“What we call the beginning is often the end. And to make an end is to make a beginning. The end is where we start from.”
— T. S. Eliot, Little Gidding (in Four Quartets)

In modern healthcare, every “ending” is meant to signal the start of the next stage of care: the end of a clinic visit should begin a clear follow-up plan; the end of a hospitalization should begin safe recovery at home. Yet this is where breakdowns most often occur. Communication failures are among the leading causes of preventable harm in U.S. healthcare. One analysis found that breakdowns in communication contributed to 30% of malpractice claims and were linked to more than 1,700 patient deaths over five years (CRICO Strategies, 2015). When patients leave an appointment uncertain about what was said, who is responsible for the next step, or what symptoms to monitor, the consequences are rarely theoretical. They are clinical.

Healthcare fragmentation amplifies this risk. Patients often see multiple clinicians across multiple settings, and without someone who “holds the story,” key information is easily lost. A large nationwide cohort study showed that higher fragmentation of care was associated with more inappropriate medication use and significantly increased mortality (Prior et al., 2023). In practical terms: when no one owns the narrative, patients pay the price.

Clarity, therefore, is not a courtesy. It is a form of safety. The end of one encounter must become the true beginning of the next. When we fail to orient patients, and to ensure we ourselves understand the plan, care does not simply pause. It unravels.

Hawthorne’s The House of the Seven Gables reminds us that injustice doesn’t disappear. It settles into the walls. Our healthcare system, too, is an inherited house: intricate, costly, and haunted by the wrongs that shaped it. From racial inequities to misaligned incentives, today’s fractures trace back through generations of policy and power. But as Hawthorne suggests, curses aren’t lifted through destruction; they’re healed through humility, compassion, and connection.