About This Project: The Mural and History’s Insights

This book began as a 25-part daily journey toward the 250th anniversary of the United States, created to trace a different kind of national story: the long, uneven history of how people in this country have responded to suffering. Decade by decade.

Recurring themes and patterns. Crucibles of pain and change. Hope.

Its daily, decade-specific entries were published in Hospice & Palliative Care Today from June 10th – July 4th, 2026. This is not a comprehensive history, nor a neutral catalogue of dates and institutions. It is a curated timeline of witness—shaped by what has been recorded, what has been remembered, and what still remains too easily unseen.

Like any mural, it has edges. It cannot fully contain the quiet labor of unnamed caregivers, the wisdom of communities left out of official archives, or the full global context in which American medicine, public health, hospice and palliative care, and other forms of compassion have taken shape. Some absences are limits of space; others reflect the deeper truth that history itself records some suffering more readily than others. That, too, is part of the story.

‌Introduction‌

We celebrate the 250th anniversary of the United States by tracing a different kind of history: how people have responded to suffering.

Across epidemics and wars, plantations and prisons, almshouses and ICUs, homes and hospice beds, this is the story of those who tried to relieve pain, protect the vulnerable, and stay present when life grew fragile. They were physicians and nurses, social workers and chaplains, midwives and neighbors, abolitionists and reformers, community organizers and family caregivers—imperfect people who often failed to see or include everyone who was suffering, yet who at crucial moments chose to become companions through suffering rather than turn away.

This content focuses on today’s hospice and palliative care, because that is my vocation, shared with valued colleagues throughout our nation. Within our broad history, hospice and palliative care have become specific, steadfast commitments: to walk with people when cure is not possible; to listen before intervening; to honor each person’s goals, values, and relationships; and to treat pain, breathlessness, fear, and grief as worthy of serious, skillful attention. Hospice and palliative professionals work at the threshold where medicine, ethics, family, and community meet, in a time when care is expanding even as capacity fractures, moral distress rises, and fraud threatens integrity. We also work amid contested questions—about diversity, equity, and inclusion, about regulations and technologies, and about Medical Aid in Dying, where law, choice, suffering, and complex moral convictions collide. Our decisions and presence reveal how seriously we take the dignity of those who are dying—and the needs of those who love them.

For this website, content is organized into these overlapping, interwoven sections:

This project looks backward and forward at once. It invites anyone who cares about suffering—whether at the bedside, in policy, in global health, in disaster response, or in the quiet labor of family life—to see themselves inside this 250-year mural of American need, service, and hope. It also asks readers to notice what lies beyond the mural’s edges: stories underrepresented in archives, communities still left out of care, and controversies that reveal how unfinished our work remains. The sung prayer “God mend thine every flaw” does not belong to a hymn alone. It belongs to the journeys we navigate and choices we make about how suffering, dying, and grief are seen, honored, and met.

~ Joy S. Berger, DMA, FT, BCC, MT-BC