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’s what I know. If you’re willing to throw caution to the wind and take a chance, the view from the other side… is spectacular ”A couple of hundred years ago, Benjamin Franklin shared with the world the secret of his success. ‘Never leave that ‘til tomorrow,’ he said, ‘Which you could do today.’ This is the man who discovered electricity. You’d think more of us would listen to what he had to say. I don’t know why we put things off, but if I had to guess, I’d say it had 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.”

“You know when you were a little kid and you believed in fairy tales? That fantasy of what your life would be — white dress, prince charming who’d carry you away to a castle on a hill. You’d lie in your bed at night and close your eyes and you had complete and utter faith. Santa clause, the tooth fairy, prince charming — they were so close you could taste them. But eventually you grow up and one day you open your eyes and the fairy tale disappears. Most people turn to the things and people they can trust. But the thing is, it’s hard to let go of that fairy tale entirely because almost everyone has that smallest bit of hope and faith that one day they would open their eyes and it would all come true. But the thing is, it’s hard to let go of that fairy tale entirely, because almost everyone has that smallest bit of faith and hope that one day they would open their eyes and it would all come true. 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 fairy tale is slightly different than your dream. The castle, well it may not be a castle. And it’s not so important that it’s happily ever after — just that it’s happy right now. See, once in a while, once in a blue moon, people will surprise you. And once in awhile, people may even take your breath away.”

“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 anymore. The problem with secrets is even when you think you’re in control, you’re not.”

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

 ”I have an aunt who whenever she poured anything for you she would say ‘Say when.’ My aunt would say ‘say when,” and of course, we 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.”

“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 because you have no other choice. Some things you keep to yourself. And not too often, but every now and then, some things simply speak for themselves.”

“Maybe we’re not supposed to be happy. Maybe gratitude has nothing to do with joy. Maybe being grateful means recognizing what you have for 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 have the courage to still be standing is reason enough to celebrate.”
“Who gets to determine when the old ends and the new begins? It’s not on the calendar, it’s not a birthday, it’s not a new year. It’s an event, big or small, something that changes us. Ideally, that gives us hope, a new way of living and looking at the world, a way of letting go of old habits, old memories. What’s important is that we never stop believing we can have a new beginning, but it’s also important to remember that, amid all the crap, there are a few things worth holding on to.”

“In general, lines are there for a reason. For security, for clarity. If you choose to cross the line, you pretty much do so at your own risk. So why is it that the bigger the line, the greater the temptation to cross it? We cant help ourselves. When we see a line we want to cross it. Maybe it’s the thrill of the unfamiliar, a sort of personal dare. The only problem is once that you’ve crossed, it’s almost impossible to go back. But, if you do manage to make it back across the line, you find safety in numbers.”

“Karma. One way or another it will leave us to face ourselves. We can look our karma in the eye or we can wait for it to sneak up from behind. But karma will always find us. The truth is, as surgeons, we have more chances than most to set the balance in our favor. Yet no matter how hard we try we can’t escape our karma. It follows us home. I guess we can’t really complain about our karma. It’s not an affair. It’s not unexpected. It just… evens the score. And even when we’re about to do something that we know will tempt karma to bite us in the ass… well, it goes without saying. We do it anyway.”

“Superstition lies in the space between what we can control and what we can’t. Find a penny, pick it up, 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 actually listening? Why do we bother doing those strange things? We rely on superstitions because we’re smart enough to know we don’t have all the answers.. and that life works in mysterious ways. Don’t diss the juju, from wherever it comes.”

“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. Just when you’ve gotten the lay of the land, the ground underneath you shifts. It knocks you off your feet. If youre lucky, you end up with nothing more than a flesh wound, something a band-aid will cover. But some wounds are deeper than they first appear, and require more than just a quick fix. With some wounds, you have to rip of the band-aid, let them breathe and give them time to heal.”

“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 can turn out to be more than we can bear.”

“In life we’re taught that there are seven deadly sins. We all know the big ones… gluttony, pride, lust. But the thing you don’t hear much about is anger. Maybe it’s because we think anger is not that dangerous, that you 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 in to a sin like envy or pride, and you only hurt yourself. Try lust or coveting and you’ll only hurt yourself and one or two others. But anger is the worst… the mother of all sins… Not only can anger drive you over the edge, when it does, you can take an awful lot of people with you.”

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

“There are times when even the best of us have trouble with commitment, and we may be surprised at the commitments we’re willing to let slip out of our grasp. Commitments are complicated. We may surprise ourselves by the commitments we’re 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.”

“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, it’s usually a load of bull. So we pick and choose who we want to remain close to, and once we’ve chosen those people, we tend to stick close by. No matter how much we 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.”
 ”No one believes that their life will turn out just kind of okay. We all think we are going to be great. And from the day we decide to be surgeons, we are filled with expectation. Great expectations of who we will be, where we will go. And then… we get there.”

“We all think we’re going to be great and we feel a little bit robbed when our expectations aren’t met. But sometimes 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’s just the beginning, the unexpected is what changes our lives.”

“Disappearances happen in science. Disease can suddenly fade away, tumors go missing, and we open someone up to discover the cancer is gone. It’s unexplained. It’s rare, but it happens. We call it mis-diagnosis. Say we never saw it in the first place, any explanation but the truth. That life is full of vanishing acts. If something that we didn’t know we had disappears… do we miss it?”

“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.”

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. And it hurts to grow, anybody who tells you it doesn’t is lying. But heres the truth: the more things change, the more they stay the same. And sometimes, oh, sometimes change is good. Oh, sometimes, change is … everything.

“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 you can possibly do… as long as you choose your moments wisely.”

“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 is as good as we’d hoped? Do we bask in the warm glow of our happiness? Or, do we just notice we’ve got a long list of other wishes waiting to be wished?”

“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 comes to us quickly and easily without hesitation, they’re the one that haunts us forever.”

“It seems we have no control what so ever over our own hearts. Condition 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 to keep the heart stable, to keep it slow, steady, regular to stop the heart from pounding out of your chest from the dread of something terrible or the anticipation or something else entirely.”

“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 can’t just 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 dieing and I can’t help. Or, it means this is really gonna hurt.”

“When something begins, you generally have no idea how it’s going to end. The house you’re 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. We spend our whole lives worrying about the future, planning for the future, trying to predict the future, as if figuring it out will cushion the blow. But the future is always changing. The future is the home of our deepest fears and wildest hopes. But one thing is certain when it finally reveals itself. The future is never the way we imagined it.”

“According to Elisabeth Kubler-Ross, when we’re dying or have suffered a catastrophic loss, we all move through five distinct stages of grief. We 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 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’ve done everything we can. We let go. We let go and move into acceptance.”
“In medical school, we have a hundred lessons that teach us how to fight off death, and not one lesson on how to go on living.”

“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, make promises, get burden by commitments, to do no harm, to tell the truth and nothing but, to love, to cherish till death do us part. So we just keep running up the tap ‘til we owe everything to everybody and suddenly … what the.”

“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 confirms our worst fears. But sometimes, it can shed new light on the problem, make you see it in a whole new way. After all the opinions have been heard and every point of view has been considered, you finally find what you’re 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.”

“Everyday 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 are not 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 you stop. But if you’re like most people I know, you give till it hurts, and then you give some more.”

This is 10% luck, 20% skill, 15% concentrated power of will, 5% pleasure, 50% pain, and a 100% reason to remember the name.