This is how most stories end in the hospital. Not with crash carts and sirens and electric shocks to the chest, but with an empty room, a crisp white bed, silence.

To the bankrupt poet, to the jilted lover, to anyone who yearns to elude the doubt within and the din without, the tidal strait between Manhattan Island and her favorite suburb offers the specious illusion of easy death. Melville prepared for the plunge from the breakwater on the South Street promenade, Whitman at the railing of the outbound ferry, both men redeemed by some Darwinian impulse, maybe some epic vision, which enabled them to change leaden water into lyric wine. Hart Crane rejected the limpid estuary for the brackish swirl of the Caribbean Sea. In each generation, from Washington Irving’s to Truman Capote’s, countless young men of promise and talent have examined the rippling foam between the nation’s literary furnace and her literary playground, questioning whether the reams of manuscript in their Brooklyn lofts will earn them garlands in Manhattan’s salons and ballrooms, wavering between the workroom and the water. And the city had done everything in its power to assist these men, to ease their affliction and to steer them toward the most judicious of decisions. It has built them a bridge.

Choose old people for enemies. They die. You win.

Arnold had never given much thought to whether or not he loved America—but now it seemed pretty obvious to him that he didn’t. Not in the way Nathan Hale had loved America. Or even in the way his late father, a Dutch-Jewish refugee, had loved America. In fact, he found the idea of sacrificing his life for his country somewhat abhorrent. Moreover, it wasn’t that he disliked abstract loyalties in general. He loved New York, for instance: Senegalese takeout at three a.m., and strolling through the Botanical Gardens on the first crisp day of autumn, and feeding the peacocks at the Cathedral of St. John the Divine. If Manhattan were invaded—if New Jersey were to send an expeditionary force of militiamen across the Hudson River—he’d willingly take up arms to defend his city. He also loved Sandpiper Key in Florida, where they owned a time-share, and maybe Brown University, where he’d spent five years of graduate school. But the United States? No one could mistake his qualified praise for love.

The most dangerous ideas are not those that challenge the status quo. The most dangerous ideas are those so embedded in the status quo, so wrapped in a cloud of inevitability, that we forget they are ideas at all.

Such is the demographic paradox of a junior physician's relationship with his patients: I worry about how to extend their lives. This anxiety inevitably shortens my own.

Maybe that is the greatest of wonders: that we can be shaped so much by those we've known closely, and equally by those we've never known at all - and that we too can change the world long after we've left it.