This one really resonated with me. I recently experienced a huge disappointment and trauma. I wrote this poem. Hope it resonates.

When Hope Waits for Readiness

My mother was forty-eight when she died, but by then illness had already been shaping our lives for years.

What I remember most clearly are the drives.

We lived in Decatur, Illinois, and the care she needed did not yet exist nearby. Her ulcerative colitis refused to follow a predictable course. Complications accumulated—dermatologic disease, recurrent sclerosing cholangitis, bile duct cancer. At one point she was evaluated for a liver transplant. Then ovarian cancer appeared, as if the body had decided to reveal all of its mysteries at once.

And so we drove.

North to Chicago.
Southwest to St. Louis.
East to Pittsburgh.

Miles of highway where hope traveled with us in quiet, fragile ways.
At the time I assumed the distance was inevitable. Medicine had limits. Expertise lived where it lived.

Only years later, when I became a physician myself, did I begin to understand something different: the distance was not only medical. It was structural. The care my mother needed simply had not yet been built where we lived.
Institutions, like treatments, evolve. What is unavailable in one decade becomes routine in another.

Timing, it turns out, matters in medicine in more ways than one.
Internists learn early that not every problem demands immediate action.
There is an old mantra: When you don’t know what to do, do nothing.
The phrase sounds passive, but it isn’t. It reflects a particular kind of clinical humility; the recognition that acting too quickly can sometimes do more harm than waiting. Disease processes often need time to declare themselves. Symptoms evolve. Patterns emerge.

The work, then, is to watch carefully. To gather information. To resist the temptation to intervene simply because uncertainty is uncomfortable.

I carried that lesson into my clinical practice. And later, into leadership.

But systems, I have learned, can be harder to read than bodies.

Over the years I have worked with colleagues to make medicine more humane, to build environments where physicians, staff, and learners can thrive rather than simply endure.

The language we use for this work is expansive: well-being, belonging, flourishing.

But the reality is often quieter.
It looks like listening to a nurse who feels invisible in decision-making.
It looks like a faculty member deciding whether they can remain in the profession they once loved.
It looks like a trainee wondering if medicine still has room for their full humanity.

Cultural change inside institutions is rarely dramatic. It happens in conversations, policies, and small shifts in how people experience their work.
And yet sometimes, despite listening carefully and working faithfully, change does not unfold as you hoped.

In those moments I find myself returning to that internist’s instinct: pause.
Observe.
Wait for the system to declare itself.

In clinical medicine we talk about the “stages of change.”
A patient may know that smoking is harming them but still feel unready to quit. Our role is not to force readiness into existence. It is to meet patients where they are, continue the conversation, and remain present for the moment when readiness appears.

Institutions are not so different.

An organization may recognize its problems yet remain ambivalent about the changes required to address them. The system hesitates. The incentives are misaligned. People worry about what might be lost as much as what might be gained.

In those moments, leadership becomes less about pushing forward and more about discerning where the organization actually stands.

Is it ready for action?
Is it still contemplating?
Or is it resisting entirely?

Understanding that difference matters.