Sunday, June 27, 2010

Grey's Anatomy: Finn Dandridge

But I’m beginning to think that my luck has changed because you like dogs, and pony births, and you save lives. I never said I wasn’t scary and damaged, too.

I never said I wasn't scary and damaged too.

Liz was my wife. When she died, you do this thing where you stop making plans because you had plans and there was a car crash and your plans disappear. I just try to get from sun up to sun down. That's as far into the future as I can handle and I've been fine with that, I have, but right now, looking at you, damn, I have all kinds of plans.

Yeah. Well I didn't say I wasn't pissed off. I said we weren't exclusive. That's all I wanted to say. Oh and, uh, and this. I know you think you're scary and damaged...

It makes you feel like you don't deserve good things. But you do. And Derek - he's bad for you. But me - I'm a good thing. And if there's a race, if there is a ring, my hat is in.

Here’s the deal. You have two options. You could come up to my place, take off all your clothes, shower off all the goop, borrow one of my shirts, and I’ll cook you dinner. That’s door No. 1. Door No. 2: You go home. I think you ought to take door No. 1 because it involves you, naked in my apartment but, you know, that’s just me.

If you choose door no. 1 I absolutely will not have sex with you. I won’t even try to kiss you.

You can't operate without her?

Grey's Anatomy: Joe the Bartender

I know that look. It's only one of two things. Either your boss is giving you hell or your boyfriend is. Which is it?

Aww, you're a tiny little kitten of joy and love.

Okay, fine, it's horrifying. But Carrie took out an entire senior class as revenge. I gotta say, I like that in a girl.

Mistakes, they happen. Imagine what happens with doctors who aren’t that experienced. Just one more reason why I’m glad I’m a bartender.

You’re knitting in a bar. You can’t knit in a bar, you’re scaring the customers.

People need a safe haven from their bitterness, loneliness, quality all their family time.

And if old flames aren’t enough of a problem, there’s always new flames to deal with.

Here’s the thing about hospitals and the people who work in them: the complications are not just surgical.

A train wreck. That’ll give ya heart burn fast.

The way I see it, sometimes you get what you want in life. Sometimes you don’t. And sometimes, sometimes you get something in between.

Okay, so, this is the story of five surgical interns. All of them just fresh out of med school, all of them pretty smart, all of them very driven, and all of them just maybe a little scared. Of course it’s not always about the medicine.

Unfortunately on your first day, the surprises aren’t always going to be surgical.

Wow, what is this? It smells like something burning.

That's Taiwan, man!

After dealing with all that life and death, where does a doctor go to unwind? They come to see me at my bar, right across the street from the hospital.

You called the gurney patrol?!

Hey! Hey! Hey! Beating each other up and there's not gonna be anybody left to set your broken bones.

Bar-owning gays don’t get picked.

If I can’t handle an ultrasound without breathing into a brown paper bag, how am I going to handle a kid? Let alone twins.

Joe’s partner: Next time we’re not going camping with straight guys.

Grey's Anatomy: Ellis Grey

It's awful being a grown up. The carousel never stops turning. You can't get off.

You are - You are anything but ordinary, Meredith. Now run. Run!

That man makes me purr like a kitten when he isn’t making me growl like a tiger. And my husband wonders why I’m not interested in him anymore. If he had any balls at all, he would leave on his own. No, he plays stupid. He’s waiting for me to kick him out. I come home with a hickey on my shoulder, a hickey for God’s sake, like I’m some sex crazed teenager. Ha, which let me tell you these days I am. And what does Thatcher do? Pretends he doesn’t see it.

I don’t have time to coddle you right now, I’m busy saving lives. Do you understand?

Heart surgeons are the ‘know it alls,’ they’re the most ambitious, the most driven. They want it all and they want it now. They don’t want anything getting in their way.

Anyone can fall in love and be blindly happy but not anyone can pick up a scalpel and save a life.

What would you do if the thing that defines who you are was taken away?

Does he understand the demands of your career? Because not all men do, they say they do upfront.

You’re what happened to her. I thought you were here for me, to offer me some hope, to help me with some new treatment. But you’re here for her. An attending, a neurosurgeon, no wonder why she’s so unfocused. I’ve seen men like you before, threatened by a women whose as equal. You just want someone to admire you. And you don’t care about the damage you do to her, along the way.

Grey's Anatomy: Patients

Annie Connors: Seriously? You're equating your pathetic love life with my record breaking tumor? Seriously?

Mr. Levangie: I tell ya what Blondie, if you don’t marry him, I will.

Mr. Levangie: I know it's not perfect, but it's life. Life is messy sometimes.

Devo 'Ester' Friedman: You don't believe in anything. How appropriate. Patron saint of lost causes.

Devo 'Ester' Friedman: My freak father likes hospital food.

Devo 'Ester' Friedman: Get a life, haven't you ever seen an Orthodox Jew?

Devo 'Ester' Friedman: Do you know what it’s like being a teenager these days. My friends spend most of their time screwing around and getting wasted. At least I have God.

Mr. Duff: I wouldn’t have picked you for the mommy track, Nurse Betty.

Mr. Duff: You're into me. I can tell. "Dr. Small and Angry" was a hot appetizer, but you, Doc, are a smorgasbord of lust.

Mr. Duff: Hello! They're not seizures, they're visions. I'm psychic.

Helen Rubenstein: I keep telling her there's more to life than surgery and career.

Helen Rubenstein: The daughter I raised would appreciate her mother's help.

Helen Rubenstein: But in this moment, you’re the ass who gave me my life back.

Bonnie Crasnoff: You're a cute doctor. Cute doctors can call me by my first name.

Bonnie Crasnoff: How can you be a surgeon and have so little respect for life?

Esme: Otters mate for life, you know.

Esme: It’s not a lie. It’s our future. I’ve been with the love of my life for 60 years. And now I’m dying. We’re going to Venice. We’re getting in that gondola.

Esme: They say that if you ride a gondola under the bridge of sighs, you’re together for eternity.

Sav: It’s not like I have a lot of options. One, take my chances and never get cancer. Two, take my chances and die young.

Weis: Yep, and here’s to bull and here’s to crap. Here’s to losing your wide. Here’s to being the ass who can’t be supportive. Here’s to that.

Sav: Menopause, I know. Boobs. But they have hormone replacements. Reconstructions. But the sexy Savvy, the Savvy that gets noticed when she walks into the room, the Savvy that loves to wake her husband up in the middle of the night to make love, yeah, I wonder if that Savvy is still gonna be there. Honestly I haven’t a clue. But then I think, is that why Weis married me? God, I hope not.

Sav: I’m sorry Derek because I love you and really glad to see you but until you grow a uterus and watch your mother die from this disease, you don’t get a vote.

Sav: I know what I’m losing. I get it. But I know what I’m gaining. My life. This gives me a shot, a shot at the future, a shot at me and Weis, becoming this crazy old, wrinkled couple that argues all the time. I mean, wouldn’t you want that. A chance to grow old with Derek?

Nicole Verma: I know you're a doctor, I'm your patient, and it's against the rules, but, I would never tell anyone.

Nicole Verma: If I had a chance to kiss someone I liked, I wouldn’t hesitate.

Nicole Verma: I’m getting the operation. You two talk and talk but have you noticed how you never ask me anything. Part of it’s my fault that I let you do it, but I’m not cheating anymore. I’m not sitting back and giving over control because I am ready to handle things for myself.

Dorie Russell: Wow, look at you two. Everybody must hate you.

Patient: You’re not a mother. You don’t know what it’s like to hold your newborn baby in your arms, and smell the top of her head, and know that your only job in this world is to protect her.

Constance Ferguson: Start off with a little small talk, why don't ya.

Tim Epstein: The good news is, my head broke my fall.

Mrs. Epstein: He'll probably be fine. He's always been a little hard-headed.

Tim Epstein: I’m so glad we came to this hospital so I could have myself treated by a bunch of quacks who don’t know the inside of their asses from my skull.

Blushing patient: I can’t get mad, I can’t be happy I can’t feel anything without the whole world knowing about it. I can't have secret. Can you imagine living that way your entire life?

Nadia's Mother: Thank God is right, because we're certainly not gonna thank you. We should sue you for all you're worth. We sat here, and sat here, and sat here, and sat here... And sat here, and watched you take patient after patient... And made my daughter wait for three whole days for her operation. I should sue you and this whole damned hospital!

Malar Pascowitz: I poured my heart and soul into that freaking book, and now it's stuck up my ass! Put that on my tombstone Audrey! On my tombstone!

Malar Pascowitz: Lying here trapped in this flesh prison I’ve reached a grim conclusion. I’m a failure.

Audrey: The man ate his novel. He’s not normal.

Dana Seabury: I have never smoked a cigarette in my life, I have never smoked pot, I've never drank, before today I hadn't a desert for ten years! I'm the picture of health and I have lung cancer!

Dana Seabury: I mean come on, it's absurd right? I'm sorry, I think I'm on a sugar high or something.

Dana Seabury: So I’m going to go into the bathroom and if I find myself alone in there after two minutes, I’ll just touch up my makeup and come back out. But should you have any interest in fulfilling the wish of a potentially dying woman, you know where I’ll be.

Frank: Dr. Stephens? Frank can sense the vibes.

Frank: What? You've never did anything crazy for love?

Frank: Then un-complicate it. Grand gesture is what I'm talking about. Be like Frank. Just figure out what she wants, then make it happen. She'll forget all about the other guy. Trust Frank. Frank knows.

Allison: I may not know much, but I do know fighting. And people who fight like you and Izzie, those people love each other. She misses her friend.

Allison: That's a good sign. Fighting leads to good make up sex. Are you watching birds fly around my head again? Am I like totally Snow White now?

“Mama” hillbilly patient: I don’t have any panties on and I do not know you well enough to let you see my good girl. Get me a lady doctor.

“Mama”: Ya’ll don’t have to whisper. I’m sittin’ right here. I can hear ya anyway. She’s my baby. She’s my little girl. Big decision like this, going back in and sewing up organs, it’s a kind of decision that a mama should be involved in. Now all her life, she’s asked me everything from what color dress she ought to wear to her kindergarten dance to what she ought to name her baby. I’m her mama. It’s my job to have an opinion. My job to have an answer. Well, I may not have an answer here, but I’m still her mama. And you just don’t have to whisper.

Jeremy West: We're not finished yet. I've not finished loving you.

Anna Loomis: When you spend your life with someone and you have kids together, you think it'll always be this amazing, and this wonderful. You think that you'll always feel that kind of love and I do, I do love Phil. I just... well little pieces of you get chipped away by another person and then you shave little pieces of yourself away so you'll fit together and then one day you look up and you don't even know who you are.

Anna Loomis: Spare me your white girl cultural divided love. You don’t anger the ancestors even if you pierce your tongue and play in a band.

Mr. Humphrey: Look, I fantasized about you. About the woman in this photo, whoever she is. I'm not proud of it, but it's a fact. Do you know what they're gonna do to me today? I have cancer. And they're gonna lift up my legs and expose me to the world, and cut out my prostate, and my nerves. Effectively neuter me. So is it so hard to understand that I don't want the woman who is in that photo to witness... my emasculation?

Old man Patient: Learning is like healing, it happens over time.

Old man Patient: Keep running but not because you want to cut corners, but because it makes you better doctors.

Naomi: You people with your tumors. I’m infected with love.

Patient: Illness is a sign of weakness. Once they see it, they never look at you the same way again.

Steve: Normally you don't expect your one night stand to stick with you through a tumor.

Yumi: Tell him I eat little boys like him for breakfast.

Yumi’s coach: She wonders how a wrestler got to be smart enough to become a doctor. Most wrestlers she knows are dumb.

Sophie Larson: With those eyes and those nice firm hands. Girl chooses a dog over you. It must be one hell of a dog.

Sophie Larson: Nursing homes are for old people. I know I’m elderly. I do know that. But if I have to go that place, I’m afraid I’ll become old.

Sophie Larson: No darling you can’t waste any more time with me. You have to go balls out with the dog. So she chose a dog over you! So what? Women are fools. That’s old news. But life’s too short for you to give in Irish. So fight, you fight for what’s yours.

Sophie Larson: I love the Irish, they have a sparkle. You can see it in the eye and they have swagger.

Justin’s mom: A mother’s job is to protect her child’s innocence.

Justin: Tell that fat ass to give it to someone else, I don’t want it.

Isaac: There is always a way. When things look like there's no way, there is a way. To do the impossible, to survive the unsurvivable... There's always a way.

Lloyd: Dying is a get out of jail free card. I can be as bold as I want and get away with it. So I flirt. Haven’t you ever been attracted to someone you know you couldn't have? To be young and in love.

Lloyd: Ah, the pretty ones always come crawling back.

Digby Owens: My art is about commitment. An ethos. Why do anything unless you're willing to go one step further than anyone else? Pain is the great divine.

Mindy: Nobody reenacts World War II, you moron. My husband and his moron best friend, decided to build some kind of big gun. So they put on their stupid costumes and they go out into the backyard. And try to shoot the damn thing. It didn’t work. So like an idiot my husband has to go stand in front of his big gun to see what went wrong. That’s when the stupid toy starts working. It’s taking up half my garage, I’ll call it whatever I want!

Jake: You have really nice eyes, you know. I’m just saying that you’re mostly all surly and hardcore, but your eyes aren’t. I’m really big on eyes, the only part of my face where the tumor isn’t growing. You get that I’m jail bait, right?

Deborah: Love means never having to use your husband as a human shield.
Neil: We shared a bullet. It went through you and into me. That’s a sign, a sign that we should be together forever.
Deborah: No, Neil. She’s shooting water through my arm. I can see you through my arm. That’s another sign.

Camille: You know that feeling when you look into someone’s eyes and you’re totally comfortable and you aren’t self conscious, and you just think everything’s just like perfect.

Camille: I wanted to go to prom; I didn’t want to be the girl with cancer again.

Camille: Be kind to him. He loves me. I’ve been loved. And that’s something everyone should have once in their life. I’m in love.

Chief’s niece’s friends: It’s okay. The hot ones are always mean. It’s like rule or something.

Chief’s niece’s friends: Don’t you dare try to judge us for trying to make our friend, who just so happens to be dying of cancer, happy. The color does matter, maybe not to you, but it does matter.

School girl: Do we look like the kind of girls who get pregnant and throw our baby in the trash?

Benjamin O’Leary: This doctor looks annoyed. Although it’s hard to tell, because she always has this pinched, uptight look on her face. Am I annoying you?

Benjamin O’Leary: Is that blonde your girlfriend? Because the way you keep looking at her, you mind as well mount her right here and now. I’m sorry, was that rude?

Benjamin O' Leary: Did you have sex with that brain surgeon? I would, he’s hot. And arrogant, in a way that’s still sexy. I would totally have sex with him if I could. Looked like you could. So what’s the hold up?

Megan: Superheroes are all kids with dead parents, like me. They all figured out when they were around my age they could do things nobody else could, like me.

Megan: You’re a homes-bag, you know that?

Patient: You are old enough to know that your parents are sexual beings and that they make mistakes.

Don(na): Are you saying if I become a woman I could die?

Patient: You’re fishing through my poop, how smart are you?

Heather Douglas: What are you all staring at? Really, if you’re expecting me to be the brave and heartwarming differently-abled girl, that isn’t going to happen. So go ahead and do your thing.

Heather Douglas: Wow. Give this girl a medal. She memorized the whole acronym, which I assure you is a hell of a lot easier than living with it.

Heather Douglas: Let’s see, if by more radical you mean having a steel rod in my spine. Then yeah, we tried. The rod just bent.

Heather Douglas: Really, so this surgery is going to get me laid? Mom, I’m sorry but she is talking about improving my quality of life. And I don’t think doctors should make promises they can’t keep.

Heather Douglas: You’re way too hot to be a doctor. I mean, aren’t people who look like you supposed to be dumb? I’m just saying, you’re not going to be in my surgery because I’m a little too young to die.

Heather Douglas: It’s not nice to mock cripple kids.

Heather Douglas: Well so much for my theory that life doesn’t suck for pretty people.

Heather Douglas: Mom, I know you still think death is the worst thing that can happen to a person. Death is not the worst thing.

Cathy: I am a sexual person. I am a normal sexual person. I like sex. I need sex. And he won’t do it. He won’t have sex with me. He just won’t.

Rebecca Bloom: I’m not going to miss out on an experience my body was made for just because it was more convenient for you.

Greg: You’re either ham or eggs. You’ve got to ask yourself in every situation, are you the chicken or are you the pig? You’ve got a plate of ham and eggs. The chicken is involved in the meal, but the pig is committed. Now the question is are you involved or committed.

Trish: You don’t leave the people you love alone, Dr. Grey. That idiot may not know it yet, but my fear is what’s going to save his life.

Martin: Illness is a sign of weakness. Once they see it, they never look at you the same way again.

Hillary: Okay, the last thing I am is a “disappointment”. I get straight A’s. I’m on honor roll. I’m run the student council. I basically am the student paper. I tutor kids with reading problems. I’m every parent’s dream come true, especially yours. I was exploring the bounds of my consciousness with the help of a mushroom. I made a calculated risk of going on the roof, and falling off; well that was the low-probability of it. And even though the low-probability events are getting weaker. And this one did. And see, you’re bummed. And this reminds you of your own fallibility. And I’m bummed too, so let’s just leave it at that.

Leech Patient: Sometimes no matter how much you love someone they just can’t love you back in the same way. Living with a woman you can’t love you back, way lonelier than being along.

Mr. Singer: So you’re going to go right into that school and show those cheerleaders you have nothing to be ashamed of. Those little bitches are poisonous.

Mr. Singer: You’re crazy. I’d never go back to those sex-crazed, teenage alcoholics.

Molly: How do you explain your boobs to the next chick who’s dumb enough to date you?

Don: I can call Kim, and we’ll get a justice of the peace, and she and Scott can get married right her in this room. You don’t even like weddings. The salmon is too dry, the flowers will make you sneeze, and Kim will be angry at you because women get angry at their mothers at weddings because that’s how they handle their stress. Do you think she cares about her wedding? Her mother is dying. They’re trying to offer you a life, a whole long life. And no, they’re not going to know what they’re going to find, and it’s a gamble. But how can you not take that chance because of a wedding? There’ll be grandkids, and arguments, and God knows what else and she’ll need you for those. And I’ll need you.

Sadie: My life is in pieces, all the time. And they just keep breaking. And as soon as I fix one, another one goes down. I’m just trying to keep it together, you know, piece by piece.

Prisoner: People are alive when they meet us. Then it all changes somehow.

Grey's Anatomy: Meredith Grey Voiceovers

The Game. They say a person either has what it takes to play, or they don't. My mother was one of the greats. Me on the other hand... I'm kinda screwed.

I can't think of any one reason why I'd want to be a surgeon. But I can think of a thousand reasons why I should quit. They make it hard on purpose. Throw lives in our hands. There comes a moment when it's more than just a game. And you either take that step forward or turn around and walk away. I could quit, but here's the thing... I love the playing field.

It's all about lines. The finish line at the end of residency, waiting in line for a chance at the operating table, and then there's the most important line: the line separative you from the people you work with. It doesn’t help to get too familiar, to make friends; you need boundaries between u and the rest of the world. Other people are far too messy. It’s all about drawing lines. Drawing lines in the sand and praying like hell no one crosses them.

To make it, really make it as a surgeon, it takes major commitment. You have to be willing to pick up that scalpel and make a cut that may or may not do more damage than good. It’s all about being committed, because if we’re not, we have no business picking up that scalpel in the first place.

There are times when even the best of us have trouble with commitment. And we may be surprised by the commitments we are willing the let slip out of our grasp. Commitments are complicated. We may surprise ourselves by the commitments we are willing to make. True commitment takes effort and sacrifice, which is why sometimes we have to learn the hard way to choose our commitments very carefully.

We live out our lives on the surgical unit. Seven days a week, fourteen hours a day. We're together more than we're apart. After a while, the ways of residency become the ways of life. Number 1: Always keep score. Number 2: Do whatever you can to outsmart the other guy. Number 3: Don't make friends with the enemy. Oh yea, and number 4: Everything... Everything is a competition. Whoever said winning wasn't everything, never held a scalpel.

There's another way to survive this competition. A way that no one ever seems to tell you about. One you have to learn for yourself. Number 5: It's not about the race at all. There are no winners or losers. Victories are counted by the number of lives saved. And once in a while, if you're smart, the life you save could be your own.

In life, we are taught that there are seven deadly sins. We all know the big ones: gluttony, pride, lust. But the sin you don’t hear much about is anger. Maybe it’s because we think it’s because anger is not that dangerous. That we can control it. My point is, maybe we don’t give anger enough credit. Maybe it can be a lot more dangerous than we think. After all, when it comes to destructive behavior, it did make the top seven.

So what makes anger different from the six other deadly sins? It’s pretty simple really. You give into a sin like envy or pride, then you only hurt yourself. Try lust or coveting, and you’ll only hurt yourself and probably one or two others. But anger, anger is the worst. The mother of all sins. Not only can anger drive you over the edge, but when it does, it can take an awful lot of other people with you.

Intimacy is a four syllable word for, "Here are my heart and soul, please grind them into hamburger and enjoy." It's both desired, and feared. Difficult to live with, and impossible to live without. Intimacy also comes attached to the three R's... relatives, romance, and roommates. There are some things you can't escape. And other things you just don't want to know.

Many people don’t know that the human eye has a blind spot in its field of vision. There’s a part of the world that we are literally blind to. The problem is, sometimes our blind spots shield us from things that really shouldn’t be ignored. Sometimes our blind spots keep our lives bright and shiny.

When it comes to our blind spots, maybe our brains aren’t compensating, maybe they’re protecting us.

We all think we’re going to be great. And we feel a little bit bogged when our expectations aren’t met. But sometimes our expectations sell us short. Sometimes the expected simply pales in comparison to the unexpected. You got to wonder why we cling to our expectations, because the expected is just what keeps us steady, standing, still. The expected is just the beginning. The unexpected is what changes our lives.

No one believes their life will turn out just kinda okay. We all think we’re going to be great. And from the day we decide to be surgeons, we are filled with expectation. Expectations of the trails we will blaze, the people we will help, the difference we will make. Great expectations of who we will be, where we will go. And then, we get there.

At the end of the day, when it comes down to it, all we really want is to be close to somebody. So this thing where we all keep our distance and pretend not to care about each other is usually a load of bull. So we pick and choose we want remain close to. And once we’ve chosen those people, we tend to stay close by. No matter how much we’ve hurt them. The people that are still with you at the end of the day, those are the ones worth keeping. And sure sometimes close can be too close. But sometimes that invasion of personal space, it can be exactly what you need.

People have scars in all sorts of unexpected places, like secret road maps of their personal histories, diagrams of all their old wounds. Most of our old wounds here leaving nothing but a scar, but some of them don’t. Some wounds we carry with us everywhere and though the cut’s long gone, the pain still lingers.

What’s worst? New wounds which are so horribly painful or old wounds that should of healed years ago and never did. Maybe our old wounds teach us something, they remind us where we’re been and what we’ve overcome. They teach us lessons about what to avoid in the future. That’s what we like to think, but that’s not the way it is, is it? Some things you just have to learn, over, and over, and over again.

Remember when you were a kid and your biggest worry was like... if you could get a bike for your birthday or if you could get to eat cookies for breakfast. Being an adult: totally overrated. I mean seriously, don't be fooled by the hot shoes and the great sex and the no parents anywhere telling you what to do. Adulthood is responsibility. Responsibility really does suck. Really, really sucks. Adults have to be places and do things and earn a living and pay the rent. And if you're training to be a surgeon, holding a human heart in your hands... Hello? Talk about responsibility! Kinda makes bikes and cookies look really good, right? The scariest part about responsibility is when you screw up and let it slip right through your fingers.

Responsibility. It really does suck. Unfortunately once you get past the age of braces and training bras, responsibility doesn't go away. It can't be avoided. Either someone makes us face it or we suffer the consequences. And still, adulthood has its perks. And the shoes, the sex, the no parents anywhere telling you what to do... That's pretty damn good.

A couple hundred years ago Benjamin Franklin shared with the world the secret of his success. "Never leave that 'til tomorrow," he said, "which you can do today." This is the man who discovered electricity; you'd think more of us would listen to what he has to say. I don't know why we put things off, but if I had to guess, I'd say it has a lot to do with fear. Fear of failure, fear of pain, fear of rejection. Sometimes the fear is just of making a decision. Because what if you're wrong? What if you make a mistake you can't undo? Whatever it is we're afraid of, one thing holds true: That by the time the pain of not doing the thing gets worse than the fear of doing it, it can feel like we're carrying around a giant tumor. And you thought I was speaking metaphorically.

'The early bird catches the worm.' 'A stitch in time saves nine.' 'He who hesitates is lost.' We can't pretend we haven't been told. We’ve all heard the proverbs, heard the philosophers, heard our grandparents warning us about wasting time. Heard the damn poets about seizing the day. Still, sometimes, we have to see for ourselves. We have to make our own mistakes. We have to learn our own lessons. We have to sweep today's possibility under tomorrow's rug until we can't anymore, until we finally understand for ourselves what Benjamin Franklin meant, that knowing is better than wondering. That waking is better than sleeping. And that even the biggest failure, even the most intractable mistake beats the hell out of never trying.

At some point, maybe we accept the dream has become a nightmare. We tell ourselves the reality is better. We convince ourselves that it’s better that we never dream at all. But the strongest of us, the most determined of us, we hold onto the dream. Or we find ourselves faced with a fresh dream we never considered. We await to find ourselves against all odds, feeling hopeful. And if we’re lucky, we realize in everything, in the face of life, the true dream is being able to dream at all.

Anyone who says you can sleep when you die, tell them to come talk to me after a few months as an intern. Of course, it's not just the job that keeps us up all night. I mean, if life's so hard already, why do we bring so much trouble down on ourselves. What's up with the need to hit the self-destruct button?

Maybe we like the pain. Maybe we're wired that way because without it... I don't know. Maybe we just wouldn't feel real. What's that saying... Why do I keep hitting myself with a hammer? Because it feels so good when I stop.

Disappearances happen in science. Diseases can fade away. Tumors go missing. We open someone up to discover the cancer is gone. It’s unexplained, it’s rare, but it happens. We call it misdiagnosis; say we never saw it in the first place, any explanation from the truth, that life is full of vanishing acts. If something that we didn’t know we have disappears, do we miss it?

Surgeons always have a plan, where to cut, where to clamp, where to stitch. Even with the best plans, complications can arise, things can go wrong, and suddenly you’re caught with your pants down.

Like I said, disappearances happen. Pains go phantom. Blood stops running. And people, people fade away. Here’s where I have to say, so much more. But I disappeared.

You know how you were a little kid and you believed in fairytales, that fantasy of what your life would be, white dress, prince charming would carry you away to a castle on a big hill, you'd lie in bed at night and close your eyes and at complete and utter faith. Santa Claus, the tooth fairy, prince charming, they were so close you could taste them. But eventually you grow up, one day you open your eyes and the fairytale disappears. Most people turn to the things and people they can trust. But the thing is, it’s hard to let go of that fairytale entirely because everyone still has that smallest bit of hope, of faith that one day they'll open their eyes and it will all come true.

Secrets can't hide in science. Medicine has a way of exposing the lies. Within the walls of the hospital the truth is stripped bare. How we keep our secrets outside the hospital, well that's a little different... One thing is certain, whatever it is we're trying to hide, we're never ready for when the truth gets naked. That's the problem with secrets... Like misery, they love company. They pile up and up until they take over everything, until you don't have room for anything else. Until you're so full of secrets you feel like you're going to burst.

The thing people forget is how good it can feel when you finally set secrets free. Whether good or bad, at least they're out in the open. Like it or not. And once your secrets are out in the open, you don't have to hide behind them. But the problem with secrets is, even when you think you're in control... You're not.

A surgeon’s education never ends. Every patient, every symptom, every operation, is a test. A chance for us to demonstrate how much we know, and how much more we have to learn.

To be a good surgeon you have to think like a surgeon. Emotions are messy, tuck them neatly away and step into a clean sterile room where the procedure is simple. Cut, suture, and close. But sometimes you're faced with a cut that won't heal, a cut that rips the stitches right open.

I have an aunt who, whenever she poured anything for you, would say 'say when'. My aunt would say, 'say when' and of course I never did. We don't say when because there's something about the possibility of more. More tequila, more love, more anything. More is better.

Too often, the thing you want most is the thing you can’t have. Desire leaves us heartbroken. It wears us out. Desire can wreck your life. But as tough as wanting something can be, the people who suffer the most are those who don’t know what they want.

There’s something to be said about a glass half full. About knowing when to say when. I think it’s a floating mind, a barometer of need and desire. It’s entirely up to the individual. And depends on what’s being poured. Sometimes, all we want is a taste. Other times there's no such thing as enough. The glass is bottomless. And all we want is more.

Surgeons are control freaks. With a scalpel in your hand you feel unstoppable. There's no fear, there's no pain. You're ten feet tall and bullet proof... And then you leave the OR and all that perfection, all that control, just falls to crap.

No one likes to lose control, but as a surgeon, there's nothing worse. It’s a sign of weakness of not being up to the task. And still there are times when it just gets away from you, when the world stops spinning and you realize that your shiny little scalpel isn't going to save you. No matter how hard you fight it, you fall and it’s scary as hell. Except he's an upside to falling, it the chance you give your friends to catch you.

The key to surviving a surgical internship is denial. We deny that we're tired; we deny that we're scared, we deny how badly we want to succeed, and most importantly, we deny that we're in denial. We only see want we want to see and believe what we want to believe. And it works. We lie to ourselves so much that after a while the lies start to see like the truth. We deny so much that we can’t recognize the truth right in front of our faces.

As interns, we know what we want, to become surgeons and will do anything to get there. Suffer through killer exams, endure 100 hour weeks, stand for hours on end in operating rooms, you name it we’ll do it. Reconciling this huge thing we want to be surgeons with everything else we want.

Pain comes in all forms. The twinge, a bit of soreness, the random pain, the normal pains we live with everyday. Then there's the kind of pain we can't ignore. A level of pain so great that it blocks out everything else. Makes the rest of the world fade away. Until all we can think about is how much we hurt. How we manage our pain is up to us. Pain, anesthetize, ride it out, embrace it, ignore it, and for some of us, the best way to manage pain is to just push through it.

Pain, you just have to ride it out, hope it goes away on its own, hope the wound that caused it heals. There are no solutions, no easy answers. You just breathe deep and wait for it to subside. Most of the time pain can be managed. But sometimes the pain gets u when you least expect it. Hits way below the belt and doesn’t let up. Pain, you just have to fight through because the truth is you can’t outrun it and life always makes more.

In general, people can be categorized in one of two ways. Those who love surprises and those who don't. I... Don't. I've never met a surgeon who enjoys a surprise, because as surgeons we like to be in the know. We have to be in the know, because when we aren't people die and lawsuits happen. Am I rambling? I think I'm rambling. Okay so my point actually, and I do have one, has nothing to do with surprises or death or lawsuits or even surgeons. My point is this... Whoever said what you don't know can't hurt you was a complete and total moron. Because for most people I know, not knowing is the WORST feeling in the world. Okay fine... Maybe it's the second worst.

As surgeons there are so many things we have to know. We have to know we have what it takes. We have to know how to take care of our patients and how to take care of each other. Eventually we even have to figure out how to take care of ourselves. As surgeons, we have to be in the know, but as human beings, sometimes it's better to stay in the dark. Because in the dark there may be fear, but there is also hope.

In the eighth grade, my English had to read 'Romeo and Juliet'. Then, for extra credit, Mrs. Snyder made us act out all the parts. Sal Scaffarillo was Romeo. As fate would have it, I was Juliet. All the other girls were jealous, but I had a slightly different take. I told Mrs. Snyder that Juliet was an idiot. For starters, she falls for the one guy that can’t have, then she blames fate for her own bad decision. Mrs. Snyder explained to me that when fate comes in life, choice sometimes goes out the window. At the ripe old age of thirteen, I was very clear, that love like life was about making choices. And fate has nothing to do with it. Everyone thinks it’s so romantic. Romeo and Juliet, true love, how sad. If Juliet was stupid enough to fall for the enemy, drink a bottle of poison, and go to sleep in a mazzolium, she deserved whatever she got.

Maybe Romeo and Juliet were fated to be together, but just for a while. And then their time passed. If they could have known beforehand, maybe it would have been okay. I told Mrs. Snyder that when I was grown up I’d take fate into my own hands. I wouldn’t let some guy drag me down. Mrs. Snyder said I’d be lucky if I ever had that kind of passion for someone, and if I did, we’d be together forever. Even now, I believe, for the most part, love is about choices. It’s about putting down the poison and the dagger and making your own happy ending, most of the time. And that sometimes, despite all your best choices and all your best intentions, fate wins anyways.

A wise man once said, you can have anything in life if you will sacrifice everything else for it. What he meant is, nothing comes without a price. So before you go into battle, you better decide how much you’re willing to lose. Too often, going after what feels good means letting go of what you know is right. And letting someone in means abandoning the walls you’ve spent a lifetime building. Of course the toughest sacrifices are the ones we don’t see coming. When we don’t have time to come up with a strategy, to pick a side, or to measure the potential loss, when that happens, when the battle chooses us and not the other way around, that’s when the sacrifice turns out to be more than we can bare.

The dream is this, that we’ll finally be happy when we reach our own goals, find the guy, finish our internship, that’s the dream. Then we get married. And if we’re human, we immediately start dreaming of something else. Because if this is the dream, then we’d like to wake up. Now, please.

At the end of the day, faith is a funny thing. It turns up when you don’t really expect it. It’s like one day you realize that the fairytale maybe slightly different than you dreamed of. Castle, well, it may not be a castle. And it’s not so happy as ever after just that it's happy right now. See once in a while, once in a blue moon, people will surprise you. Then once in a while people may even take your breath away.

There's an old proverb that says you can't choose your family. You take what the fates hand you. And like them or not, love them or not, understand them or not, you cope. Then there's the school of thought that says the family you're born into is simply a starting point. They feed you, and clothe you, and take care of you, until you're ready to go out into the world and find your tribe.

As doctors, we're trained to be skeptical. Because our patients lie to us all the time. The rule is, every patient is a liar, until proven honest. Lying is bad. Or so we're told. Constantly. From birth. Honesty is the best policy. Truthfully, I chopped down the cherry tree. Whatever. The fact is, lying is a necessity. We lie to ourselves because the truth hurts.

As doctors, as friends, as human beings, we all try to do the best we can. But the world is full of unexpected twists and turns, and just when you’ve gotten the lay of the land the ground underneath shifts and knocks you off your feet. If you’re lucky, you end up with nothing more than a flesh wound, something a band aid will cover. But some wounds are deeper than they appear and require more than just a quick fix. With some wounds, you have to rip off the band aid, let them breathe, and give them time to heal.

In surgery, there is a red line on the floor that marks the point where the hospital goes from being accessible to being off limits to all, but a special few. Crossing the line, unauthorized is not tolerated. In general, lines are there for a reason, for safety, for security, for clarity. If you choose to cross the line, you do so at your own risk. So why is it that the bigger the line, the greater the temptation to cross it?

We can't help ourselves. We see a line, we want to cross it. Maybe it's the thrill of trading the familiar for the unfamiliar. A sort of personal dare. Only problem is, once you crossed, it's almost impossible to go back. But if you do manage to make it back across that line, you find safety in numbers.

I heard that it is impossible to grow up. I’ve just never met anyone who’s actually done it. Without parents to defy we break the rules we make for ourselves. We throw tantrums when things don’t go our way. We whisper secrets with our best friends in the dark. We look for comfort where we can find it. And we hope against all logic, against all experience. Like children, we never give up hope.

After careful consideration and many sleepless nights, here's what I've decided. We move on, we move out, we move away from our families and form our own. But the basic insecurities, the basic fears and all those old wounds just grow up with us. And just when we think life and circumstance have forced us truly to become an adult, your mother says something like that. Or worse, something like that. We get bigger, we get taller, we get older. But, for the most part, we're still a bunch of kids, running around the playground, trying desperately to fit in.

As surgeons we’re trained to look for disease. Sometimes the problem is easily detected. Most of the time we need to go step by step. First, probing the surface, looking for any sign of trouble: a mole, or a lesion, or an unwelcomed lump. Most of the time we can’t tell what’s wrong with somebody by just looking at them. After all, they can look perfectly fine on the outside, while their insides tell us a whole other story.

Not all wounds are superficial. Most wounds run deeper than we imagine. You can’t see them with a naked eye. And then there are the wounds that take us by surprise. The trick with any kind of wound or disease is to dig down and find the real source of the injury. And once you’ve found it, try like hell to heal that sucker.

As doctors, patients are always telling us how they would do our jobs. Just stitch me up, slap a band aid on it, and send me home. It’s easy to suggest a quick solution when you don’t know much about the problem, when you don’t understand the underlying cause, or just how deep the wound really is. The first step towards a real cure is to know exactly what the disease is to begin with, but that’s not what people want to hear. We’re supposed to forget the past that landed us here, ignore the future complications that might arise, and go for the quick fix.

As surgeons, we live in a world of worst case scenarios. We cut ourselves off from hoping for the best because too many times, the best doesn’t happen. But every now and then, something extraordinary occurs. And suddenly, best case scenarios seem possible. And every now and then, something amazing happens. And against our better judgment we start to have hope.

As doctors, we’re trained to give our patients just the facts, but what our patients really want to know is, ‘Will the pain ever go away?’ ‘Will I feel better?’ ‘Am I cured?’ But what our patients really want to know is, ‘Is there hope?’ but inevitably there are times when you find yourself in the worst case scenario. When the patient’s body has betrayed them and all the science we have to offer has failed them, when the worst case scenario comes true, clinging to hope is all we’ve got left.

In hospitals, they say you know, you know when you're going to die. Some doctors say it's a look patients get in their eyes, some say there's a scent, a smell of death. Some think there's just some kind of sixth sense when the great beyond is heading for you, you feel it coming. Whatever it is, it's creepy because if you know, what do you do about it? Forget about the fact that you're scared out of your mind: if you knew this was your last day on earth, how would you want to spend it?

My college campus has a magic statue. It’s a long-standing tradition for student to rub its nose for good luck. My freshman roommate really believed in the statue’s power and insisted on visiting it to rub its nose before every exam. Studying might have been a better idea. She flunked out in sophomore year. But the fact is, we all have superstitious things that we do. If it’s not believing in magic statues, it’s avoiding sidewalk cracks. Always putting our left shoe on first, knock on wood, step on a crack break your mother’s back. The last thing we want to do is offend the gods.

Superstition lies in the space between what we can control and what we can’t. Find a penny, pick it up. And all day long, you’ll have good luck. No one wants to pass up a chance for good luck, but does saying it 33 times really help? Is anyone really listening? And if no one’s listening, why do we bother doing those strange things at all? We rely on superstitions because we’re smart enough to know that we don’t have all the answers. And that life works in mysterious ways. Don’t diss the ju-ju from where ever it comes.

The thing about addiction is, it never ends well. Because eventually, whatever it is that was getting us high, stops feeling good, and starts to hurt. Still, they say you don't kick the habit until you hit rock bottom. But how do you know when you are there? Because no matter how badly a thing is hurting us, sometimes, letting it go hurts even worse.

Life is not a spectator sport. Win, lose, or draw, the game is in progress whether we want it to be or not. So go ahead. Argue with the refs, change the rules, cheat a little, take a break and tend to your wounds. But play. Play. Play hard. Play fast. Play loose and free. Play as if there’s no tomorrow. Okay, so it’s not whether you win or lose, it’s how you play the game, right?

There are medical miracles. Being worshipers at the alter of science, we don't like to believe miracles exist, but they do. Things happen. We can't explain them, we can't control them, but they do happen. Miracles do happen in medicine. They happen every day. Just not always when we need them to happen.

The thing about plans is they don’t take into account the unexpected. So when we’re thrown a curve ball, whether it’s in the O.R. or in live, we have to improvise. Of course, some of us are better at it than others. Some of us just have to move on to Plan B and make the best of it. And sometimes, what we want is exactly what we need, but sometimes, sometimes what we need is a new plan.

At the end of a day like this, a day when so many prayers are answered and so many aren’t. We take our miracles where we find them. We reach across the gap and sometimes against all odds, against all logic, we touch.

But as tough as wanting something can be, the people who suffer the most are those who don't know what they want.

In the hospital, we see addiction every day. It's shocking, how many kinds of addiction exist. It would be too easy if it was just drugs and booze and cigarettes. I think the hardest part of kicking a habit is wanting to kick it. I mean, we get addicted for a reason, right? Often, too often, things that start out as just a normal part of your life at some point cross the line to obsessive, compulsive, out of control. It's the high we're chasing, the high that makes everything else fade away.

Change. We don't like it. We fear it, but we can't stop it from coming. We either adapt to change or we get left behind. It hurts to grow, anybody who tells you it doesn't is lying, but here's the truth sometimes the more things change the more they stay the same. And sometimes, oh, sometimes change is good. Sometimes change is everything.

In life, only one thing is certain apart from death and taxes. No matter how hard you try, no matter how good your intentions, you are going to make mistakes. You are going to hurt people. You are going to get hurt. And if you ever want to recover, there’s really only one thing you can say.

Forgive and forget, that’s what they say. It’s good advice but it’s not very practical. When someone hurts us, we want to hurt them back. When someone wrongs us, we want to be right. Without forgiveness, old scores are never settled. Old wounds never heal. And the most we can hope for is that one day, we’ll be lucky enough to forget.

Bones break. Organs burst. Flesh tears. We can sew the flesh, repair the damage, ease the pain. But when life breaks down... when we break down... there's no science, no hard and fast rules. We just have to feel our way through, and to a surgeon, there's nothing worse, and there's nothing better.

Sometimes reality has a way of sneaking up and biting us in the ass. And when the damn bursts, all you can do is swim. The world of pretend is a cage not a cocoon. We can only lie to ourselves for so long. We are tired; we are scared, denying it won’t change the truth. Sooner r later we have to put aside our denial and face the world, head on, guns blazing. Denial, it’s not just a river in Egypt, it’s a freaking ocean. So how do you keep from drowning in it?

They say practice makes perfect. Theory is, the more you think like a surgeon, the more you become one. The better you get at remaining neutral, clinical, cutting, sutures, close. The harder it becomes to turn it off, to stop thinking like a surgeon, and remember what it means to think like a human being.

Gratitude. Appreciation. Giving thanks. No matter what words you use, it all means the same thing. Happy. We're supposed to be happy. Grateful for friends, family. Happy to just be alive. Whether we like it or not.

I wish there were a rule book for intimacy. Some kind of guide that can tell you when you've crossed the line. It would be nice if you could see it coming, and I don't know how you fit it on a map. You take it where you can get it, and keep it as long as you can. And as for rules, maybe there are none. Maybe the rules of intimacy are something you have to define for yourself.

At the end of the day, there are some things you just can't help but talk about. Some things we just don't want to hear, and some things we say because we can't be silent any longer. Some things are more than what you say, they're what you do. Some things you say cause there's no other choice. Some things you keep to yourself. And not too often, but every now and then, some things simply speak for themselves.

Communication. It's the first thing we really learn in life. Funny thing is, once we grow up, learn our words, start talking, the harder it becomes to know what to say. Or how to ask for what we really need.

Four hundred years ago, another English guy had a well-known opinion about being alone. John Donne. He thought we were never alone. Of course, it was fancier when he said it. "No man is an island entire unto himself." Boil down that island talk, and he just meant that all anyone needs is someone to step in and let us know we're not alone. And who's to say that someone can't have four legs. Someone to play with or run around with, or just hang out.

When you were a kid, it was Halloween candy. You hid it from your parents and ate it until you go sick. In college, it was the heavy combo of youth, tequila and well, you know. As a surgeon, you take as much of the good as you can get. Because it doesn’t come around nearly as often as it should. Cause good things aren’t always what they seem. Too much of anything, even love, is not always a good thing.

Maybe we’re not supposed to be happy. Maybe gratitude has nothing to do with joy. Maybe being grateful means recognizing what you have, or what it is. Appreciating small victories. Admiring the struggle it takes simply to be human. Maybe we’re thankful for the familiar things we know. And maybe we’re thankful for the things we’ll never know. At the end of the day, the fact that we still have the courage to be standing is reason enough to celebrate.

It’s an urban myth that suicide rates spike at the holidays. Turns out, they actually go down. Experts think it’s because people are less inclined to off themselves when surrounded by family. Ironically, that same family togetherness is thought to be the reason why depression rates actually do spike at the holidays.

Fresh starts. Thanks to the calendar they happen every year, just set your watch to January. Our reward for survive the holiday season is a new year, bringing on the great tradition of New Year's resolutions. Put your past behind you and start over. It's hard to resist the chance of a new beginning,a chance to put the problems of last year to bed.

No matter how hard we try to ignore it, or deny it. Eventually the lies fall away. Whether we like it or not. But here’s the truth about the truth. It hurts. So, we lie.

A patient’s history is as important as their symptoms. It’s what helps us decide if heartburn is a heart attack, if a headache’s a tumor. Sometimes patients will try to rewrite their own history. They’ll claim they don’t smoke or forget to mention certain drugs, which in surgery, can be the kiss of death. We can ignore it all we want, but our history eventually comes back to haunt us.

Some people believe that without history, our lives amount to nothing. At some point we all have to choose, do we fall back on what we know, or do we step forward to something new? It’s hard not to be haunted by our past. Our history is what shapes us, what guides us. Our history resurfaces time after time after time. So we have to remember, sometimes the most important history, is the history we’re making today.

Who gets to determine when the old ends and the new begins? It’s not a day on a calendar. Not a birthday, not a new year. It’s an event, big or small, something that changes us. Ideally it gives us hope. A new way of living and looking at the world. Letting go of old habits, old memories. What’s important is that we never stop believing that we can have a new beginning. But it’s also important to remember that amid all the crap are a few things really worth holding onto.

It’s a look patients get in their eyes. It’s a scent, a smell of death, some kind of sixth sense. When the great beyond is headed for you, you feel it coming. What’s the one thing you’ve always dreamed of doing before you die?

A good basketball game can have us all on the edge of our seats. Games are all about the glory, the pain, and the play by play. And then there are the more solitary games. The games we each play all by ourselves. The social games, the mind games, you use them to pass the time, to make life more interesting, to distract us from what’s really going on.

We all go through life like bowls in a China shop. A chip here, a crack there. Doing damage to ourselves, to other people. The problem is, trying to figure out how to control the damage we have done or that has been done to us. Sometimes the damage catches us by surprise. Sometimes we think we can fix the damage. And sometimes the damage is something we can’t even see.

We’re all damaged it seems. Some of us more than others. We carry the damage with us from childhood. Then as grownups we give as good as we get. Ultimately we all do damage. And then we set about the business of fixing.

Chemistry. Either you got it. Or you don't.

There comes a point in your life when you're officially an adult. Suddenly you're old enough to vote, drink, and engage in other adult activities. Suddenly people expect you to be responsible. Serious, a grown up. We get taller, we get older, but do you ever really grow up.

No matter how much we grow taller, grow older, we are still forever stumbling. Forever wondering, forever young.

The key to being a successful intern is what we give up: sleep, friends, and normal life. We sacrifice it all for that one amazing moment. That moment when you can legally call yourself a surgeon. There are days that make the sacrifice seem worthwhile. And there are the days when everything feels like a sacrifice. And then there are the sacrifices that you can’t even figure out why you’re making.

We go into medicine because we want to save lives. We go into medicine because we want to do good. We go into medicine for the rush, for the high, for the ride. But what we remember at the end of most days are the losses. What we lay awake at night replaying is the pain we caused or failed to cure, the lives we’ve ruined or failed to save. So the experience of practicing medicine rarely resembles the goal. The experience, too often, is ass backwards and upside down.

Fifteen minutes. Fifteen hours. Inside the OR the best surgeons make time fly. Outside the OR however, time takes pleasure in kicking our asses. For even the strongest of us, it seems to play tricks. Slowing down, hovering, until it freezes, leaving us stuck in a moment, unable to move in one direction or the other.

The joy, supposedly, is in the giving. So when the joy is gone; when the giving starts to feel more like a burden, that's when you stop. But if you're like most people I know, you give 'til it hurts. And then you give some more.

Deep down, everyone wants to believe they can be hardcore. But being hardcore isn’t just about being tough. It’s about acceptance. Sometimes you have to give yourself permission to not be hardcore for once. You don’t have to be tough every minute of every day. It’s okay to let down your guard. In fact there are moments when it’s the best thing to do... as long as you choose your moments wisely.

According to Elizabeth Kubler-Ross, when we are dying or have suffered a catastrophic loss, we all move through five distinct stages of grief. We all go into denial, because the loss is so unthinkable, we can't imagine it's true. We become angry with everyone - angry with survivors, angry with ourselves. Then we bargain. We beg, we plead, we offer everything we have. We offer up our souls in exchange for just one more day. When the bargaining has failed and the anger is too hard to maintain, we fall into depression, despair, until finally we have to accept that we have done everything we can. We let go. We let go and move into acceptance.

Every day we face death. Every day we lose life. And every day we're hoping for a stay of execution. We are attached to death, chained like prisoners, captives.

Practicing medicine doesn't lend itself well to the making of friends. Maybe because life and mortality are in our faces all the time. Maybe because instead of staring down death every day, we're forced to know that life, every minute, is borrowed time. And each person we let ourselves care about is just one more loss somewhere down the line. For this reason, I know some doctors who just don't bother making friends at all. But the rest of us, we make it our job to move that line, to push each loss as far away as we can.

At some point, you have to make a decision. Boundaries don’t keep other people out, they fence you in. life is messy, that’s how we're made. So you can waste your life drawing lines, or you can live your life, crossing them. But there are some lines that are way too dangerous to cross. Here what I know, if you're willing to take the chance, the view from the other side, is spectacular.

Before we were doctors, we were med students, which meant we spent a lot of time studying chemistry. Organic chemistry, biochemistry, we learned it all. But when you're talking about human chemistry, only one thing matters. Either you got it, or you don't.

Time flies. Time waits for no man. Time heals all wounds. All any of us wants is more time. Time to stand up. Time to grow up. Time to let go. Time.

At any given moment, the brain has fourteen billion neurons firing at a speed of 450 miles per hour. We don’t have control over most of them. When we get a chill: goose bumps. When we get excited: adrenaline. The body naturally follows its impulses which I think is part of what makes it so hard for us to control ours. Of course, we have impulses we would rather not control, that we later wish we had.

The body is a slave to its impulses. But the thing that makes us human is what we can control. After the storm, after the rush, after the heat of the moment has passed, we can cool off and clean up the messes we’ve made. We can try to let go of what was. And then again...

Surgeons usually fantasize about why old and improbable surgeries. Someone collapses in a restaurant, we slice them open with a butter knife, replace a valve with a hollowed out carrot stick. But every now and then, some other kind of fantasy slips in. most of our fantasies dissolve when we wake, banish to the back of our minds, sometimes we’re sure, if we try hard enough, we can live the dream.

The fantasy is simple. Pleasure is good. And twice as much pleasure is better. That pain is bad. And no pain is better. But the reality is different. The reality is that pain is there to tell us something. And there is only so much pleasure we can take without getting a stomachache. And maybe that's okay. Maybe some fantasies are only supposed to live in our dreams.

At some point during surgical residency, most interns get a sense of who they are as doctors and the kinds of surgeons they’re going to become. If you ask them, they’ll tell you they’re going to be general surgeons, orthopedic surgeons, neurosurgeons, distinctions that do more than describe their areas of expertise. They help to define who they are because outside the operating room, not only do most surgeons have an idea of who they are, they’re afraid to find out.

If you knew this was your last day on Earth, how would you wanna spend it?

First, do no harm. Easier said than done. We can take all the oaths in the world, but the fact is most of us do harm all the time. Sometimes when we’re even trying to help, we do more harm than good. And then the guilt rears its ugly head. What you do with that guilt is up to you. We’re left with a choice. Either let the guilt throw you back into the behavior that got you into trouble in the first place, or learn from the guilt and do your best to move on.

First, do no harm. As doctors, we pledge to live by this oath. But harm happens and then guilt happens and there’s no oath for how to deal with that. Guilt never goes anywhere on its own. It brings its own friends: doubt and insecurity.

I am a rock. I am an island. That's the mantra of pretty much every surgeon I've ever met. We like to think we're independent, loners, mavericks, but all we need to do our job is an O.R., a scalpel, and a willing body. But the truth is, not even the best of us can do it alone. Surgery, like life, is a team sport. And eventually, you've got to get off the bench and decide... what team are you batting for?

The thing about choosing teams in real life, it's nothing like it used to be in gym class. Being first pick can be terrifying. And being chosen last isn't the worst thing in the world. So we watch from the sidelines clinging to our isolation. Because we know, as soon as we let go of the bench, someone comes along and changes the game completely.

For a surgeon, every patient is a battlefield. They're our terrain, where we advance, retreat, try to remove all the landmines. And just when you think you've won the battle and made the world safe again, along comes another land mine.

Some wars are never over. Some end in an uneasy truce. Some wars result in complete and total victory. Some wars end with a peace offering. And some wars end in hope. But all these wars are nothing compared to the most frightening war of all. The one you have yet to fight.

If you're a normal person, one of the few things you can count on in life is death. But if you’re a surgeon, even that comfort is taken away from you. Surgeons cheat death. We prolong it, we deny it. We stand and defiantly give death the finger.

We’re born. We live. We die. Sometimes not necessarily in that order. We put things to rest only to have them rise up again. So if death is not the end, what can you count on anymore? Life is right. Life is the most fragile, unstable, unpredictable thing there is. In fact, there is only one thing about life we can be sure.

It’s intense what happens in the OR, when lives are on the line. And you’re poking at brains like they are silly putty. You form a bond with the surgeons right next to you, an unbreakable indescribable bond. It’s intimate being tied together like that. Whether you like it or not, whether you like them or not, you become family.

The ties that bind us are sometimes impossible to explain. They connect us even after it seems like the ties should be broken. Some bonds defy distance and time and logic. Because some ties are simply meant to be.

When you’re little, nighttime is scary because there are monsters hiding right under the bed. When you get older, the monsters are different. Self-doubt, loneliness, regret, and though you may be older and wiser, you still find yourself scared of the dark.

Sleep. It’s the easiest thing to do, you just close your eyes. But for so many of us, sleep seems out of grasp. We want it, but we don’t know how to get it. But once we face our demons, face our fears, and turn to each other for help. Night time isn’t so scary because you realize we aren’t all alone in the dark.

My mother called it the greatest and most terrifying moment in her life. Standing at the head of the surgical table knowing that the patient’s life depends on you and you alone. It’s what we all dream about. Because the first person that gets to fly solo in the OR, it’s kinda a bad ass.

We enter the world alone and we leave it alone. And everything that happens in between, we owe it to ourselves to find a little company. We need help, we need support. Otherwise we’re in it by ourselves, strangers, cut off from each other. And we forget just how connected we all are. So instead we choose love, we choose life. And for a moment we feel just a little bit less alone.

We all get at least one good wish a year, over the candles on our birthday. Some of us throw in more, on eyelashes, fountains, lucky stars, and every now and then, one of those wishes comes true. So what then, is it as good as we hoped? Do we bask in the warm glow of our happiness, or do we just notice we have a long list of wishes waiting to be wished?

We don’t wish for the easy stuff. We wish for big things, things that are ambitious, out of reach. We wish because we need help and we’re scared and we know we may be asking too much. We still wish though, because sometimes they come true.

My mother used to say this about residency: It takes a year to learn how to cut. It takes a lifetime to learn not to. Of all the tools on the surgical tray, sound judgment is the trickiest one to master, and without it, we’re all just toddlers running around with ten blades.

We’re human. We make mistakes. We misestimate. We call it wrong. But when a surgeon makes a bad judgment call, it’s not as simple. People get hurt. They bleed. So we struggle over every stitch, we agonize over every suture. Because the snap judgments the ones that come to us quickly and easily without hesitation, they're the ones that haunt us forever.

Any first year med student knows that an increased heart rate is a sign of trouble. A racing heart could indicate anything, from a panic disorder to something much, much more serious. A heart that flutters or one that skipped a beat could be a sign of secret affliction. Or it could indicate romance which, is the biggest trouble of all.

It seems we have no control whatsoever over our own hearts. Conditions can change without warning. Romance can make the heart pound just like panic can. And panic can make it stop cold in your chest. It’s no wonder doctors spend so much time trying to keep the heart stable. To keep its flow, steady, regular. To stop the heart from pounding out of your chest. To keep the dread from something terrible. Or the anticipation of something else entirely.

Every patient’s story starts the same way. It starts with them being fine. It starts in the before. They cling to this moment, this memory of being fine, this before. As they’re talking about it may somehow get back. But what they don’t realize is that the fact that they’re talking about it to us, their doctors, means there’s no going back. By the time they see us, they’re already in the after. And while every patient’s story starts the same way, how the story ends depends on us, on how well we diagnose and treat. We know the story hinges on us. And we all want to be the hero.

Every surgeon I know has a shadow, a dark cloud, a fear in doubt that follows even the best of us into the OR. We pretend the shadow isn’t there. Hoping that if we save more lives, master harder techniques, run faster and farther, it’ll get tired and give up the chase. But like they say, you can’t outrun your shadow.

Every surgeon has a shadow. And the only way to get rid of a shadow is to turn off the lights, to stop running from the darkness, to face what you fear, head on.

When something begins, you generally have no idea how it’s going to end. The house you were going to sell becomes your home. The roommates you were forced to take in become your family. And the one night stand you were determined to forget becomes the love of your life.

How do you know how much is too much? Too much too soon? Too much information? Too much fun? Too much love? Too much to ask? And when is it all just too much to bear?

It’s impossible to describe the panic that comes over you when you’re a surgeon and your pager goes off in the middle of the night. Your heart starts to race, your mind freezes, and your fingers go numb. You’re invested. They're someone’s mom, someone’s dad, someone’s kid, and now it’s on you because that someone's life is in your hands. As surgeons, we’re always invested in our patients. But when your patient’s a child, you’re not just invested. You’re responsible, responsible for whether or not that child survives, has a future, and that’s enough to terrify anyone.

Forty years ago, The Beatles asked the world a simple question. They wanted to know where all the lonely people come from. My theory is that all the lonely people come from hospitals, more precisely, the surgical wing of hospitals. As surgeons we ignore our own needs so we can meet our patients’ needs. We ignore our friends and families, so we can save other people‘s friends and families. Which means at the end of the day all we have are ourselves, and nothing in the world can make you feel more alone than that.

Surgeons are detail-oriented. We like statistics and checklists and operating procedures. Our patients live because we enjoy following the steps, but as much as we love to always rely on number, the plan, we also know that some of the greatest medical discoveries have happened by accident. Mold, penicillin, poisonous tree bark, a cure for malaria, a little blue pill for high blood pressure, impotence be damned. It’s hard for us to accept that it’s not always the hard work or attention to detail that will get us the answers we’re looking for. And sometimes we have to sit back, relax, and wait for the happy accident.

No matter how many plans we make or steps we follow, we never know how our day is going to end up. We prefer to know, of course, curve balls will be thrown our way. It’s the accidents that always turn out to be the most interesting parts of our day, of life. The people we never expected to show up, the turn of events we never would have chosen for ourselves, all of a sudden you find yourself somewhere you never expected to be, and it’s nice or it takes some time getting used to. Still, you know you’ll find yourself appreciating it somewhere down the line. So you go to sleep each night thinking about tomorrow, going over your plans, making your first incisions, and hoping whatever accidents come your way, will be happy ones.

Doctors live in a world of constant progress and forward motion. Stand still for a second and you’ll be left behind. But as hard as we try to move forward, as tempting as it is to never look back, the past always comes back to bite us in the ass. And as history shows us again, and again, those who forget the past are doomed to repeat it.

Sometimes the past is just something you can’t let go of. And sometimes the past is something we’ll do anything to forget. And sometimes we learn something new about the past that changes everything we know about the present.

Surgeons aren’t complacent people. We don’t put our feet up, we don’t sit still. Whatever the game is, we like to win. And once we win, we get a new game. We push ourselves, residents, attendings, it doesn’t matter how much we achieve. If you’re a climber, there’s always another mountain.

It’s the most important job in the world. You probably should need a license to do it but then most of us probably wouldn’t even pass the written exam. Some people are naturals; they were born to do it. Some have other gifts. But the good news is, biology dictates that you don’t have to do it alone. You can waste your whole life wondering but the only way to find out what kind of parent you’ll be, is to finally stop talking about it, and just do it.

In the practice of medicine, change is inevitable. New surgical techniques are created, procedures are updated, levels of expertise increased. Innovation is everything. Nothing remains the same for long. We either adapt to change or we get left behind.

Doctors give patients a number of things. We give them medicine, we give them advice, and most of the time, we give them our undivided attention. But by far the hardest thing you can give a patient is the truth. The truth is hard, the truth is awkward and very awful, the truth hurts. I mean, people say they want the truth, but do they really?

The truth is painful. Deep down nobody wants to hear it especially when it hits close to home. Sometimes we tell the truth because the truth is all we have to give. Sometimes we tell the truth because you need to say it out loud to really hear it for ourselves. And sometimes we tell the truth because we just can’t help ourselves. And sometimes we tell them because we owe them at least that much.

There’s a reason surgeons learn to wield scalpels, we like to pretend we’re hard, cold scientists. We like to pretend we’re fearless. But the truth is we become surgeons because somewhere, deep down we can cut away that which haunts us. Weakness, frailty, death.

It isn’t just surgeons. The truth is I don’t know anyone who isn’t haunted by something or someone. And whether we try to slice the pain away with a scalpel or shove it in the back of a closet, our efforts usually fail. So the only way we can clear out the cobwebs is to turn a new page. Or put an old story to rest. Finally, finally to rest.

There’s this thing about being a surgeon. Maybe it’s pride or just about being tough. But a true surgeon never admits they need help unless absolutely necessary. Surgeons don’t need to ask for help because they’re tougher than that. Surgeons are cowboys, rough around the edges, hardcore, at least that’s what they want you to think.

In some ways we grow up. We have families, we get married, divorced. But for the most part we still have the same problems that we did when we were fifteen. No matter how much we grow taller, grow older, we are still forever stumbling, forever wondering, forever young.

At the end of the day, the experience of practicing of medicine bears little resemblance to the dream. We go into medicine because we want to save lives. We go into medicine because we want to do good. We go into medicine for the rush, for the high, but what we remember at the end of most days are the losses. What we lie awake at night replaying is the pain we caused, the ills we couldn’t cure, the lives we ruined or failed to save. The end of the day the reality is nothing like we hoped. The reality is at the end of the day, more often than not, turned inside out and upside down.

And then somehow, and probably, when you least expect it, the world rights itself again.

We like to think that we are rational beings, humane, conscientious, civilized, thoughtful. But when things fall apart, even just a little, it becomes clear. We’re no better than animals. We have opposable thumbs, we think, we walk erect, we speak, we dream. But deep down we’re all still rooting around in the primordial ooze; biting, clawing, scratching out in existence in the cold dark world like the rest of the tree-toads and sloths.

There’s a little animal in all of us and maybe that’s something to celebrate. Our animal instinct is what makes us seek comfort, warmth, a pack to run with. We may feel caged, we may feel trapped, but still as humans we can find ways to feel free. We are each other’s keepers, we are the guardians of our own humanity and even though there’s a beast inside all of us, what sets us apart from the animals is that we can think, feel, dream, and love. And against all odds, against all instinct, we evolve.

Great surgeons aren't made. They're born. It takes gestation, incubation, sacrifice. A lot of sacrifice. But after all the blood and guts and gooey stuff is washed away, that surgeon you become: totally worth it.

Giving birth may be all intense and magical and stuff, but the act itself: it's not exactly pleasant. But it's also a beginning... of something incredible. Something new. Something unpredictable. Something true. Something worth loving. Something worth missing. Something that will change your life... forever.

There’s this person, in my head, she is brilliant, capable. She can do chest tubes and craniotomies. She can run a code without freaking out. She’s a really good surgeon. Maybe even a great surgeon. She’s me, only so much better.

The problem with being a resident is, you feel crazy all the time. You haven’t slept in years. You spend every day around people in massive crisis, lose your ability to judge what’s normal, in yourself or anyone else. And yet people are constantly asking you to tell them how they’re doing. How the hell are you supposed to know? You don’t even know how you’re doing.

Don't wonder why people go crazy. Wonder why they don't. In face of what we can lose in a day, in an instant, wonder what the hell it is that make us hold it together.

My mother used to say that for a surgeon a day without death is a rare gift. Every day we face death. Every day we lose life. And every day we’re hoping for a stay of execution. We’re attached to death, chained like prisoners, captives.

It was a good day. Maybe even a great day. I was a good doctor, even when it was hard, I was the ‘me’ in my head. There was a moment when I thought I can’t do this, I can’t do this alone. I close my eyes and imagine myself doing it, and I did, I blocked out the fear, and I did it.

We all remember the bedtime stories of our childhoods. The shoe fits Cinderella, the frog turns into a prince, Sleeping Beauty is awaken with a kiss, ‘once upon a time’ and ‘then they lived happily ever after’. Fairytales, the stuff of dreams. The problem is, fairytales don’t come true. It’s the other stories, the ones that begin with dark and stormy nights and end in the unspeakable. It’s the nightmares that always seem to become reality. The person that invented the phrase happily ever after should have his ass kicked so hard.

Once upon a time. Happily ever after. The stories we tell are the stuff of dreams. Fairytales don’t come true. Reality is much stormier, much murkier, much scarier. Reality, it’s so much more interesting than living happily ever after.

As surgeons we are trained to fix what's broken. The breaking point is our starting line... at work. But in our lives the breaking point is a sign of weakness and we'll do everything we can to avoid it.

In 6500 BC, some guy looked at his sick friend and said, ‘I have an idea. Why don’t I drill a hole in your skull? It will make you feel better.’ And thus surgery was born. It takes a certain brand of crazy to think of drilling into someone's skull, but surgeons have always been a confident bunch. We usually know what we're doing, and when we don’t, we still act like we do. We walk boldly into an undiscovered country, plant a flag and start ordering people around. It's invigorating and terrifying.

We like to think we're fearless, eager to explore unknown lands and soak up new experiences, but the fact is, we're always terrified. Maybe the terror is part of the attraction. Some people go to horror movies. We cut things open. Dive into dark water. And at the end of the day, isn't that what you'd rather to hear about? If you've got one drink and one friend and 45 minutes. Slow rides make for boring stories. A little calamity. Now that's worth talking about.

There’s this thing that happens, when people find out you’re a doctor. They stop seeing you as a person and begin to see you as something bigger than you are. They have to see us that way, as gods, otherwise we’re just like everyone else: unsure, flawed, normal. So we act strong, we remain stoic, we hide the fact that we’re all too human.

Patients see us as gods or they see us as monsters, but the fact is we’re just people. We screw up. We lose our way. Even the best of us have our off days. Still we move forward. We don’t rest on our morals or celebrate the lives we’ve saved in the past. Because there’s always some other patient that needs our help. So we force ourselves to keep trying, to keep learning, in the hope that maybe, someday, we’ll come just a little bit closer to the gods our patients need us to be.

Surgeons aren’t known for being warm and cuddly. They’re arrogant, impatient, mean as often as not. You’d think they wouldn’t have friends, ‘cause who could stand them. But surgeons, are like a bad cold, nasty, but persistent. Surgeons, nasty, aggressive, unstoppable, just the kind of people you want on your side when you’re really screwed.

Defeat isn’t an option. Not for surgeons. We don’t back away from the table until the last breath is long gone. ‘Terminal’s a challenge, ‘life threatening’s what gets us out of bed in the morning. We’re not easily intimidated. We don’t flinch. We don’t back down. And we certainly don’t surrender. Not at work anyway.

To do our jobs we have to believe defeat is not an option. That no matter how sick our patients get, there’s hope for them. But even when our hopes give way to reality, and we finally have to surrender to the truth, it just means we’ve lost today’s battle, not tomorrow’s war. Here’s the thing about surrender, once you do it, actually give in, you forget why you were even fighting in the first place.

Remember when we were little and we would accidentally bite a kid on the playground. Our teachers would go, ‘Say you’re sorry,’ and we would say it, but we wouldn’t mean it, because the stupid kid we bit totally deserved it. But as we get older, making amends isn’t so simple. After the playground days are over, you just can’t say it, you have to mean it. Of course, when you become a doctor, ‘sorry’ is not a happy word. It either means ‘you’re dying and I can’t help’ or it means, ‘this is really gonna hurt.’

As doctors, we can’t undo our mistakes and we rarely forgive ourselves for them, but it’s a hazard of the trait. But as human beings, we can always try to do better, to be better, to right or wrong, even when it feels irreversible. Of course, ‘I’m sorry’ doesn’t always cut it. Maybe because we use it so many different ways, as a weapon, as an excuse. But when we are really sorry, when we use it right, when we mean it, when our actions say what words never can. When we get it right, ‘I’m sorry’ is perfect. When we get it right, ‘I’m sorry’ is redemption.

We spend our whole lives worrying about the future, planning for the future, trying to predict the future. As if figuring it our will somehow cushion the blow. But the future is always changing. The future is the home of our deepest fears and our wildest hopes. But one thing is certain, when it finally reveals itself, the future is never the way we imagine it.

Doctors spend a lot of time focused on the future, planning it, working toward it. But at some point you start to realize your life is happening now. Not after med school, not after residency, right now. This is it. It’s here. Blink and you’ll miss it.

Did you say it? I love you. I don’t ever want to live without you. You changed my life. Did you say it? Make a plan, set a goal, work toward it. But every now and then look around, drink it in. ‘Cause this is it. It might all be gone tomorrow.

In medical school we have a hundred classes that teach us how to fight off death. Not one lesson in how to go on living.

The dictionary defines grief as ‘key mental suffering or distress over affliction or loss, sharp sorrow, painful regret.’ As surgeons, as scientists, we’re taught to learn from and rely on books on definitions, on definitives. But in life, strict definitions rarely apply. In life, grief can look like a lot of things that bare little resemblance to sharp sorrow.

Paranoia gives you an edge in the OR. Surgeons play out worst case scenarios in their heads. You’re ready to close, you got the bleeder, you know it, but there’s that voice in your head asking, ‘What if you didn’t? What if the patient dies and you could of prevented it?’ So you check your work one more time before you close. Paranoia is a surgeon’s best friend.

We’re all susceptible to it, the dread and anxiety of not knowing. It’s pointless in the end. Because all the worrying and all the making of plan that could or could not happen, it only makes things worse. So walk your dog, or take a nap. Just whatever you do, stop worrying. Because the only cure for paranoia is to be here, just as you are.

We begin life with few obligations. We pledge allegiance to the flag. We swear to return our library books. But as we get older we take vows, we make promises, we get burdened by commitments to do no harm, to tell the truth and nothing but, to love and cherish til death do us part. So we just keep running up a tab until we owe everything to everybody and suddenly think, ‘What the -!’

The thing about being a surgeon, everybody wants a piece of you. We take one little oath and suddenly we’re drowning in obligations to our patients, to our colleagues, to medicine itself. So we do what any sane person would be. We run like hell from our promises, hoping they’ll be forgotten. But sooner or later, they always catch up. And sometimes you find the obligation you dread the most isn’t worth running from at all.

When you get sick, it starts out with a single bacterium. One alone, nasty intrudent. Pretty soon, it duplicates, becomes two. Then those two become four and those four become eight. Then, before your body knows it, it’s under attack. It’s an invasion. The question for the doctor is, once the invaders have landed, once they have taken over your body, how the hell do you get rid of them?

What do you do when the infection hits you? When it takes over? Do you do what you’re supposed to and take your medicine or do you learn to live with that pain and hope that someday it goes away? Or do you just give up entirely and let it kill you?

In order to get a good diagnosis, doctors have to constantly change their perspective. We start by getting the patient’s point of view, thought they often don’t have a clue what’s going on. So we look at the patient from every possible angle. We rule things out. We uncover new information, trying to get to what’s actually wrong. We’re asked for second opinions hoping we’ll see something others might have missed. For the patient, a fresh perspective can mean the difference between living and dying. For the doctor, it can mean you’re picking a fight with everyone who got there before you.

When we’re headed toward an outcome that’s too horrible to face, that’s when we go looking for a second opinion. And sometimes, the answer we get just confirmed our worst fears. But sometimes, it can shed new light on the problem. It makes you see it in a whole new way. After all the opinions had been heard and every point of view had been considered, you finally find what you were after, the truth. But the truth isn’t where it ends. That’s just where you begin again, with a whole new set of questions.

They say the bigger your investment the bigger your return. But you have to be willing to take a chance. You have to understand you might lose it all. But if you take that chance, if you invest wisely, the payoff might surprise you.

The best gift I ever got was for Christmas when I was ten. My very first suture kit. I used it until my fingers bled then I tried to use it to stitch up my fingers. It put me on the path to becoming a surgeon. My point is, sometimes the best gifts come in really surprising packages.

Every day we get to give the gift of life. It can be painful. It can be terrifying. But in the end, it’s worth it. Every time. We all have the opportunity to give. Maybe the gifts aren’t as dramatic as what happens in the operating room. Maybe the gift is to try and make a simple apology. Maybe it’s to understand another person’s point of view. Maybe it’s to hold a secret for a friend. The joy, supposedly, is in the giving. So when the joy is gone, when the giving starts to feel more like a burden, that’s when it stops. But if you’re like most people I know, you give until it hurts, then you give some more.

We assume the really serious changes in our lives happen slowly, over time, but it’s not true. The big stuff happens in an instance. Becoming an adult, becoming a parent, becoming a doctor, one minute you’re not and the next you are. Ask any doctor and they can point to the one moment they became a physician. It usually isn’t med school graduation day. Whatever it is, nobody forgets it. Sometimes you don’t even know anything’s changed. You’re still you and your life is still your life. You wake up one day and look around and you don’t recognize anything. Not anything at all.

You never forget the moment you become a doctor. A switch flips; suddenly you’re not playing dress up anymore. You own the white coat. What you may not notice is, that being a doctor changes you.

Number one rule of surgery is limit exposure. Keep your hands clean, your incisions small, and your wounds covered. Number two rule of surgery is that when number one stops working, try something else. Because sometimes you can’t limit exposure, because sometimes the injury is so bad you have to cut and cut big.

In surgery, the healing process begins with a cut, an incision, the tearing of flesh. We have to damage the healthy flesh in order to expose the unhealthy. It feels cruel and against common sense but it works. You risk exposure for the sake of healing. And when it’s over, once the incision has been closed, you wait. You wait and you hope that your patient will heal, that you haven’t in fact just made everything worse.

The surgical scalpel is made of sterilized, carbonized, stainless steel. This is a vast improvement over the first scalpel, which was pretty much a sharp stick. Medicine is constantly reinventing itself, that means surgeons have to keep reinventing themselves too. There’s constant pressure to adapt to changes. It can be a painful process. But without it, you’ll find yourself moving backwards instead of forward.

We have to keep reinventing ourselves almost every minute because the world can change in an instance. And there’s no time for looking back. Sometimes the changes are forced on us. Sometimes they happen by accident. And we make the most of them. We have to constantly come up with new ways to fix ourselves. So we change, we adapt, we create new versions of ourselves. We just need to be sure this one is an improvement over the last.

They take pictures of mountain climbers at the top of the mountain. They’re smiling, ecstatic, triumphant. They don’t take pictures along the way because who wants to remember the rest of it. We push ourselves because we have to not because we like it. The relentless climb, the pain and anguish of taking it to the next level, nobody takes pictures of that, nobody wants to remember. We just want to remember the view from the top. The breath taking moment at the end on the world, that’s what keeps us climbing, and it’s worth the pain. That’s the crazy part. It’s worth anything.

Maybe you have to be dying to understand, but there’s this thing that happens where death stops being scary. What starts being scary is hope, because it’s not true. Even if they found a cure for cancer tomorrow, it’s too late for me. And hanging on to hope, it may make you feel better, but it just makes me feel alone. I don’t want to die alone. I am not afraid of this. Why are you? Why are you so afraid to let me die?

Psychologists believe that every aspect of our lives, all our thought processes and behavioral patterns, are the direct result of our relationship to our parents. That every relationship that we have is the result of that first relationship. It’s just us trying over and over again to get it right.

We’re doctors. We’re trained to care for human beings and we’re pretty sure we know what to look for. Cuts, infection, genetic mutation.

As doctors, we have an arsenal of weapons at the ready. Antibiotics to kill infections, narcotics to fight pain, scalpels and retractors to remove tumors and cancers, to eradicate the threat. But just he physical threat to every other kind, you’re on your own.

The skin is the largest organ in the body. It protects us, holds us together, literally lets us know what we’re feeling. The skin can be soft and vulnerable, highly sensitive, easy to break. Skin doesn’t matter to a surgeon. We’ll cut right through it. go inside, find the secrets underneath. It takes delicacy and sensitivity.

No matter how thick skin we try to be, there’s millions of electrifying nerve endings in there, open and exposed and feeling way too much. Try as we might to keep from feeling pain. Sometimes it’s just unavoidable. Sometimes that’s the only thing left. Just feeling.

It’s a common belief that positive thinking leads to a happier, healthier life. As children, we’re told to smile and be cheerful and put on a happy face. As adults, we’re told to look on the bright side, make lemonade and see the glass as half full. Sometimes reality can get in the way of our ability to act the happy part. Your health can fail, boyfriends can cheat, friends can disappoint. It’s in these moments when you just want to get real and drop the act and be your true, scared, unhappy self.

Ask most people what they want out of life and the answer is simple, to be happy. Maybe it’s this expectation though, the wanting to be happy that keeps us from getting there. Maybe the more we try to will ourselves to states of bliss the more confuse we get, to the point where we don’t recognize ourselves. Instead we just keep smiling, trying like hell to be the happy people we were, until eventually it hits us, it’s been here all along. Not in our dreams or our hopes but in the now, the comfortable, the familiar.

For most people, a hospital is a scary place, a hostile place, a place where bad things happen. Most people would prefer church, or school, or home. But I grew up here. While my mom was on rounds, I learned to read in the OR gallery, I played in the morgue, I colored with crayons on old ER charts, a hospital was my church, my school, my home. The hospital was my safe place, my sanctuary, I love it here. Correction, loved it here.

I learned to read in the OR gallery. I played in the morgue. I colored with crayons on old ER charts. The hospital was my church, my school, my home, my safe place, my sanctuary. I love it here. Correction, loved it here.

Doctors practice deception every day — on our patients, on their families. But the worst deception we practice is on ourselves. Which is why sometimes it takes us a while to realize that the truth has been in front of us the whole time.

Doctors practice deception all the time. We give vague answers to hard questions. We don't talk about post-op pain. We say you'll experience some discomfort. If you didn't die, we tell you the surgery went well, but the placebo has to be the doctor's greatest deception. Half of our patients we tell the other truth ... the other half, we pray the placebo effect's real. And we tell ourselves that they'll feel better anyhow, believing help's on the way, when, in fact, we're leaving them to die.

Surgery is a high stakes game. But no matter how high the stakes, sooner or later, you're just going to have to go with your gut, and, maybe just maybe, that'll take you right where you were meant to be in the first place.

One of the hardest lessons as a doctor is learning to prioritize. We're trained to do all we can to save life and limb, but, if cutting off a limb, means saving a life, we learn to do it without hesitation. It's not an easy lesson to learn, and it always comes down to one question, "what are the stakes?" What do we stand to gain or lose? At the end of the day, we're just gamblers trying not to bet the farm.

An hour, one hour, can change everything forever. An hour can save your life. An hour can change your life. Sometimes an hour is a gift we give ourselves. For some, an hour can mean almost nothing. For others, an hour makes all the difference in the world. But in the end, it's still just an hour. One of many. Many more to come. Sixty minutes. Thirty-six hundred seconds. That's it. Then it starts all over again. And who knows what the next hour might hold.

How much can you actually accomplish in an hour? Run an errand maybe, sit in traffic, get an oil change. When you think about it an hour isn't very long. Sixty minutes. Thirty-six hundred seconds. That's it. In medicine, though, an hour is often everything. We call it the golden hour. That magical window of time that can determine whether a patient lives or dies.

We are responsible with our patients. The problem is we blow it all out at work. In our own lives, we can't think things through. We don't make the sound choice. We did that all day at the hospital. When it comes to ourselves, we've got nothing left. And is it worth it—being responsible? Because if take your vitamins and pay your taxes and never cut the line, the universe still gives you people to love and then lets them slip through your fingers like water, and what've you got? Vitamins and nothing.

Everyone figures doctors are the most responsible people they know. They hold lives in their hands. They're not flakes. They don't lose track of important details or make stunningly bad judgment calls. 'Cause that would be bad, right?

It's every doctor's dilemma. Do you play it safe and follow protocol? Or take a risk and invent a new one? There can be reward in risk. There can also be fallout. Still you need to book the system every once in a while. Bet big. And when you get the results you want, there's no better feeling in the world, but when you don't...

Renegades, rule-breakers, gangsters with scalpels. This is the way we like to think of ourselves. It makes us feel bad ass, sexy. Problem is it's not exactly true. At heart, we're rule followers, sheep. We don't break protocol. We follow it to a "T." Because if we don't follow protocol, our patients die, and then we're no longer bad ass. We're just bad.

The length of your recovery is determined by the extent of your injuries. And it's not always successful. No matter how hard we work at it. Some wounds might never fully heal. You might have to adjust to a whole new way of living. Things may have changed too radically to ever go back to what they were. You might not even recognize yourself. It's like you haven't recovered anything at all. You're a whole new person with a whole new life.

After a trauma, your body is at its most vulnerable. Response time is critical. So you're suddenly surrounded by people—doctors, nurses, specialists, technicians—surgery is a team sport. Everyone pushing for the finish line. Putting you back together again. But surgery is a trauma in and of itself, and once it's over, the real healing begins. It's called recovery. Recovery is not a team sport. It's a solitary distance run. It's long. It's exhausting. And it's lonely as hell.

Diseases. Toxins. Our bodies encounter dangers all the time. Just beneath the surface hidden. Whether you realize it or not, your body is constantly protecting itself. Every time you blink your eye, you wash away thousands of unwanted microbes. Breathe in too much unwanted pollen, and you sneeze. The body detects the invader. It releases its white blood cells, and it attacks.

Just when we think we figured things out, the universe throws us a curve ball. So, we have to improvise. We find happiness in unexpected places. We find ourselves back to the things that matter the most. The universe is funny that way. Sometimes it just has a way of making sure we wind up exactly where we belong.

We've all heard the saying. It's one of those things you learn in seventh grade science class. Adapt or die. Adapting isn't easy though. You have to fight your competition and off their attacks. And sometimes, you have to kill. You do what you need to do to survive.

Adapt or die. As many times as we've heard it, the lesson doesn't get easier. The problem is we're human. We want more than just to survive. We want love. We want success. We want to be the best that we can be. So, we fight like hell to get those things. Anything else feels like death.

There's a reason I said I'd be happy alone. It wasn't 'cause I thought I'd be happy alone. It was because I thought if I loved someone and then it fell apart, I might not make it. It's easier to be alone, because what if you learn that you need love and you don't have it? What if you like it and lean on it? What if you shape your life around it and then it falls apart? Can you even survive that kind of pain? Losing love is like organ damage. It's like dying. The only difference is death ends. This? It could go on forever.

Every cell in the human body regenerates on average every seven years. Like snakes, in our own way we shed our skin. Biologically we are brand new people. We may look the same, we probably do, the change isn't visible at least in most of us, but we are all changed completely forever.

When we say things like "people don't change" it drives scientist crazy because change is literally the only constant in all of science. Energy. Matter. It's always changing, morphing, merging, growing, dying. It's the way people try not to change that's unnatural. The way we cling to what things were instead of letting things be what they are. The way we cling to old memories instead of forming new ones. The way we insist on believing despite every scientific indication that anything in this lifetime is permanent. Change is constant. How we experience change that's up to us. It can feel like death or it can feel like a second chance at life. If we open our fingers, loosen our grips, go with it, it can feel like pure adrenaline. Like at any moment we can have another chance at life. Like at any moment, we can be born all over again.

They say lightning never strikes twice, but that is a myth. It doesn't happen often, lightening usually gets it right the first time. When you're hit with 30,000 amps of electricity you feel it. It can make you forget who you are. It can burn you, blind you, stop your heart. And cause massive internal injuries. But, for something that happens in only a millisecond, it can change your life forever.

Lightning doesn't often strike twice. It's a once in a lifetime thing. Even if it feels like the shock is coming over and over again. Eventually the pain will go away, the shock will wear off. And you start to heal yourself. To recover from something you never saw coming. But, sometimes the odds are in your favor. If you're in just the right place at just the right time you can take a hell of a hit. And still have a shot at surviving.

Most surgeons grew up as freaks. While other kids played outside, we hold up in our rooms memorizing our periodic table, hovering for hours over our junior microscopes, dissecting our first frogs.

Nobody chooses to be a freak. Most people don't realize they're a freak until it's way to late to change it. No matter how much of a freak you end up being, chances are there's still someone out there for you. Unless of course, they've already moved on. Because when it comes to love, even freaks can't wait forever.

Biology determines much of the way we live. From the moment we're born we know how to breathe and eat. As we grow older new instincts kick in. We become territorial. We learn to compete. We seek shelter. Most important of all, we reproduce. Sometimes biology can turn on us though. Yeah, biology sucks sometimes.

Biology says that we are who we are from birth. That are DNA is set in stone. Unchangeable. Our DNA doesn't account for all of us though, we're human. Life changes us. We develop new traits. Become less territorial. We start competing. We learn from our mistakes. We face our greatest fears. For better or worse, we find ways to become more than our biology. The risk of course is that we can change too much to the point where we don't recognize ourselves. Finding our way back can be difficult. There's no compass, no map. We just have to close our eyes, take a step, and hope to God we get there.

They train doctors slowly. They watch us practice on frogs and pigs and dead people and then live people. They grill us relentlessly. They raise us like children and eventually they take a cold hard boot and kick us out of the next.

We all want to grow up. We're desperate to get there. Grab all the opportunities we can to live. We're so busy trying to get out of that mess, we don't think about the fact that it's going to be cold out there. Really freaking cold. Because growing up sometimes means leaving people behind. And by the time we stand on our own two feet, we're standing there alone.

Question - when was the last time a complete stranger took off her close in front of you, pointed to a big purple splash on her back and asked, "what the hell is this thing?" If you're a normal person the answer is hopefully never; if you're a doctor the answer is probably about five years ago. People expect doctors to have all the answers. The truth is we love to think we have all the answers too. Basically, doctors are know-it-alls until something comes along that reminds us that we're not.

We are all looking for answers. In medicine, in life, in everything. Sometimes the answers we were looking for were hiding just below the surface. Other times, we find answers when we didn't realize we were asking a question. Sometimes, the answers can catch us completely by surprise. And sometimes, even when we find the answer we've been looking for, we're still left with a whole hell of a lot of questions.

The human body is a highly pressurized system. The blood pressure measures the force of blood pulsating through the arteries. It's important to keep this pressure regulated. Low or inadequate pressure can cause weakness or failure. It's when the pressure gets too high that problems really occur. If the pressure continues to increase, a closer examination is called for. Because it's the best indicator that something is going terribly wrong.

Every pressurized system needs a relief valve. There has to be a way to reduce the stress, the tension, before it becomes too much to bare. There has to be a way to find relief because if the pressure doesn't find a way out, it will make one. It will explode. It's the pressure we put on ourselves that's the hardest to bare. The pressure to be better than we already are. The pressure to be better than we think we can be. It never ever lets up. It just builds and builds and builds.

We doctors take pride in the fact that we can basically sleep standing up. Anytime, anywhere. But, it's a false pride because the truth is after twenty hours without sleep you might as well just come to work drunk, doctor or not. So it's no wonder that fatal medical errors increase at night when we doctors are proudly sleeping on our feet. Recently our communal pride has been shattered and our egos have been wounded by new laws that require we sleep all day before we work all night. We are not happy about it. But, as someone who might need medical care, you really should be.

Under the cover of darkness, people do things they never do under the harsh glare of day. Decisions feel wiser. People feel older. But, when the sun rises, you have to take responsibility for what you did in the dark. And face yourself under the cold harsh light of day.

The first 24 hours after surgery are critical. Every breath you take, every fluid you make, is meticulously reported and analyzed. Celebrated or mourned. But what about the next 24 hours? What happens with that first day turns to two and weeks turn into months? What happens when the immediate danger has passed, when the machines are disconnected and the teams of doctors and nurses are gone? Surgery is when you get saved, but post-op, after surgery, is when you heal. But, what if you don't?

The goal of any surgery is total recovery - to come out better than you were before. Some patients heal quickly and feel immediate relief. For others the healing happens gradually, and it's not until months or even years later that you realize you don't hurt anymore. So the challenge after any surgery is to be patient. But if you can make it through the first weeks and months, if you believe that healing is possible, then you can get your life back. But that's a big if.

Surgery is extreme. We cut into your body, take out pieces, and put what's left back together. Good thing life doesn't come with a scalpel because if it did, when things started to hurt, we would just cut and cut and cut. The thing is what we take away with a scalpel we can't ever get back. So, like a said, good thing.

To a degree, medicine is a science...but I would argue that it's also an art. The doctors who see medicine as a science only, you don't want them by your side when you're bleeding won't stop or when your child is screaming in pain. The clinicians go by the book. The artists follow their guts. The artists feel your pain and they go to extremes to make it stop. Extreme measures. That's where science ends and art begins.

People are really romantic about the beginnings of things. Fresh start. Clean slate. A world of possibility. But no matter what adventure you're embarking on, you're still you. You bring you into every new beginning in your life, so how different can it possibly be.

It's all anybody wants, right? Clean slate. A new beginning. Like that's gonna be any easier. Ask the guy pushing the boulder up the hill. Nothing's easy about starting over. Nothing at all.