Last night I talked to my friend, a medical resident at an elite urban hospital. She called me on her walk home after a stressful day in the general medical wards. She had 17 patients with a wide range of problems: heart failure, emphysema, HIV, alcohol withdrawal, diabetes complications, even a man who had swallowed a handful of razor blades.

The last time we had talked, a month ago, she was working in the cardiac intensive care unit. That week she was juggling five patients, all with heart failure. She was literally running from one to the next to slow down the inevitable: They were all going to die soon, it was just a matter of when and how painfully. She was