument you'll ever own. Dance, even if you have nowhere to do it but your living room. Read the directions, even if you don't follow them. Do not read beauty magazines. They will only make you feel ugly. Get to know your parents. You never know when they'll be gone for good. Be nice to your siblings. They're your best link to your past and the people most likely to stick with you in the future. Understand that friends come and go, but with a precious few you should hold on. Work hard to bridge the gaps in geography and lifestyle, because the older you get, the more you need the people who knew you when you were young. Live in New York City once, but leave before it makes you hard. Live in Northern California once, but leave before it makes you soft. Travel. Accept certain inalienable truths: Prices will rise. Politicians will philander. You, too, will get old. And when you do, you'll fantasize that when you were young, prices were reasonable, politicians were noble, and children respected their elders. Respect your elders. Don't expect anyone else to support you. Maybe you have a trust fund. Maybe you'll have a wealthy spouse. But you never know when either one might run out. Don't mess too much with your hair or by the time you're 40 it will look 85. Be careful whose advice you buy, but be patient with those who supply it. Advice is a form of nostalgia. Dispensing it is a way of fishing the past from the disposal, wiping it off, painting over the ugly parts and recycling it for more than it's worth. But trust me on the sunscreen.

If I did not simply live from one moment to another, it would be impossible for me to be patient, but I only look at the present, I forget the past, and I take good care not to forestall the future.

And I can imagine Farmer saying he doesn't care if no one else is willing to follow their example. He's still going to make these hikes, he'd insist, because if you say that seven hours is too long to walk for two families of patients, you're saying that their lives matter less than some others', and the idea that some lives matter less is the root of all that's wrong with the world.

If the modern world were a patient in my care... I would diagnose it suicidal." - Dr. Sofia Lamb

Why are you so patient with me?” I whisper. “Because every part of me wants to take care of you.

The doctor of the future will give no medicine, but will interest his (sic)patient in the care of the human frame, in diet and in the cause and prevention of disease

Freddie once told me that I was the worst kind of stubborn-because I wasn't stubborn at all. I was patient. Patient, but determined. A stubborn person could be distracted, or tricked. But not me. I just held on and on and on, never giving up until I got my way, long after everyone else stopped caring.

Bingo pup. It's a lesson best learned early. They're all afraid of us." He strolled over to Derek. "You're trying to be a good kid, aren't you? You think that'll show them they're wrong. So how'd that working out for you? Guess what? They don't care. To them, you're a monster, and nothing you do--or don't do--will change their minds. My advice? Give 'em what they want. It's a short, brutal life." He smiled. "Live it up." Derek stared straight ahead, patiently waiting. "He can't hear a word I'm saying, can he?" Liam said. "Nope.

You're going to make it; You're going to be at peace; You're going to create, and love, and laugh, and live; You're going to do great things.

I often feel caught in a dilemma: on the one hand I wish to be more natural with you and yet, on the other hand, because I feel that you’re easily wounded and that you give my comments inordinate power, I feel I must consider my wording very, very carefully.

I’ve stopped being sorry for all my soft. I won’t apologise because I miss you, or because I said it, or because I text you first, or again. I think everyone spends too much time trying to close themselves off. I don’t want to be cool or indifferent, I want to be honest. If I love you at 5AM, I’d damn well rather that you know I felt it. If I love you two hours later, I’ll tell you then too. Listen, I won’t wait double the time it takes for you to text me back because I don’t want to. I don’t care enough to be patient with you. I’m happy, you made me feel that way, don’t you want to know? So that’s how it’s going to be. I’m going to leave myself as open as a church door. And I’m going to wake you up before the crack of dawn to tell you that I’m fucking joyful, no pretending, not from me, not ever. Would you like some coffee, would you please kiss me? Here, these are my hands, this is my mouth, it is all yours.

I know what the problem is, of course. The disorientation, the distraction, the difficulty focusing - all classic Phase One signs of deliria. But I don't care. If pneumonia felt this good I'd stand out in the snow in the winter with bare feet and no coat, or march into the hospital and kiss pneumonia patients

Be careful whose advice you buy, but be patient with those who supply it. Advice is a form of nostalgia.

Health is a human necessity; health is a human right

In a properly organized society like ours, nobody has any opportunities for being noble or heroic. Conditions have got to be thoroughly unstable before the occasion can arise. When there are wars, where there are divided allegiances, where there are temptations to be resisted, objects of love to be fought for or defended - there, obviously, nobility and heroism have some sense. But there aren't any wars nowadays. The greatest care is taken to prevent you from loving anyone too much. There's no such thing as a divided allegiance; you're so conditioned that you can't help doing what you ought to do. And what you ought to do is on the whole so pleasant, so many of the natural impulses are allowed free play, that there really aren't any temptations to resist. And if ever, by some unlucky chance, anything unpleasant should somehow happen, why, there's always soma to give you a holiday from the facts. And there's always soma to calm your anger, to reconcile you to your enemies, to make you patient and long-suffering. In the past you could only accomplish these things by making a great effort and after years of hard moral training. now, you swallow two or three half-gramme tablets, and there you are. Anybody can be virtuous now. You can carry at least half your mortality about in a bottle. Christianity without tears - that's what soma is.

I am someone who is completely unique in this world, someone I need to take care of for the rest of my life, and therefore someone I need to help take each step forwards, warmly and patiently, to allow to rest on some days and to encourage on others - I believe that the more I look into this strange being, myself, the more routes I will find to happiness.

In order to master compassion, you have to spend time getting to know monsters. When you can do that you will see that there are no monsters, only people that acted like monsters because no one gave them the time or compassion to hear their story.

The hospital will never be healthy for patients if it's not a healthy environment for nurses, where their voices are heard and where they can care for their patients and use the full extent of their knowledge, abilities, and skills. After all, hospitals today have become one big intensive care unit: all patients need intensive caring.

There are more than 9,000 billing codes for individual procedures and units of care. But there is not a single billing code for patient adherence or improvement, or for helping patients stay well.

Suddenly he was in the doorway, looming over her in a determined fashion. Gone was sweet, patient Griffin. This was the Duke of Greythorne, one of the most powerful men in England. “I don’t care that you came to Dandy,” he said, his voice low, but sharp. “If you want to blame yourself for Sam’s injury, then go ahead and be a fool. And I don’t care that you could cosh my head in if you wanted. I came here to get you and if I have to, I’ll toss you over my shoulder like a sack of potatoes and carry you all the way to Mayfair. I’m taking you home where you belong.

Cultivate your craft. Water it daily, pour some tender loving care into it, and watch it grow. Remember that a plant doesn’t sprout immediately. Be patient, and know that in life you will reap what you sow.

The thing is, you cannot ask people to coexist by having one side bow their heads and rely on a solution that is only good for the other side. What you can do is stop blaming each other and engage in dialogue with one person at a time. Everyone knows that violence begets violence and breeds more hatred. We need to find our way together. I feel I cannot rely on the various spokespersons who claim they act on my behalf. Invariably they have some agenda that doesn't work for me. Instead, I talk to my patients, to my neighbors and colleagues--Jews, Arabs--and I find out they feel as I do: we are more similar than we are different, and we are all fed up with the violence.

Be kind to your body, gentle with your mind and patient with your heart. Stay true to your spirit, cherish your soul and never doubt yourself. You are still becoming, my love, and there is no one more deserving of the nurturing grace of your love.

Of course it's jealousy," said Adrian nonchalantly. "What do you expect? The former love of your life comes back—from the dead, no less. That's not something I'm really excited about. But I don't blame you for feeling confused." "I told you before—" "I know, I know." Adrian didn't sound particularly upset. In fact, there was a surprisingly patient tone in his voice. "I know you said him coming back wouldn't affect things between us. But saying one thing before it happens and then actually having that thing happen are two different things." "What are you getting at?" I asked, kind of confused. "I want you, Rose." He squeezed my hand more tightly. "I've always wanted you. I want to be with you. I'd like to be like other guys and say I want to take care of you too, but...well. When it comes down to it, you'd probably be the one taking care of me." I laughed in spite of myself. "Some days I think you're in more danger from yourself than anyone else. You smell like cigarettes, you know." "Hey, I have never, ever said I was perfect. And you're wrong. You're probably the most dangerous thing in my life.

We're not hunter-gatherers anymore. We're all living like patients in the intensive care unit of a hospital. What keeps us alive isn't bravery, or athleticism, or any of those other skills that were valuable in a caveman society. It's our ability to master complex technological skills. It is our ability to be nerds. We need to breed nerds.

Don’t predict the condition of the entire day by the state of the morning. You don’t judge a book by its cover. A cloudy morning is no guarantee for a rainy day!

Changes in Relationship with others: It is especially hard to trust other people if you have been repeatedly abused, abandoned or betrayed as a child. Mistrust makes it very difficult to make friends, and to be able to distinguish between good and bad intentions in other people. Some parts do not seem to trust anyone, while other parts may be so vulnerable and needy that they do not pay attention to clues that perhaps a person is not trustworthy. Some parts like to be close to others or feel a desperate need to be close and taken care of, while other parts fear being close or actively dislike people. Some parts are afraid of being in relationships while others are afraid of being rejected or criticized. This naturally sets up major internal as well as relational conflicts.

What was she thinking?” muttered Alexander, closing his eyes and imagining his Tania. “She was determined. It was like some kind of a personal crusade with her,” Ina said. “She gave the doctor a liter of blood for you—” “Where did she get it from?” “Herself, of course.” Ina smiled. “Lucky for you, Major, our Nurse Metanova is a universal donor.” Of course she is, thought Alexander, keeping his eyes tightly shut. Ina continued. “The doctor told her she couldn’t give any more, and she said a liter wasn’t enough, and he said, ‘Yes, but you don’t have more to give,’ and she said, ‘I’ll make more,’ and he said, ‘No,’ and she said, ‘Yes,’ and in four hours, she gave him another half-liter of blood.” Alexander lay on his stomach and listened intently while Ina wrapped fresh gauze on his wound. He was barely breathing. “The doctor told her, ‘Tania, you’re wasting your time. Look at his burn. It’s going to get infected.’ There wasn’t enough penicillin to give to you, especially since your blood count was so low.” Alexander heard Ina chuckle in disbelief. “So I’m making my rounds late that night, and who do I find next to your bed? Tatiana. She’s sitting with a syringe in her arm, hooked up to a catheter, and I watch her, and I swear to God, you won’t believe it when I tell you, Major, but I see that the catheter is attached to the entry drip in your IV.” Ina’s eyes bulged. “I watch her draining blood from the radial artery in her arm into your IV. I ran in and said, ‘Are you crazy? Are you out of your mind? You’re siphoning blood from yourself into him?’ She said to me in her calm, I-won’t-stand-for-any-argument voice, ‘Ina, if I don’t, he will die.’ I yelled at her. I said, ‘There are thirty soldiers in the critical wing who need sutures and bandages and their wounds cleaned. Why don’t you take care of them and let God take care of the dead?’ And she said, ‘He’s not dead. He is still alive, and while he is alive, he is mine.’ Can you believe it, Major? But that’s what she said. ‘Oh, for God’s sake,’ I said to her. ‘Fine, die yourself. I don’t care.’ But the next morning I went to complain to Dr. Sayers that she wasn’t following procedure, told him what she had done, and he ran to yell at her.” Ina lowered her voice to a sibilant, incredulous whisper. “We found her unconscious on the floor by your bed. She was in a dead faint, but you had taken a turn for the better. All your vital signs were up. And Tatiana got up from the floor, white as death itself, and said to the doctor coldly, ‘Maybe now you can give him the penicillin he needs?’ I could see the doctor was stunned. But he did. Gave you penicillin and more plasma and extra morphine. Then he operated on you, to get bits of the shell fragment out of you, and saved your kidney. And stitched you. And all that time she never left his side, or yours. He told her your bandages needed to be changed every three hours to help with drainage, to prevent infection. We had only two nurses in the terminal wing, me and her. I had to take care of all the other patients, while all she did was take care of you. For fifteen days and nights she unwrapped you and cleaned you and changed your dressings. Every three hours. She was a ghost by the end. But you made it. That’s when we moved you to critical care. I said to her, ‘Tania, this man ought to marry you for what you did for him,’ and she said, ‘You think so?’ ” Ina tutted again. Paused. “Are you all right, Major? Why are you crying?

What we are fighting isn't godlessness--this is the most godly country on earth. We aren't even fighting disease. Its poverty. Money for food, medicines... that helps. When we cannot cure or save a life, our patients can at least feel cared for. It should be a basic human right.

Back in 1903, Thomas Edison predicted that the “doctor of the future will give no medicine, but will instruct his patient in the care of [the] human frame in diet and in the cause and prevention of diseases.

But after a while, she began to experience the new reality of each person as being as strong and as weak as anyone else. Slowly, she learned that each of us grown-ups has as much and as little power as the other, and that we had best learn to take care of ourselves.(83)

I had tried years earlier to kill myself, and nearly died in the attempt, but did not consider it either a selfish or a not-selfish thing to have done. It was simply the end of what I could bear, the last afternoon of having to imagine waking up the next morning only to start all over again with a thick mind and black imaginings. It was the final outcome of a bad disease, a disease it seemed to me I would never get the better of. No amount of love from or for other people0and there was a lot-could help. No advantage of a caring family and fabulous job was enough to overcome the pain and hopelessness I felt; no passionate or romantic love, however strong, could make a difference. Nothing alive and warm could make its way in through my carapace. I knew my life to be a shambles, and I believed-incontestably-that my family, friends, and patients would be better off without me. There wasn't much of me left anymore, anyway, and I thought my death would free up the wasted energies and well-meant efforts that were being wasted on my behalf.

Our secret thoughts - do they ever show up? The small flame of our soul can be burning hot, but no one comes to its warmth. Passersby see only a small whiff going through the chimney. Don't we need to take care of that flame, cherish it and patiently wait until someone will come and sit at it, do we?

Indeed, the capacity to tolerate uncertainty is a prerequisite for the profession. Though the public may believe that therapists guide patients systematically and sure-handedly through predictable stages of therapy to a foreknown goal, such is rarely the case: instead, as these stories bear witness, therapists frequently wobble, improvise, and grope for direction. The powerful temptation to achieve certainty through embracing an ideological school and a tight therapeutic system is treacherous: such belief may block the uncertain and spontaneous encounter necessary for effective therapy. This encounter, the very heart of psychotherapy, is a caring, deeply human meeting between two people, one (generally, but not always, the patient) more troubled than the other. Therapists have a dual role: they must both observe and participate in the lives of their patients. As observer, one must be sufficiently objective to provide necessary rudimentary guidance to the patient. As participant, one enters into the life of the patient and is affected and sometimes changed by the encounter.

With savages, the weak in body or mind are soon eliminated; and those that survive commonly exhibit a vigorous state of health. We civilised men, on the other hand, do our utmost to check the process of elimination; we build asylums for the imbecile, the maimed, and the sick; we institute poor-laws; and our medical men exert their utmost skill to save the life of every one to the last moment. There is reason to believe that vaccination has preserved thousands, who from a weak constitution would formerly have succumbed to small-pox. Thus the weak members of civilised societies propagate their kind. No one who has attended to the breeding of domestic animals will doubt that this must be highly injurious to the race of man. It is surprising how soon a want of care, or care wrongly directed, leads to the degeneration of a domestic race; but excepting in the case of man himself, hardly any one is so ignorant as to allow his worst animals to breed. The aid which we feel impelled to give to the helpless is mainly an incidental result of the instinct of sympathy, which was originally acquired as part of the social instincts, but subsequently rendered, in the manner previously indicated, more tender and more widely diffused. Nor could we check our sympathy, if so urged by hard reason, without deterioration in the noblest part of our nature. The surgeon may harden himself whilst performing an operation, for he knows that he is acting for the good of his patient; but if we were intentionally to neglect the weak and helpless, it could only be for a contingent benefit, with a certain and great present evil. Hence we must bear without complaining the undoubtedly bad effects of the weak surviving and propagating their kind; but there appears to be at least one check in steady action, namely the weaker and inferior members of society not marrying so freely as the sound; and this check might be indefinitely increased, though this is more to be hoped for than expected, by the weak in body or mind refraining from marriage.

I watched them tearing a building down, A gang of men in a busy town. With a ho-heave-ho and a lusty yell, They swung a beam, and the side wall fell. I asked the foreman: "Are these skilled-- And the men you'd hire if you had to build?" He gave me a laugh and said: "No, indeed! Just common labor is all I need. I can wreck in a day or two What builders have taken a year to do." And I thought to myself as I went my way, Which of these roles have I tried to play? Am I a builder who works with care Measuring life by a rule and square? Am I shaping my deeds to a well made Plan, Patiently doing the best I can? Or am I a wrecker, who walks the town Content with the labor of tearing down?

One of the first things we teach medical students is to listen to the patient by taking a careful medical history. Ninety percent of the time, you can arrive at an uncannily accurate diagnosis by paying close attention, using physical examination and sophisticated lab test to confirm your hunch (and to increase the bill to the insurance company).

The conviction that we know others better than they know us—and that we may have insights about them they lack (but not vice versa)—leads us to talk when we would do well to listen and to be less patient than we ought to be when others express the conviction that they are the ones who are being misunderstood or judged unfairly. The same convictions can make us reluctant to take advice from others who cannot know our private thoughts, feelings, interpretations of events, or motives, but all too willing to give advice to others based on our views of their past behavior, without adequate attention to their thoughts, feelings, interpretations, and motives. Indeed, the biases documented here may create a barrier to the type of exchanges of information, and especially to the type of careful and respectful listening, that can go a long way to attenuating the feelings of frustration and resentment that accompany interpersonal and intergroup conflict.

He never looked at her; and yet, the careful avoidance of his eyes betokened that in some way he knew exactly where, if they fell by chance, they would rest on her. If she spoke, he gave no sign of attention, and yet his next speech to any one else was modified by what she had said; sometimes there was an express answer to what she had remarked, but given to another person as though unsuggested by her. It was not the bad manners of ignorance: it was the willful bad manners arising from deep offense. It was willful at the time; repented of afterwards. But no deep plan, no careful cunning could have stood him in such good stead. Margaret thought about him more than she had ever done before; not with any tinge of what is called love, but with regret that she had wounded him so deeply, — and with a gentle, patient striving to return to their former position of antagonistic friendship; for a friend’s position was what she found that he had held in her regard, as well as in that of the rest of the family.

Food, Ivan Arnoldovich, is a subtle thing. One must know how to eat, yet just think – most people don’t know how to eat at all. One must not only know what to eat, but when and how.’ (Philip Philipovich waved his fork meaningfully.) ‘And what to say while you’re eating. Yes, my dear sir. If you care about your digestion, my advice is – don’t talk about bolshevism or medicine at table. And, God forbid – never read Soviet newspapers before dinner.’ ‘M’mm . . . But there are no other newspapers.’ ‘In that case don’t read any at all. Do you know I once made thirty tests in my clinic. And what do you think? The patients who never read newspapers felt excellent. Those whom I specially made read Pravda all lost weight.

When he talked politics, it was with me, or my sister, pointing a steady and patient finger at us, saying, “I don’t care about left or right. It’s all nonsense. All I ask of you is this: Be kind. Be decent. And don’t be greedy.

no recovery from trauma is possible without attending to issues of safety, care for the self, reparative connections to other human beings, and a renewed faith in the universe. The therapist's job is not just to be a witness to this process but to teach the patient how.

The most insidious of the premature responsibilities that may be foisted onto some children is the expectation that the child is somehow supposed to take care of his parents, rather than the other way around. Parents who were themselves raised with too little attention given to their own early feelings, if they have not worked out the resulting emotional problems in subsequent years, often look forward to having children of their own so that the children will make them happy. (81)

This was my wake-up call. I opened my eyes to the depressing fact that there are other forces at work in medicine besides science. The U.S. health care system runs on a fee-for-service model in which doctors get paid for the pills and procedures they prescribe, rewarding quantity over quality. We don’t get reimbursed for time spent counseling our patients about the benefits of healthy eating. If doctors were instead paid for performance, there would be a financial incentive to treat the lifestyle causes of disease. Until the model of reimbursement changes, I don’t expect great changes in medical care or medical education.5

I thought I was going to die. I wanted to die. And I thought if I was going to die I would die with you. Someone like you, young as I am, I saw so many dying near me in the last year. I didn’t feel scared. I certainly wasn’t brave just now. I thought to myself, We have this villa this grass, we should have lain down together, you in my arms, before we died. I wanted to touch that bone at your neck, collarbone, it’s like a small hard wing under your skin. I wanted to place my fingers against it. I’ve always liked flesh the colour of rivers and rocks or like the brown eye of a Susan, do you know what that flower is? Have you seen them? I am so tired, Kip, I want to sleep. I want to sleep under this tree, put my eye against your collarbone I just want to close my eyes without thinking of others, want to find the crook of a tree and climb into it and sleep. What a careful mind! To know which wire to cut. How did you know? You kept saying I don’t know I don’t know, but you did. Right? Don’t shake, you have to be a still bed for me, let me curl up as if you were a good grandfather I could hug, I love the word ‘curl,’ such a slow word, you can’t rush it...

Patience is the mother of joy. It is through patience that we can endure each others company long enough to fall in love, through patience that we can cooperate in a task, through patience that we can go from abysmally bad to almost all right, through patience that we can restrain ourselves from wasting our lives in anger and disappointment. The patient person waits, listens, expects, hopes, nurtures, cares, remembers, speaks, trusts, and is courteous. The impatient person demands, gets angry, hurries, presumes, is careless, despairs, forgets, complains, distrusts, disrupts.

The core predicament of medicine - the thing that makes being a patient so wrenching, being a doctor so difficult, and being a part of society that pays the bills they run up so vexing - is uncertainty. With all that we know nowadays about people and diseases and how to diagnose and treat them, it can be hard to see this, hard to grasp how deeply uncertainty runs. As a doctor, you come to find, however, that the struggle in caring for people is more often with what you do not know than what you do. Medicine's ground state is uncertainty. And wisdom - for both the patients and doctors - is defined by how one copes with it.

But that can never be," said Milo, jumping to his feet. "Don't be too sure," said the child patiently, "for one of the nicest things about mathematics, or anything else you might care to learn, is that many of the things which can never be, often are. You see," he went on, "it's very much like your trying to reach Infinity. You know that it's there, but you just don't know where — but just because you can never reach it doesn't mean that it's not worth looking for.

The mental health system is filled with survivors of prolonged, repeated childhood trauma. This is true even though most people who have been abused in childhood never come to psychiatric attention. To the extent that these people recover, they do so on their own.[21] While only a small minority of survivors, usually those with the most severe abuse histories, eventually become psychiatric patients, many or even most psychiatric patients are survivors of childhood abuse.[22] The data on this point are beyond contention. On careful questioning, 50-60 percent of psychiatric inpatients and 40-60 percent of outpatients report childhood histories of physical or sexual abuse or both.[23] In one study of psychiatric emergency room patients, 70 percent had abuse histories.[24] Thus abuse in childhood appears to be one of the main factors that lead a person to seek psychiatric treatment as an adult.[25]

A real man, the kind of man a woman wants to give her life to, is one who will respect her dignity, who will honor her like the valuable treasures she is. A real man will not attempt to rip her precious pearl from its protective shell, or persuade her with charm to give away her treasure prematurely, but he will wait patiently until she willingly gives him the prize of her heart. A real man will cherish and care for that precious prize forever.

Seeing modern health care from the other side, I can say that it is clearly not set up for the patient. It is frequently a poor arrangement for doctors as well, but that does not mitigate how little the system accounts for the patient's best interest. Just when you are at your weakest and least able to make all the phone calls, traverse the maze of insurance, and plead for health-care referrals is that one time when you have to — your life may depend on it.

Do one thing every day that scares you...Enjoy your body. Use it every way you can. Don't be afraid of it or of what other people think of it. It's the greatest instrument you'll ever own...Be careful whose advice you buy, but be patient with those who supply it. Advice is a form of nostalgia. Dispensing it is a way of fishing the past from the disposal, wiping it off, painting over the ugly parts and recycling it for more than it's worth.

Don’t let us take doubts with exaggerated seriousness nor let them grow out of proportion, or become black-and-white or fanatical about them. What we need to learn is how slowly to change our culturally conditioned and passionate involvement with doubt into a free, humorous, and compassionate one. This means giving doubts time, and giving ourselves time to find answers to our questions that are not merely intellectual or “philosophical,” but living and real and genuine and workable. Doubts cannot resolve themselves immediately; but if we are patient a space can be created within us, in which doubts can be carefully and objectively examined, unraveled, dissolved, and healed. What we lack, especially in this culture, is the right undistracted and richly spacious environment of the mind, which can only be created through sustained meditation practice, and in which insights can be given the change slowly to mature and ripen. 129-130

The very fact that they were naturally caring and loving would be the milestone that weighed them down. The formula is perfect. The nurse becomes willing to sacrifice herself in the patient. But the patient isn’t suffering from an external illness, he’s suffering from self-inflicted wounds. The nurse wants to prevent him from this pain. The patient wants her to feel the pain, too.

There is a saying that "paper is more patient than man";it came back to me on one of my slightly melancholy days,while I sat chin in hand,feeling too bored and limp even to make up my mind whether to go out or stay at home. Yes, there is no doubt that paper is patient and as I don't intend to show this cardboard-covered notebook,bearing the proud name of"diary",to anyone,unless I find a real friend,boy or girl,probably nobody cares.And now I come to the root of the matter,the reason for my starting a diary:it is that I have no such real friend. Let me put it more clearly,since no one will believe that a girl of thirteen feels herself quite alone in the world,nor is it so.I have darling parents and a sister of sixteen.I know about thirty people whom one might call friends--I have strings of boy friends,anxious to catch a glimpse of me and who,failing that,peep at me through mirrors in class.I have relations,aunts and uncles,who are darlings too,a good home,no--I don't seem to lack anything.But it's the same with all my friends,just fun and joking,nothing more.I can never bring myself to talk of anything outside the common round.We don't seem to be able to get any closer,that is the root of the trouble.Perhaps I lack confidence,but anyway,there it is,a stubborn fact and I don't seem to be able to do anything about it.

The panic disappeared under those soothing old fingers and the breathing slowed down and stopped hurting the chest as if a fox was caught in it, and then at last Mr. Kroger began to lecture the boy as he used to, Pablo, he murmured, don't ever be so afraid of being lonely that you forget to be careful. Don't forget that you will find it sometimes but other times you won't be lucky, and those are the times when you have got to be patient, since patience is what you must have when you don't have luck. ("The Mysteries of the Joy Rio")

In psychology it is very important that the doctor should not strive to heal at all costs. One has to be exceedingly careful not to impose one's own will and conviction on the patient. You have to give him a certain amount of freedom. You can't wrest people away from their fate, just as in medicine you cannot cure a patient if nature means him to die. Sometimes it is really a question whether you are allowed to rescue a man from the fate he must undergo for the sake of his further development.

no disease suffered by a live man can be known, for every living person has his own peculiarities and always has his own peculiar, personal, novel, complicated disease, unknown to medicine -- not a disease of the lungs, liver, skin, heart, nerves, and so on mentioned in medical books, but a disease consisting of one of the innumerable combinations of the maladies of those organs. This simple thought could not occur to the doctors (as it cannot occur to a wizard that he is unable to work his charms) because the business of their lives was to cure, and they received money for it and had spent the best years of their lives on that business. But above all that thought was kept out of their minds by the fact that they saw they were really useful [...] Their usefulness did not depend on making the patient swallow substances for the most part harmful (the harm was scarcely perceptible because they were given in small doses) but they were useful, necessary, and indispensable because they satisfied a mental need of the invalid and those who loved her -- and that is why there are, and always will be, pseudo-healers, wise women, homoeopaths, and allopaths. They satisfied that eternal human need for hope of relief, for sympathy, and that something should be done, which is felt by those who are suffering.

As far back as Yossarian could recall, he explained to Clevinger with a patient smile, somebody was always hatching a plot to kill him. There were people who cared for him and people who didn't, and those who hated him were out to get him. They hated him because he was Assyrian. But they couldn't touch him, he told Clevinger, because he had a sound mind in a pure body and was as strong as an ox. They couldn't touch him because he was Tarzan, Mandrake, Flash Gordon. He was Bill Shakespeare. He was Cain, Ulysses, the Flying Dutchman; he was Lot in Sodom, Deirdre of the Sorrows, Sweeney in the nightingales among trees. He was miracle ingredient Z-247. He was - Crazy!" Clevinger interrupted, shrieking. "That's what you are! Crazy!" "immense. I'm a real slam-bang, honest-to-goodness, three-fisted humdinger. I'm a bona fide Supraman." "Superman?" Clevinger cried. "Superman?" Supraman," Yossarian corrected.

A landmark 2010 study from the Massachusetts General Hospital had even more startling findings. The researchers randomly assigned 151 patients with stage IV lung cancer, like Sara’s, to one of two possible approaches to treatment. Half received usual oncology care. The other half received usual oncology care plus parallel visits with a palliative care specialist. These are specialists in preventing and relieving the suffering of patients, and to see one, no determination of whether they are dying or not is required. If a person has serious, complex illness, palliative specialists are happy to help. The ones in the study discussed with the patients their goals and priorities for if and when their condition worsened. The result: those who saw a palliative care specialist stopped chemotherapy sooner, entered hospice far earlier, experienced less suffering at the end of their lives—and they lived 25 percent longer. In other words, our decision making in medicine has failed so spectacularly that we have reached the point of actively inflicting harm on patients rather than confronting the subject of mortality.

This was the tenth month of my "fellowship" in oncology - a two-year immersive medical program to train cancer specialists - and I felt as if I had gravitated to my lowest point. In those ten indescribably poignant and difficult months, dozens of patients in my care had died. I felt as if I was slowly becoming inured to the deaths and the desolation - vaccinated against the constant emotional brunt.

You went back in time,” he repeated, “and you expect his cell phone to work?” “Well, no, I just, I mean, I came back and he hasn’t! Shouldn’t he have?” Morrison, very steadily, said, “Were you together?” “No! I just said he went to fight the Morrigan!” “I see.” There was a pause. “The man is seventy-four years old, Joanie. He can take care of himself. If you were,” a great and patient pause filled the line before he went on, “time traveling. If you were time traveling and got separated, then I can’t think of any reason he would necessarily come back to the present at the same time you did.” “Except I was the focal point, it was my fault, it --!” “Joanne. Siobhan. Siobhan Grainne MacNamarra Walkingstick.” I didn’t think anybody had ever said my name like that before. I gulped down a hysterical sob and whispered, “Yeah?” Morrison, with gentle emphasis, said, “I love you. Now pull yourself together and go find the bad guy,” and hung up.

Our increasing use of drugs to treat these conditions doesn’t address the real issues: What are these patients trying to cope with? What are their internal or external resources? How do they calm themselves down? Do they have caring relationships with their bodies, and what do they do to cultivate a physical sense of power, vitality, and relaxation? Do they have dynamic interactions with other people? Who really knows them, loves them, and cares about them? Whom can they count on when they’re scared, when their babies are ill, or when they are sick themselves? Are they members of a community, and do they play vital roles in the lives of the people around them? What specific skills do they need to focus, pay attention, and make choices? Do they have a sense of purpose? What are they good at? How can we help them feel in charge of their lives?

Why say 'the world is complicated' and stop there? I say the world is complicated but not incomprehensible. Only you have to look at it steadily. Isn't it true a person's shoulder hurts sometimes because they've got a disorder in their stomach? And then what does a stupid doctor do? Order massages for the shoulder. What does a wise doctor do? He takes time to think about it, watches the patient carefully, gives him some medicine for his stomach, and the pain in his shoulder goes away. Better yet, he explains to his patients what they have to do to keep their stomach from getting out of order. One day his patient's going to get old and die, just like himself, just like us, and one day, incredible as it may seem, the Empire's going to die, and how foolish people are who whine about it, and whine about how complicated the world is. A seamstress's room is complicated too, but even at night, with the lights out, she can reach out in the darkness and find the yellow thread, the needles, the pincushion. We couldn't, because we don't know the order things are in, in the seamstress's room. And we can't see the order the world is in. But all the same it's there, right under our eyes.

I think timing is better left up to God to decide then religious leaders. I once met a man that brought his wife flowers in the hospital. They held hands, kissed and were as affectionate as any cute couple could be. They were both in their eighties. I asked them how long they were married. I expected them to tell me fifty years or longer. To my surprise, they said only five years. He then began to explain to me that he was married thirty years to someone that didn’t love him, and then he remarried a second time only to have his second wife die of cancer, two years later. I looked at my patient (his wife) sitting in the wheelchair next to him smiling. She added that she had been widowed two times. Both of her marriages lasted fifteen years. I was curious, so I asked them why they would even bother pursuing love again at their age. He looked at me with astonishment and said, “Do you really think that you stop looking for a soulmate at our age? Do you honestly believe that God would stop caring about how much I needed it still, just because I am nearing the end of my life? No, he left the best for last. I have lived through hell, but if I only get five years of happiness with this woman then it was worth the years of struggle I have been through.

Real faith, however, is required to endure this necessary but painful developmental process. As things unfold, sometimes in full view, let us be merciful with each other. We certainly do not criticize hospital patients amid intensive care for looking pale and preoccupied. Why then those recovering from surgery on their souls? No need for us to stare; those stitches will finally come out. And in this hospital, too, it is important for everyone to remember that the hospital chart is not the patient. Extending our mercy to someone need not wait upon our full understanding of their challenges! Empathy may not be appreciated or reciprocated, but empathy is never wasted.

Reading for me, was like breathing. It was probably akin to masturbation for my brain. Getting off on the fantasy within the pages of a good novel felt necessary to my survival. If I wasn't asleep, knitting, or working, I was reading. This was for several reasons, all of them focused around the infititely superior and enviable lives of fictional heroines to real-life people. Take romans for instance. Fictional women in romance novels never get their period. They never have morning breath. They orgasm seventeen times a day. And they never seem to have jobs with bosses. These clean, well-satisfied, perm-minty-breathed women have fulfilling careers as florists, bakery owners, hair stylists or some other kind of adorable small business where they decorate all day. If they do have a boss, he's a cool guy (or gal) who's invested in the woman's love life. Or, he's a super hot billionaire trying to get in her pants. My boss cares about two things: Am I on time ? Are all my patients alive and well at the end of my shift? And the mend in the romance novels are too good to be true; but I love it, and I love them. Enter stage right the independently wealthy venture capitalist suffering from the ennui of perfection until a plucky interior decorator enters stage left and shakes up his life and his heart with perky catch phrases and a cute nose that wrinkles when she sneezes. I suck at decorating. The walls of my apartment are bare. I am allergic to most store-bought flowers. If I owned a bakery, I'd be broke and weigh seven hundred pounds, because I love cake.

MY BETH. Sitting patient in the shadow Till the blessed light shall come, A serene and saintly presence Sanctifies our troubled home. Earthly joys and hopes and sorrows Break like ripples on the strand Of the deep and solemn river Where her willing feet now stand. O my sister, passing from me, Out of human care and strife, Leave me, as a gift, those virtues Which have beautified your life. Dear, bequeath me that great patience Which has power to sustain A cheerful, uncomplaining spirit In its prison-house of pain. Give me, for I need it sorely, Of that courage, wise and sweet, Which has made the path of duty Green beneath your willing feet. Give me that unselfish nature, That with charity divine Can pardon wrong for love's dear sake— Meek heart, forgive me mine! Thus our parting daily loseth Something of its bitter pain, And while learning this hard lesson, My great loss becomes my gain. For the touch of grief will render My wild nature more serene, Give to life new aspirations, A new trust in the unseen. Henceforth, safe across the river, I shall see for evermore A beloved, household spirit Waiting for me on the shore. Hope and faith, born of my sorrow, Guardian angels shall become, And the sister gone before me By their hands shall lead me home.

it’s a terrible feeling when you first fall in love. your mind gets completely taken over, you can’t function properly anymore. the world turns into a dream place, nothing seems real. you forget your keys, no one seems to be talking English and even if they are you don’t care as you can’t hear what they’re saying anyway, and it doesn’t matter since your not really there. things you cared about before don’t seem to matter anymore and things you didn’t think you cared about suddenly do. I must become a brilliant cook, I don’t want to waste time seeing my friends when I could be with him, I feel no sympathy for all those people in India killed by an earthquake last night; what is the matter with me? It’s a kind of hell, but you feel like your in heaven. even your body goes out of control, you can’t eat, you don’t sleep properly, your legs turn to jelly as your not sure where the floor is anymore. you have butterflies permanently, not only in your tummy but all over your body - your hands, your shoulders, your chest, your eyes everything’s just a jangling mess of nerve endings tingling with fire. it makes you feel so alive. and yet its like being suffocated, you don’t seem to be able to see or hear anything real anymore, its like people are speaking to you through treacle, and so you stay in your cosy place with him, the place that only you two understand. occasionally your forced to come up for air by your biggest enemy, Real Life, so you do the minimum then head back down under your love blanket for more, knowing it’s uncomfortable but compulsory. and then, once you think you’ve got him, the panic sets in. what if he goes off me? what if I blow it, say the wrong thing? what if he meets someone better than me? Prettier, thinner, funnier, more like him? who doesn’t bite there nails? perhaps he doesn’t feel the same, maybe this is all in my head and this is just a quick fling for him. why did I tell him that stupid story about not owning up that I knew who spilt the ink on the teachers bag and so everyone was punished for it? does he think I'm a liar? what if I'm not very good at that blow job thing and he’s just being patient with me? he says he loves me; yes, well, we can all say words, can’t we? perhaps he’s just being polite. of course you do your best to keep all this to yourself, you don’t want him to think you're a neurotic nutcase, but now when he’s away doing Real Life it’s agony, your mind won’t leave you alone, it tortures you and examines your every moment spent together, pointing out how stupid you’ve been to allow yourself to get this carried away, how insane you are to imagine someone would feel like that about you. dad did his best to reassure me, but nothing he said made a difference - it was like I wanted to see Simon, but didn’t want him to see me.

. I was often surprised by the dispassionate way patients’ symptoms were discussed and by how much time was spent on trying to manage their suicidal thoughts and self-destructive behaviors, rather than on understanding the possible causes of their despair and helplessness. I was also struck by how little attention was paid to their accomplishments and aspirations; whom they cared for, loved, or hated; what motivated and engaged them, what kept them stuck, and what made them feel at peace—the ecology of their lives.

The years lay spread out before her, spacious untouched canvases on which she was presently going to paint the picture of her life. It was to be a very beautiful picture, she said to herself with an extraordinary feeling of proud confidence; not beautiful because of any gifts or skill of hers, for never was a woman more giftless, but because of all the untiring little touches, the ceaseless care for detail, the patient painting out of mistakes; and every touch and every detail was going to be aglow with the bright colours of happiness.

Cry Out in Your Weakness A dragon was pulling a bear into its terrible mouth. A courageous man went and rescued the bear. There are such helpers in the world, who rush to save anyone who cries out. Like Mercy itself, they run toward the screaming. And they can’t be bought off. If you were to ask one of those, “Why did you come so quickly?” He or she would say, “Because I heard your helplessness.” Where lowland is, that’s where water goes. All medicine wants is pain to cure. And don’t just ask for one mercy. Let them flood in. Let the sky open under your feet. Take the cotton out of your ears, the cotton of consolations, so you can hear the sphere-music. . . . Give your weakness to One Who Helps. Crying out loud and weeping are great resources. A nursing mother, all she does is wait to hear her child. Just a little beginning-whimper, and she’s there. God created the child, that is, your wanting, so that it might cry out, so that milk might come. Cry out! Don’t be stolid and silent with your pain. Lament! And let the milk of Loving flow into you. The hard rain and wind are ways the cloud has to take care of us. Be patient. Respond to every call that excites your spirit. Ignore those that make you fearful and sad, that degrade you back toward disease and death.

Although, in principle, the psychoanalytical theory of borderlines is not punitive, in practice 'borderline' is almost always used to indicate that the patient is hostile, demanding, unpleasant, manipulative, attention-seeking, and prone to regression and dependency if admitted to hospital; in other words patient is a witch by Malleus Maleficarum criteria. The term 'borderline' functions to rationalize sadistic counter-transference, and to legitimize rejecting triaging decisions within the health-care system. Actually, most of the time, in my experience, the splitting is coming from the staff, not the patient, and it is the mental-health professionals who are using projection and denial. This is an example of 'blaming the victim,' which is a fundamental borderline psychodynamic.

Many years later when I began training as a plastic surgeon, I understood something that I had not that day in the kitchen arguing for Thalia to leave Tinos for the boarding school. I learned that the world didn't see the inside of you, that it didn't care a whit about the hopes and dreams, and sorrows, that lay masked by skin and bone. It was as simple, as absurd, and as cruel as that. My patients knew this. They saw that much of what they were, would be, or could be hinged on the symmetry of their bone structure, the space between their eyes, their chin length, the tip projection of their nose, whether they had an ideal nasofrontal angle or not. Beauty is an enormous unmerited gift given randomly, stupidly.

LAWS OF THE HOUSE OF GOD I Gomers don’t die. II Gomers go to ground. III At a cardiac arrest, the first procedure is to take your own pulse. IV The patient is the one with the disease. V Placement comes first. VI There is no body cavity that cannot be reached with a #14 needle and a good strong arm. VII Age + BUN = Lasix dose. VIII They can always hurt you more. IX The only good admission is a dead admission. X If you don’t take a temperature, you can’t find a fever. XI Show me a BMS who only triples my work and I will kiss his feet. XII If the radiology resident and the BMS both see a lesion on the chest X ray, there can be no lesion there. XIII The delivery of medical care is to do as much nothing as possible.

Doctors tend to enter the arenas of their profession's practice with a brisk good cheer that they have to then stop and try to mute a bit when the arena they're entering is a hospital's fifth floor, a psych ward, where brisk good cheer would amount to a kind of gloating. This is why doctors on psych wards so often wear a vaguely fake frown of puzzled concentration, if and when you see them in fifth-floor halls. And this is why a hospital M.D.--who's usually hale and pink-cheeked and poreless, and who almost always smells unusually clean and good--approaches any psych patient under this care with a professional manner somewhere between bland and deep, a distant but sincere concern that's divided evenly between the patient's subjective discomfort and the hard facts of the case.

The important question isn't how to keep bad physicians from harming patient; it's how to keep good physicians from harming patients. Medical malpractice suits are a remarkably ineffective remedy. (In reference to a Harvard Medical Practice Study)... fewer than 2 percent of the patients who had received substandard care ever filed suit. Conversely, only a small minority among patients who did sue had in fact been victims of negligent care. And a patient's likelihood of winning a suit depended primarily on how poor his or her outcome was, regardless of whether that outcome was caused by disease or unavoidable risks of care. The deeper problem with medical malpractice is that by demonizing errors they prevent doctors from acknowledging & discussing them publicly. The tort system makes adversaries of patient & physician, and pushes each other to offer a heavily slanted version of events.

Especially when we are afraid, angry, or confused, we may be tempted to give away bits of our freedom—or, less painfully, somebody else’s freedom—in the quest for direction and order. Bill Clinton observed that when people are uncertain, they’d rather have leaders who are strong and wrong than right and weak. Throughout history, demagogues have often outperformed democrats in generating popular fervor, and it is almost always because they are perceived to be more decisive and sure in their judgments. In times of relative tranquility, we feel we can afford to be patient. We understand that policy questions are complicated and merit careful thought. We want our leaders to consult experts, gather as much information as possible, test assumptions, and give us a chance to voice our opinions on the available options. We see long-term planning as necessary and deliberation as a virtue, but when we decide that action is urgently needed, our tolerance for delay disappears. In those moments, many of us no longer want to be asked, “What do you think?” We want to be told where to march. That is when Fascism gets its start: other options don’t seem enough.

This love meditation is adapted from the Visuddhimagga by Buddhaghosa, a 5th century C.E. systematization of the Buddha's teaching. We begin by practicing the love meditation on ourselves ("May I"). Until we are able to love and take care of ourselves, we cannot be much help to others. After that, we practice them on others ("May he/she/they") - first on someone we like, then on someone neutral to us, and finally on someone who makes us suffer. May I be peaceful, happy, and light in body and spirit. May I be safe and free from injury. May I be free from anger, afflictions, fear and anxiety. May I learn to look at myself with the eyes of of understanding and love. May I be able to recognize and touch the seeds of joy and happiness in myself. May I learn to identify and see the sources of anger, craving, and delusion in myself. May I know how to nourish the seeds of joy in myself every day. May I be able to live fresh, solid, and free. May I be free from attachment and aversion, but not indifferent. Love is not just the intention to love, but the capacity to reduce suffering, and offer peace and happiness. The practice of love increases our forbearance, our capacity to be patient and embrace difficulties and pain. Forbearance does mean that we try to suppress pain.

or to what we hope they are. The more we work through our family of origin issues, the less we will find ourselves needing to work through them with the people we’re attracted to. Finishing our business from the past helps us form new and healthier relationships. The more we overcome our need to be excessive caretakers, the less we will find ourselves attracted to people who need to be constantly taken care of. The more we learn to love and respect ourselves, the more we will become attracted to people who will love and respect us and who we can safely love and respect. This is a slow process. We need to be patient with ourselves. The type of people we find ourselves attracted to does not change overnight. Being attracted to dysfunctional people can linger long and well into recovery. That does not mean we need to allow it to control us. The fact is, we will initiate and maintain relationships with people we need to be with until we learn what it is we need to learn—no matter how long we’ve been recovering. No matter who we find ourselves relating to, and what we discover happening in the relationship, the issue is still about us, and not about the other person. That is the heart, the hope, and the power of recovery.

When Ronan was young and didn’t know any better, he thought everyone was like him. He made rules for humanity based upon observation, his idea of the truth only as broad as his world was. Everyone must sleep and eat. Everyone has hands, feet. Everyone’s skin is sensitive; no one’s hair is. Everyone whispers to hide and shouts to be heard. Everyone has pale skin and blue eyes, every man has long dark hair, every woman has long golden hair. Every child knows the stories of Irish heroes, every mother knows songs about weaver women and lonely boatmen. Every house is surrounded by secret fields and ancient barns, every pasture is watched by blue mountains, every narrow drive leads to a hidden world. Everyone sometimes wakes with their dreams still gripped in their hands. Then he crept out of childhood, and suddenly the uniqueness of experience unveiled itself. Not all fathers are wild, charming schemers, wiry, far-eyed gods; and not all mothers are dulcet, soft-spoken friends, patient as buds in spring. There are people who don’t care about cars and there are people who like to live in cities. Some families do not have older and younger brothers; some families don’t have brothers at all. Most men do not go to Mass every Sunday and most men do not fall in love with other men. And no one brings dreams to life. No one brings dreams to life. No one brings dreams to life.

As humans, we have invented lots of useful kinds of lie. As well as lies-to-children ('as much as they can understand') there are lies-to-bosses ('as much as they need to know') lies-to-patients ('they won't worry about what they don't know') and, for all sorts of reasons, lies-to-ourselves. Lies-to-children is simply a prevalent and necessary kind of lie. Universities are very familiar with bright, qualified school-leavers who arrive and then go into shock on finding that biology or physics isn't quite what they've been taught so far. 'Yes, but you needed to understand that,' they are told, 'so that now we can tell you why it isn't exactly true.' Discworld teachers know this, and use it to demonstrate why universities are truly storehouses of knowledge: students arrive from school confident that they know very nearly everything, and they leave years later certain that they know practically nothing. Where did the knowledge go in the meantime? Into the university, of course, where it is carefully dried and stored.

A critical analysis of the present global constellation-one which offers no clear solution, no “practical” advice on what to do, and provides no light at the end of the tunnel, since one is well aware that this light might belong to a train crashing towards us-usually meets with reproach: “Do you mean we should do nothing? Just sit and wait?” One should gather the courage to answer: “YES, precisely that!” There are situations when the only true “practical” thing to do is to resist the temptation to engage immediately and to “wait and see” by means of a patient, critical analysis. Engagement seems to exert its pressure on us from all directions. In a well-known passage from his ‘Existentialism and Humanism’, Sartre deployed the dilemma of a young man in France in 1942, torn between the duty to help his lone, ill mother and the duty to enter the war and fight the Germans; Sartre’s point is, of course, that there is no a priori answer to this dilemma. The young man needs to make a decision grounded only in his own abyssal freedom and assume full responsibility for it. An obscene third way out of this dilemma would have been to advise the young man to tell his mother that he will join the Resistance, and to tell his Resistance friends that he will take care of his mother, while, in reality, withdrawing to a secluded place and studying. There is more than cheap cynicism in this advice. It brings to mind a well-known Soviet joke about Lenin. Under socialism; Lenin’s advice to young people, his answer to what they should do, was “Learn, learn, and learn.” This was evoked all the time and displayed on the school walls. The joke goes: Marx, Engels, and Lenin are asked whether they would prefer to have a wife or a mistress. As expected, Marx, rather conservative in private matters, answers, “A wife!” while Engels, more of a bon vivant, opts for a mistress. To everyone’s surprise, Lenin says, “I’d like to have both!” Why? Is there a hidden stripe of decadent jouisseur behind his austere revolutionary image? No-he explains: “So that I can tell my wife that I am going to my mistress and my mistress that I am going to my wife. . .” “And then, what do you do?” “I go to a solitary place to learn, learn, and learn!” Is this not exactly what Lenin did after the catastrophe in 1914? He withdrew to a lonely place in Switzerland, where he “learned, learned, and learned,” reading Hegel’s logic. And this is what we should do today when we find ourselves bombarded with mediatic images of violence. We need to “learn, learn, and learn” what causes this violence.

The uncomfortable, as well as the miraculous, fact about the human mind is how it varies from individual to individual. The process of treatment can therefore be long and complicated. Finding the right balance of drugs, whether lithium salts, anti-psychotics, SSRIs or other kinds of treatment can be a very hit or miss heuristic process requiring great patience and classy, caring doctoring. Some patients would rather reject the chemical path and look for ways of using diet, exercise and talk-therapy. For some the condition is so bad that ECT is indicated. One of my best friends regularly goes to a clinic for doses of electroconvulsive therapy, a treatment looked on by many as a kind of horrific torture that isn’t even understood by those who administer it. This friend of mine is just about one of the most intelligent people I have ever met and she says, “I know. It ought to be wrong. But it works. It makes me feel better. I sometimes forget my own name, but it makes me happier. It’s the only thing that works.” For her. Lord knows, I’m not a doctor, and I don’t understand the brain or the mind anything like enough to presume to judge or know better than any other semi-informed individual, but if it works for her…. well then, it works for her. Which is not to say that it will work for you, for me or for others.

Several years ago, researchers at the University of Minnesota identified 568 men and women over the age of seventy who were living independently but were at high risk of becoming disabled because of chronic health problems, recent illness, or cognitive changes. With their permission, the researchers randomly assigned half of them to see a team of geriatric nurses and doctors—a team dedicated to the art and science of managing old age. The others were asked to see their usual physician, who was notified of their high-risk status. Within eighteen months, 10 percent of the patients in both groups had died. But the patients who had seen a geriatrics team were a quarter less likely to become disabled and half as likely to develop depression. They were 40 percent less likely to require home health services. These were stunning results. If scientists came up with a device—call it an automatic defrailer—that wouldn’t extend your life but would slash the likelihood you’d end up in a nursing home or miserable with depression, we’d be clamoring for it. We wouldn’t care if doctors had to open up your chest and plug the thing into your heart. We’d have pink-ribbon campaigns to get one for every person over seventy-five. Congress would be holding hearings demanding to know why forty-year-olds couldn’t get them installed. Medical students would be jockeying to become defrailulation specialists, and Wall Street would be bidding up company stock prices. Instead, it was just geriatrics. The geriatric teams weren’t doing lung biopsies or back surgery or insertion of automatic defrailers. What they did was to simplify medications. They saw that arthritis was controlled. They made sure toenails were trimmed and meals were square. They looked for worrisome signs of isolation and had a social worker check that the patient’s home was safe. How do we reward this kind of work? Chad Boult, the geriatrician who was the lead investigator of the University of Minnesota study, can tell you. A few months after he published the results, demonstrating how much better people’s lives were with specialized geriatric care, the university closed the division of geriatrics.

My Father, the Age I Am Now Time, which diminishes all things, increases understanding for the aging. —PLUTARCH My mother was the star: Smart and funny and warm, A patient listener and an easy laugher. My father was . . . an accountant: Not one to look up to, Ask advice from, Confide in. A man of few words. We faulted him—my mother, my sister, and I, For being this dutiful, uninspiring guy Who never missed a day of work, Or wondered what our dreams were. Just . . . an accountant. Decades later, My mother dead, my sister dead, My father, the age I am now, Planning ahead in his so-accountant way, Sent me, for my records, Copies of his will, his insurance policies, And assorted other documents, including The paid receipt for his cemetery plot, The paid receipt for his tombstone, And the words that he had chosen for his stone. And for the first time, shame on me, I saw my father: Our family’s prime provider, only provider. A barely-out-of-boyhood married man Working without a safety net through the Depression years That marked him forever, Terrified that maybe he wouldn’t make it, Terrified he would fall and drag us down with him, His only goal, his life-consuming goal, To put bread on our table, a roof over our head. With no time for anyone’s secrets, With no time for anyone’s dreams, He quietly earned the words that made me weep, The words that were carved, the following year, On his tombstone: HE TOOK CARE OF HIS FAMILY.

Communities need tensions if they are to grow and deepen. Tensions come from conflicts within each person - conflicts born out of a refusal of personal and community growth, conflicts between individual egoisms, conflicts arising from a diminishing gratuite, from a class of temperaments and from individual psychological difficulties. These are natural tensions. Anguish is the normal reaction to being brought up against our own limitations and darkness, to the discovery of our deep wound. Tension is the normal reaction to responsibilities we find hard because they make us feel insecure. We all weep and grieve inwardly at the successive deaths of our own interests. . . . When everything is going well, when the community feels it is living successfully, its members tend to let their energies dissipate, and to listen less carefully to each other. Tensions bring people back to the reality of their helplessness; obliging them to spend more time in prayer and dialogue, to work patiently to overcome the crisis and refind lost unity; making them understand that the community is more than just a human reality, that it also needs the spirit of God if it is to live and deepen. I am told that there is a Chinese word for 'crisis' which means 'opportunity and danger'. Every tension, every crisis can become a source of new life if we approach it wisely, or it can bring death and division.

an empathic and patient listener, coaxing each of us through the maze of our feelings, separating out our weapons from our wounds. He cautioned us when we got too lawyerly and posited careful questions intended to get us to think hard about why we felt the way we felt. Slowly, over hours of talking, the knot began to loosen. Each time Barack and I left his office, we felt a bit more connected. I began to see that there were ways I could be happier and that they didn’t necessarily need to come from Barack’s quitting politics in order to take some nine-to-six foundation job. (If anything, our counseling sessions had shown me that this was an unrealistic expectation.) I began to see how I’d been stoking the most negative parts of myself, caught up in the notion that everything was unfair and then assiduously, like a Harvard-trained lawyer, collecting evidence to feed that hypothesis. I now tried out a new hypothesis: It was possible that I was more in charge of my happiness than I was allowing myself to be. I was too busy resenting Barack for managing to fit workouts into his schedule, for example, to even begin figuring out how to exercise regularly myself. I spent so much energy stewing over whether or not he’d make it home for dinner that dinners, with or without him, were no longer fun. This was my pivot point, my moment of self-arrest. Like a climber about to slip off an icy peak, I drove my ax into the ground. That isn’t to say that Barack didn’t make his own adjustments—counseling helped him to see the gaps in how we communicated, and he worked to be better at it—but I made mine, and they helped me, which then helped us. For starters, I recommitted myself to being healthy. Barack and I belonged to the same gym, run by a jovial and motivating athletic trainer named Cornell McClellan. I’d worked out with Cornell for a couple of years, but having children had changed my regular routine. My fix for this came in the form of my ever-giving mother, who still worked full-time but volunteered to start coming over to our house at 4:45 in the morning several days a week so that I could run out to Cornell’s and join a girlfriend for a 5:00 a.m. workout and then be home by 6:30 to get the girls up and ready for their days. This new regimen changed everything: Calmness and strength, two things I feared I was losing, were now back. When it came to the home-for-dinner dilemma, I installed new boundaries, ones that worked better for me and the girls. We made our schedule and stuck to it. Dinner each night was at 6:30. Baths were at 7:00, followed by books, cuddling, and lights-out at 8:00 sharp. The routine was ironclad, which put the weight of responsibility on Barack to either make it on time or not. For me, this made so much more sense than holding off dinner or having the girls wait up sleepily for a hug. It went back to my wishes for them to grow up strong and centered and also unaccommodating to any form of old-school patriarchy: I didn’t want them ever to believe that life began when the man of the house arrived home. We didn’t wait for Dad. It was his job now to catch up with

But God's the reason for everything noble and fine and heroic. If you had a God …" "My dear young friend," said Mustapha Mond, "civilization has absolutely no need of nobility or heroism. These things are symptoms of political inefficiency. In a properly organized society like ours, nobody has any opportunities for being noble or heroic. Conditions have got to be thoroughly unstable before the occasion can arise. Where there are wars, where there are divided allegiances, where there are temptations to be resisted, objects of love to be fought for or defended–there, obviously, nobility and heroism have some sense. But there aren't any wars nowadays. The greatest care is taken to prevent you from loving any one too much. There's no such thing as a divided allegiance; you're so conditioned that you can't help doing what you ought to do. And what you ought to do is on the whole so pleasant, so many of the natural impulses are allowed free play, that there really aren't any temptations to resist. And if ever, by some unlucky chance, anything unpleasant should somehow happen, why, there's always soma to give you a holiday from the facts. And there's always soma to calm your anger, to reconcile you to your enemies, to make you patient and long-suffering. In the past you could only accomplish these things by making a great effort and after years of hard moral training. Now, you swallow two or three half-gramme tablets, and there you are. Anybody can be virtuous now. You can carry at least half your morality about in a bottle. Christianity without tears–that's what soma is.

New Rule: Republicans must stop pitting the American people against the government. Last week, we heard a speech from Republican leader Bobby Jindal--and he began it with the story that every immigrant tells about going to an American grocery store for the first time and being overwhelmed with the "endless variety on the shelves." And this was just a 7-Eleven--wait till he sees a Safeway. The thing is, that "endless variety"exists only because Americans pay taxes to a government, which maintains roads, irrigates fields, oversees the electrical grid, and everything else that enables the modern American supermarket to carry forty-seven varieties of frozen breakfast pastry.Of course, it's easy to tear government down--Ronald Reagan used to say the nine most terrifying words in the Englishlanguage were "I'm from the government and I'm here to help." But that was before "I'm Sarah Palin, now show me the launch codes."The stimulus package was attacked as typical "tax and spend"--like repairing bridges is left-wing stuff. "There the liberals go again, always wanting to get across the river." Folks, the people are the government--the first responders who put out fires--that's your government. The ranger who shoos pedophiles out of the park restroom, the postman who delivers your porn.How stupid is it when people say, "That's all we need: the federal government telling Detroit how to make cars or Wells Fargo how to run a bank. You want them to look like the post office?"You mean the place that takes a note that's in my hand in L.A. on Monday and gives it to my sister in New Jersey on Wednesday, for 44 cents? Let me be the first to say, I would be thrilled if America's health-care system was anywhere near as functional as the post office.Truth is, recent years have made me much more wary of government stepping aside and letting unregulated private enterprise run things it plainly is too greedy to trust with. Like Wall Street. Like rebuilding Iraq.Like the way Republicans always frame the health-care debate by saying, "Health-care decisions should be made by doctors and patients, not government bureaucrats," leaving out the fact that health-care decisions aren't made by doctors, patients, or bureaucrats; they're made by insurance companies. Which are a lot like hospital gowns--chances are your gas isn't covered.

Last month, on a very windy day, I was returning from a lecture I had given to a group in Fort Washington. I was beginning to feel unwell. I was feeling increasing spasms in my legs and back and became anxious as I anticipated a difficult ride back to my office. Making matters worse, I knew I had to travel two of the most treacherous high-speed roads near Philadelphia – the four-lane Schuylkill Expressway and the six-lane Blue Route. You’ve been in my van, so you know how it’s been outfitted with everything I need to drive. But you probably don’t realize that I often drive more slowly than other people. That’s because I have difficulty with body control. I’m especially careful on windy days when the van can be buffeted by sudden gusts. And if I’m having problems with spasms or high blood pressure, I stay way over in the right hand lane and drive well below the speed limit. When I’m driving slowly, people behind me tend to get impatient. They speed up to my car, blow their horns, drive by, stare at me angrily, and show me how long their fingers can get. (I don't understand why some people are so proud of the length of their fingers, but there are many things I don't understand.) Those angry drivers add stress to what already is a stressful experience of driving. On this particular day, I was driving by myself. At first, I drove slowly along back roads. Whenever someone approached, I pulled over and let them pass. But as I neared the Blue Route, I became more frightened. I knew I would be hearing a lot of horns and seeing a lot of those long fingers. And then I did something I had never done in the twenty-four years that I have been driving my van. I decided to put on my flashers. I drove the Blue Route and the Schuylkyll Expressway at 35 miles per hour. Now…Guess what happened? Nothing! No horns and no fingers. But why? When I put on my flashers, I was saying to the other drivers, “I have a problem here – I am vulnerable and doing the best I can.” And everyone understood. Several times, in my rearview mirror I saw drivers who wanted to pass. They couldn’t get around me because of the stream of passing traffic. But instead of honking or tailgating, they waited for the other cars to pass, knowing the driver in front of them was in some way weak. Sam, there is something about vulnerability that elicits compassion. It is in our hard wiring. I see it every day when people help me by holding doors, pouring cream in my coffee, or assist me when I put on my coat. Sometimes I feel sad because from my wheelchair perspective, I see the best in people. But those who appear strong and invulnerably typically are not exposed to the kindness I see daily. Sometimes situations call for us to act strong and brave even when we don't feel that way. But those are a few and far between. More often, there is a better pay-off if you don't pretend you feel strong when you feel weak, or pretend that you are brave when you’re scared. I really believe the world might be a safer place if everyone who felt vulnerable wore flashers that said, “I have a problem and I’m doing the best I can. Please be patient!

It’s no one’s fault really,” he continued. “A big city cannot afford to have its attention distracted from the important job of being a big city by such a tiny, unimportant item as your happiness or mine.” This came out of him easily, assuredly, and I was suddenly interested. On closer inspection there was something aesthetic and scholarly about him, something faintly professorial. He knew I was with him, listening, and his grey eyes were kind with offered friendliness. He continued: “Those tall buildings there are more than monuments to the industry, thought and effort which have made this a great city; they also occasionally serve as springboards to eternity for misfits who cannot cope with the city and their own loneliness in it.” He paused and said something about one of the ducks which was quite unintelligible to me. “A great city is a battlefield,” he continued. “You need to be a fighter to live in it, not exist, mark you, live. Anybody can exist, dragging his soul around behind him like a worn-out coat; but living is different. It can be hard, but it can also be fun; there’s so much going on all the time that’s new and exciting.” I could not, nor wished to, ignore his pleasant voice, but I was in no mood for his philosophising. “If you were a negro you’d find that even existing would provide more excitement than you’d care for.” He looked at me and suddenly laughed; a laugh abandoned and gay, a laugh rich and young and indescribably infectious. I laughed with him, although I failed to see anything funny in my remark. “I wondered how long it would be before you broke down and talked to me,” he said, when his amusement had quietened down. “Talking helps, you know; if you can talk with someone you’re not lonely any more, don’t you think?” As simple as that. Soon we were chatting away unreservedly, like old friends, and I had told him everything. “Teaching,” he said presently. “That’s the thing. Why not get a job as a teacher?” “That’s rather unlikely,” I replied. “I have had no training as a teacher.” “Oh, that’s not absolutely necessary. Your degrees would be considered in lieu of training, and I feel sure that with your experience and obvious ability you could do well.” “Look here, Sir, if these people would not let me near ordinary inanimate equipment about which I understand quite a bit, is it reasonable to expect them to entrust the education of their children to me?” “Why not? They need teachers desperately.” “It is said that they also need technicians desperately.” “Ah, but that’s different. I don’t suppose educational authorities can be bothered about the colour of people’s skins, and I do believe that in that respect the London County Council is rather outstanding. Anyway, there would be no need to mention it; let it wait until they see you at the interview.” “I’ve tried that method before. It didn’t work.” “Try it again, you’ve nothing to lose. I know for a fact that there are many vacancies for teachers in the East End of London.” “Why especially the East End of London?” “From all accounts it is rather a tough area, and most teachers prefer to seek jobs elsewhere.” “And you think it would be just right for a negro, I suppose.” The vicious bitterness was creeping back; the suspicion was not so easily forgotten. “Now, just a moment, young man.” He was wonderfully patient with me, much more so than I deserved. “Don’t ever underrate the people of the East End; from those very slums and alleyways are emerging many of the new breed of professional and scientific men and quite a few of our politicians. Be careful lest you be a worse snob than the rest of us. Was this the kind of spirit in which you sought the other jobs?