PRELUDE

“O say, can we see—by the dawn’s early light?”

Not only the flag, the anthem, or the anniversary. Can we also see, with fresh and steadier vision, the long and uneven history of how people in this country have responded to suffering—not only the pain that marked the journey, but the service, courage, and hope that answered it?

This book began as a journey toward the 250th anniversary of the United States, but its deeper purpose reaches beyond a date on the calendar. It asks a different kind of national question: across epidemics and wars, plantations and prisons, almshouses and hospitals, homes and hospice beds, how have Americans understood the suffering of others—and how have they tried to meet it?

The “we” in that question matters. It includes those whose names fill official archives and those whose labor was rarely recorded; physicians and nurses, chaplains and social workers, reformers and public-health leaders, neighbors and family caregivers. It includes imperfect people who did not always see clearly, yet who again and again chose to protect, relieve, accompany, build, and hope.

To see clearly is never only intellectual. It is moral, relational, and practical. In hospice and palliative care, to see means recognizing pain and symptoms, but also fear and grief, family love, spiritual longing, quiet resilience, and the many forms of care that help people live meaningfully through fragile times.

There is something fitting in the kinship of mourning and morning. The words share roots that stretch from darkest midnight to noonday, from flickering light to fuller illumination, and they draw on deep wells of wisdom and memory. Grief and dawning do not cancel each other. They share a threshold: in one, we name what has been lost; in the other, we begin again with what can still be given, repaired, and renewed.

The history in these pages moves through both realities at once—need and service, sorrow and courage, suffering and hope. It traces not only the wounds that have shaped this country, but the persistent, imperfect, and often beautiful ways people have tried to mend, accompany, and sustain one another.

This is not a comprehensive history, nor a neutral catalogue of dates and institutions. It is a curated timeline of witness. Like any mural, it has edges; it cannot contain every story, every loss, or every act of care that shaped this nation. But perhaps it can help us see more honestly some of what has too often been hidden, while also honoring the many people and movements that widened compassion, strengthened care, and carried hope forward.

Within this broad history, hospice and palliative care hold a particular vocation: to stay present when cure is not possible, to listen before intervening, to honor each person’s goals and relationships, and to treat pain, breathlessness, fear, and grief as worthy of serious, skillful attention. They remind us that care is not only a clinical task. It is also a human promise.

So this Prelude is not an overture to sentiment. It is an invitation to witness more fully—to see both need and service, both grief and courage, and the enduring hope that people can choose to draw near rather than turn away. If it offers any light, let it be a modest one: enough to help us look again, ask better questi

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