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

“The English, who look on stoically as national health hospitals in run-down metropolitan areas close their wards through lack of support and patients spend time on trolleys in corridors, are comforted by the knowledge that wounded hedgehogs are tenderly cared for in a hedgehog hospital.”

“Ronkers was getting out of the elevator on the first floor when the intercom paged 'Dr Heart'. There was no Dr Heart at University Hospital. 'Dr Heart' meant someone's heart had stopped.'Dr Heart?' the intercom asked sweetly. 'Please come to 304 . . .'Any doctor in the hospital was supposed to hurry to that room. There was an unwritten rule that you looked around and made a slow move to the nearest elevator, hoping another doctor would beat you to the patient. Ronkers hesitated, letting the elevator door close. He pushed the button again, but the elevator was already moving up.'Dr Heart, room 304,' the intercom said calmly. It was better than urgently crying, 'A doctor! Any doctor to room 304! Oh my God, hurry!' That might disturb the other patients and the visitors.”

“I don’t think the people today who start hearing voices, stop eating and sleeping, and run amuck are likely to get good treatment. Having more knowledge, better diagnostic capabilities, better medications with fewer side effects, can’t make up for the fact that most patients are being treated by doctors, therapists, and hospitals, who are operating under constraints and incentives that reward non-treatment, non-hospitalization, non-therapy, non-follow-up, non-care. Lost to follow-up is the best outcome a health insurer can hope for.”

“Nearly everyone who is asked where they want to spend their final days says at home, surrounded by people they love and who love them. That's the consistent finding of surveys and, in my experience as a doctor, remains true when people become patients. Unfortunately, it's not the way things turn out. At present, just over one-fifth of Americans are at home when they die. Over 30 percent die in nursing homes, where, according to polls, virtually no one says they want to be. Hospitals remain the site of over 50 percent of deaths in most parts of the country, and nearly 40 percent of people who die in a hospital spend their last days in ICU, where they will likely be sedated or have their arms tied down so they will not pull out breathing tubes, intravenous lines, or catheters. Dying is hard, but it doesn't have to be this hard.”

“The day I understand what's going on in her psychotic little brain they'll have to lock me in a psych ward.”