Thank you for writing this, Douglas Flora. The line that stayed with me is your insistence that “it’s okay to not be okay”, because that’s not softness; it’s an accurate description of moral injury and cumulative load when clinicians are asked to keep functioning as if nothing outside the hospital walls is happening. I also appreciate how you frame the exam room as a witness: patients don’t arrive as “a diagnosis,” they arrive carrying housing insecurity, fear for family, fractured communities and we’re often the only place where those realities are spoken out loud without consequences. 
The historical lens (1968, civic unrest, and clinicians continuing to show up) is powerful precisely because it doesn’t romanticize the moment, but it clarifies the job: we cannot repair the whole world from the bedside, but we can refuse to let the person in front of us be alone in it. In practice, that’s a clinical skill: presence, naming distress, small acts that restore agency, and team-based “load sharing” that protects nurses, navigators, and trainees from silently drowning. 
This piece feels like a reminder that compassion isn’t an extra, but it’s infrastructure. When the weight becomes unbearable, the ethical move isn’t heroic individual endurance; it’s building conditions where people can keep showing up together.
A much needed and thoughtful essay. Thank you, Dr. Doug.
A beautiful essay and a balm for every reader. Thank you.
Thank you, Doug. Your words and leadership make this time feel a little bit lighter.
Thank you for writing this, Douglas Flora. The line that stayed with me is your insistence that “it’s okay to not be okay”, because that’s not softness; it’s an accurate description of moral injury and cumulative load when clinicians are asked to keep functioning as if nothing outside the hospital walls is happening. I also appreciate how you frame the exam room as a witness: patients don’t arrive as “a diagnosis,” they arrive carrying housing insecurity, fear for family, fractured communities and we’re often the only place where those realities are spoken out loud without consequences. 
The historical lens (1968, civic unrest, and clinicians continuing to show up) is powerful precisely because it doesn’t romanticize the moment, but it clarifies the job: we cannot repair the whole world from the bedside, but we can refuse to let the person in front of us be alone in it. In practice, that’s a clinical skill: presence, naming distress, small acts that restore agency, and team-based “load sharing” that protects nurses, navigators, and trainees from silently drowning. 
This piece feels like a reminder that compassion isn’t an extra, but it’s infrastructure. When the weight becomes unbearable, the ethical move isn’t heroic individual endurance; it’s building conditions where people can keep showing up together.
Amazing!!! Now wear is my tissue box!!!
Love you Dr Flora!!
Love this. Thank you for sharing these thoughts.
Thanks, Doug. My mom is in the hospital right now and I’ve been observing all the doctors, nurses, et.al. They truly are super heroes.
You have a gift for instilling hope during dark times. Thank you.