This is what it means to have autonomy - you may not control life's circumstances, but getting to be the author of your life means getting to control… - Atul Gawande

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

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.

If end-of-life discussions were an experimental drug, the FDA would approve it.

The seemingly easiest and most sensible rule for a doctor to follow is: Always Fight. Always look for what more you could do. (...)

But our fight is not always to do more. It is to do right by our patients, even though what is right is not always clear.