Epistemic status: This one is personal, not statistical. Where the other field notes argue from sourced numbers, this one argues from proximity. I have tried to stay honest about the limits of that proximity in the last section, because a CEO's closeness to death is not a nurse's, and pretending otherwise would break the whole piece.
01The Proximity
Most people stand close to death a handful of times in a life. A grandparent. A parent, eventually. If they are unlucky, someone out of order. Each time it arrives as an event, overwhelming and singular, and then life closes back over it and the lessons fade the way dreams do.
My work does not let the lessons fade. I run a home health and hospice company, which means some number of the families we serve this month are in the last chapter, and my teams are in the room for it. I am not the one at the bedside. The nurses, the chaplains, the social workers, the aides are, and they are better at it than I will ever be. But I hire them, I sit in the meetings where their cases are discussed, I read what families write to us afterward, and I have stood in enough of those living rooms over twenty years in this industry to know what the end of a life actually looks like in America. Which is to say: not like television. Quieter. Slower. More ordinary and more sacred at the same time.
Here is the strange gift of that proximity. The end of life is the only vantage point from which a whole life becomes visible at once. Everyone else is guessing about what matters. The people my teams serve have finished collecting the data.
02The Findings
I called this the most honest first-principles review that exists in an earlier field note, and I meant it technically. At the end, every requirement gets questioned. Every ornament falls away. What survives that audit is remarkably consistent, and after years of being briefed on its findings, I can report them.
Nobody talks about their title. In all the accounts that reach me, no one has ever spent their final weeks reliving a promotion. The org chart, which consumed decades of striving, does not make the closing argument.
Nobody wishes they had optimized harder. The productivity systems, the inbox discipline, the schedule packed to the margins: all of it turns out to have been scaffolding, and scaffolding comes down.
What people hold onto is small and specific. People, by name. Stretches of time that were fully attended. Whether there was kindness in the room, both the kindness they gave and the kindness they received. Reconciliations made or missed. The ocean, a porch, a particular meal, a daughter's laugh. The inventory at the end is almost embarrassingly humble, and it is the same inventory, family after family, year after year.
And I should be clear about whose voices carry this piece, because it is not the famous ones. I never met Jobs or Buffett. The voices that live in my soul belong to the patients who have died in our care, and to their families, and sometimes to the silence where a family should have been. What comes back from a death visit is the most authentic testimony that exists, because the speaker is not projecting toward the deathbed the way every author on the shelf was. They are in it. Some of what comes back is beautiful: gratitude, peace, a life signed off on. But a great deal of it is regret with specific coordinates. Grudges with children carried past the point of repair. Reconciliations rehearsed for years and never delivered. Things unsaid, trips untaken, plans unmade, paperwork and forgiveness both left for a tomorrow that had already been spent. So much life, visible all at once, right at the moment it stops being editable. Those are my primary sources. Everything else in this piece is commentary.
The findings are not new. Every hospice worker knows them. Bronnie Ware, a palliative nurse, built a famous book from them, and her five regrets of the dying match what reaches my desk almost line for line. What is new, for me, is treating them the way I treat any other audit: not as sentiment, but as data about what the product of a life actually is. And then noticing that almost everything upstream of that room, including the industry I work in and the culture I live in, is optimized for the things that do not survive the audit.
03What It Changed in Me
I will not pretend I float above ambition. I run multiple companies, I publish predictions with confidence intervals, I like winning. But standing adjacent to the end of life for this long has quietly rewritten my operating system, and the changes are concrete enough to list.
The biggest one: I stopped drinking. Completely. There is no dramatic story attached, no rock bottom, and I am not here to preach about anyone else's choices. It was an audit decision. I know, in a way most people are spared knowing, exactly how close death is and exactly what people wish they had changed when the time to change it is gone. The same regrets, family after family: time surrendered, presence diluted, years spent at less than full strength. Drinking was costing me clarity, hours, and mornings, and when I held it against the final inventory it simply did not survive the review. What I got back is most of the productivity people ask me about. It is not a hack. It is just what remains when you delete the fog, and the deletion has never once been missed.
It deleted most of my fake urgency. In hospice you learn the difference between urgent and important at a depth no business book reaches. Almost nothing in my inbox is urgent. A handful of things in my life are important. The audit at the end never once flags the emails.
It made presence a discipline instead of a mood. I have written before about presence mattering more than polish, and that conviction comes from this proximity. When my daughters have my attention, they have all of it, because I have read too many accounts of parents who were in the room and not in the room. Time with fully attended people is the single largest line item in the final inventory. I am trying to make deposits.
It reordered my values, literally. The four words my companies run on are Kindness, Unity, Humility, Patience, in that order, and kindness is first because of what the end of life teaches. Whether there was kindness in the room is one of the only questions that survives to the last day. A culture that makes kindness operational is not being soft. It is optimizing for the metric with the longest shelf life.
And it keeps me honest about what I am for. It is very hard to build your identity out of vanity metrics when your company's work reminds you weekly what the terminal dashboard actually displays.
Follow all of that one step further and you arrive at the real reason culture became my work. Run the numbers on a life. Most of our waking minutes get spent at work. Not with the people we would name in the final inventory, but with colleagues, in buildings and on video calls, doing tasks. That is where the minutes actually go. So I made two decisions about it. The first was for me: I fill my working hours with people I genuinely want to be around, because I know now what those hours are made of, and I refuse to spend the bulk of my one life in rooms I am enduring. The second is the one I consider my job. The people who work at my companies are spending their irreplaceable minutes with us, and they have families running the same clock. If the end-of-life audit asks whether the time was attended and whether there was kindness in the room, then the workplace is where most of that question gets answered, for all of us. Building an environment where those minutes are actually worth something is not an HR initiative. It is the deathbed audit, applied to the ninety thousand hours everyone spends working. That is what the culture work is. It always was.
04Invert, Always Invert
I know the shelf this piece sits on, because I have read the shelf. This idea has one of the longest and most distinguished paper trails in human thought, and it is worth walking, oldest to newest, because half of it turns out to be business history.
Moses got there first. Psalm 90 asks to be taught to number our days, so that we may gain a heart of wisdom. The audit is three thousand years old and it began as a prayer. Seneca wrote On the Shortness of Life two thousand years ago to argue that life is long enough, and only feels short because we spend it like people who will never die. Marcus Aurelius, running the Roman Empire by day, filled his private notebook with reminders that he could depart life at any moment and should let that govern every act. Tolstoy gave the idea its great novel in The Death of Ivan Ilyich, a successful judge who discovers on his deathbed that a life done entirely correctly was done entirely wrong. Ernest Becker won a Pulitzer arguing that most of civilization is an elaborate machine for not thinking about this.
Then the businesspeople picked it up, which is the part of the lineage I collect. Peter Drucker built his whole philosophy of management around a question a teacher asked him at thirteen: what do you want to be remembered for? He said if you cannot answer it by fifty, you have wasted your life. Stephen Covey made habit two of his seven literally an exercise in attending your own funeral and listening to the eulogies. Jeff Bezos decided to leave the safest job on Wall Street by projecting himself to age eighty and asking which choice he would regret, and later named Amazon's entire product methodology Working Backwards, starting every build from the press release at the end. I did not name this field note by accident. Bezos works backward from the launch. I work backward from the last room. Steve Jobs stood at Stanford in 2005 and told the graduates that remembering he would soon be dead was the most important tool he had ever found for making the big choices, that death is very likely the single best invention of life. And Bronnie Ware, from the bedside, wrote down what the dying actually regret.
The shelf is long, the authors are serious, and some of the modern additions are a phone app that texts you about your mortality between meetings.
And because I read history the way I read case files, here is the question I always ask of that shelf, the one the shelf never asks itself: what happened when the authors reached their own last rooms? Did the ending match the philosophy? The record exists. Seneca passed his audit under the worst possible conditions, ordered to die by Nero and, by Tacitus's account, meeting it with the calm his books had spent a lifetime rehearsing. Marcus Aurelius is said to have gone out telling his companions to weep for the plague's many dead rather than for him. Steve Jobs, by his sister's published eulogy, left on three words of pure wonder: oh wow, oh wow, oh wow. The speech and the deathbed matched. But Tolstoy. The man who wrote the definitive novel of deathbed regret died at a rural train station at eighty-two, having fled his own home in the night, his wife of forty-eight years kept from his room until nearly the end. The author of Ivan Ilyich died inside an unresolved family rupture, the single most common regret my teams hear. I cannot think of a more important data point on this entire shelf. Writing the audit is not passing it. The end of a life is like culture that way: it is not a speech, it is a habit you prove under pressure, and the proving goes on to the last day.
Writing the audit is not passing it.
So what could I possibly add? Two things the shelf is missing. The first is residence. Jobs visited the idea, under the pressure of his own diagnosis. The Stoics rehearsed it in the imagination. I work where it lives. My company is at the bedside every week, year after year, which turns the epiphany into a dataset. The second is direction. The genre points death at the self: sharpen your choices, seize your day. Fine, it worked on me too. But the audit does not stop at the individual, and most of this piece is about what happens when you point it outward, at how a company treats its people's minutes and at what a health system should be manufacturing. That is the part I have not found on the shelf.
Charlie Munger spent his life repeating a piece of advice he borrowed from a nineteenth century mathematician: invert, always invert. If a problem is hard forward, work it backward. Do not ask how to live a good life; ask what guarantees a wasted one, and avoid that. Do not ask how to build a great company; study exactly how companies die.
Hospice is inversion made physical. My industry begins at the ending. And once you have spent years at the ending, you cannot help but run every forward question backward. What should healthcare produce? Work backwards from the room where it is too late to produce anything. What should a company culture protect? Work backwards from what its people will remember about how they were treated. What should I do with a Tuesday? Work backwards from the inventory.
Warren Buffett teaches the same inversion to students, aimed at a life instead of a portfolio. He tells them to write their own obituary and then reverse engineer their way into it. Decide what the last document should say, then work backward to the Tuesdays that would make it true. And when he defines success, the org chart never appears. His measure, said to decades of students, is whether the people you want to love you actually do love you. That is a deathbed metric, chosen by the best forward-looking investor alive, and it matches my industry's field data exactly. The richest scorekeeper in American history and the hospice reports agree on what counts.
Those two ideas did real work on me. The obituary exercise is where several of my own deletions came from, including the one at the top of the last section. This is the same move Musk runs on factories and Munger ran on investments, pointed at the one problem everyone actually shares.
I should say plainly where I stand, because it shapes how I hold all of this. I believe in God. I believe in heaven. Some people assume the deathbed audit only carries weight if you think the lights simply go out, that memento mori is a tool for the secular. My experience is the opposite. Faith has not prevented me from using death in reverse; if anything it sharpens the exercise, because it says the minutes are entrusted to me, not owned by me, and stewardship is a stricter standard than ownership. And I notice that the hospice findings and the faith I grew up with hand in the same report: love people, be kind, be present, hold the rest loosely. Numbering your days was scripture before it was strategy. Believing there is more after the last room has never once felt like permission to waste a Tuesday in this one. The end of life is not just an event my industry manages. It is the specification sheet for everything upstream. Most of healthcare has never read it.
05The Factory, Designed from the Last Room
Two field notes ago I argued that a health system is a factory whose real product is healthy years, and that America's factory has the worst yield in the developed world: double the spending, a dozen fewer healthy years per person than the countries we are supposed to be racing. Some readers asked, fairly, where my conviction about that frame comes from. It does not come from a spreadsheet. It comes from working backwards.
Because here is what the last room teaches about the product. The people in it do not wish for more healthcare. They wish for more healthy time, further back, when it could still be spent on the things that survive the audit. More years when the knees worked and the grandkids were small. More functional Octobers. The demand signal at the end of life is not for treatment. It is for the healthy years the system failed to manufacture earlier, and by the time the signal is audible, it cannot be filled.
That is why I write about yield, about deleting waste, about culture as a clinical multiplier, about giving the playbook away. I am trying to work backwards from the clearest customer feedback in existence to the factory that could have answered it. Hospice is the quality inspection station at the very end of the line, and I happen to run one, which means I read the inspection reports. The reports say the same thing every week. Ship more healthy years. Ship them earlier. The rest is process.
And yes, the strange loop is still there: the better the factory gets, the smaller some of my market becomes. I settled that account in the last field note and it stays settled. I did not get into end-of-life care to root against life.
06The Operator Application
You do not need to run a hospice to run this inversion. You need one uncomfortable hour.
Do the deathbed audit of your calendar. Take last month's schedule and score each block against the final inventory: people, attended time, kindness, work that ships something real. Be honest about how much of the month was scaffolding. I do this quarterly and the results are never flattering, and the deletions that follow are never regretted.
Then do it for your company. If your organization ended next year, what would the people who worked there hold onto? What would customers actually remember? The answers are your real product and your real culture. Everything on your dashboard that does not trace to them is a vanity metric with a good lawyer.
Then, if you lead people, remember that you are already in someone's final inventory. Somebody who works for you will one day remember, near their own end, how it felt to be on your team during these exact years. Whether there was kindness in the room. You are writing that memory right now, on ordinary Tuesdays, whether you mean to or not.
07The Ledger
Every field note that makes a prediction puts a line on the public ledger with a confidence level and a resolve date, so it can be scored. This one gets a ledger line too, and it is unlike any other I will ever write.
The prediction: that my ending will match my working backwards. That the man in the last room and the man who wrote this field note turn out to be the same man. That the inventory taken over my deathbed reads the way I am trying, now, on ordinary Tuesdays, to write it: people attended to, kindness in the room, no grudge carried past the point of repair, nothing important left unsaid or unplanned, the minutes entrusted to me spent like they were entrusted. Tolstoy is my warning that the authors fail this one. The families my teams serve are my weekly reminder of exactly how it is failed.
There is no resolve date I get to know, and I will not be present for the scoring. The scorers will be the people in the room, and my teams' successors, whoever holds the hand. Confidence level: I am human, and I will try my best. That is the only honest number I have.
Ways I’m Wrong
The honest limits, because this piece breaks without them. My proximity is mediated. I am the CEO, not the night nurse. The people who truly stand at the bedside are my teams, and any wisdom in this piece is borrowed from their work and filtered through meetings and letters. They have standing I do not, and I try to write accordingly.
The findings may also be survivorship-shaped. The reflections that reach me come disproportionately from deaths with time and language, hospice deaths, the kind with room for meaning-making. Sudden deaths, angry deaths, deaths in pain that was never controlled do not file tidy reports, and a philosophy built only on the articulate endings is missing data by construction.
And there is a version of this piece that romanticizes death into a productivity hack, which would be its own kind of obscene. Grief is not a framework. Loss is not a masterclass. If any sentence above drifted there, the failure is mine. The claim I will defend is narrower: that the end of life is real information about what matters, that my work gives me unusual access to it, and that I would be wasting the access if I did not let it redesign everything upstream, including me.
The factory gets built forward. The blueprint comes from the last room.
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Weekly · Unsubscribe anytimeReferences · 11 sources
1. Psalm 90:12, “teach us to number our days.”
2. Seneca, On the Shortness of Life, c. 49 AD.
3. Marcus Aurelius, Meditations; his reported last words per the Historia Augusta.
4. Leo Tolstoy, The Death of Ivan Ilyich, 1886; his death at Astapovo station, November 1910, per contemporary accounts.
5. Tacitus, Annals, Book XV, on the death of Seneca.
6. Ernest Becker, The Denial of Death, 1973. Pulitzer Prize, 1974.
7. Peter Drucker on the question “what do you want to be remembered for,” recounted in Managing Oneself and interviews.
8. Stephen R. Covey, The 7 Habits of Highly Effective People, Habit 2, 1989.
9. Jeff Bezos, regret minimization framework, various interviews; Colin Bryar and Bill Carr, Working Backwards, 2021.
10. Steve Jobs, Stanford commencement address, June 12, 2005. news.stanford.edu. Last words per Mona Simpson’s eulogy, The New York Times, October 30, 2011.
11. Bronnie Ware, The Top Five Regrets of the Dying, 2011.
12. The Yield and Why I Open-Sourced the Way I Run My Companies, The Culture Lab.