I saw her in the office twice: the first time to put on her cast and the second to check that her wrist was doing well. I tried to give what comfort I could, knowing there was little else I could do. She died about 5 weeks after breaking her radius, well before the fracture could fully heal with either surgical treatment or my cast. Among other things, I remember quite well the softness of her voice, and I realized how hard it is to hear a quiet patient's voice when we are surrounded by such a cacophony of sounds: the manufacturer's representative's braying about his new, expensive plate and the need to keep up with the most advanced surgical technology, the surgical suite manager's praise and admiration when I book a heavy load of cases, the practice management consultants' chirpy remarks about the need to view patients as revenue sources and maximize the income streams that can flow from each encounter, and my anesthesiologist's thanks for keeping him busy with insured cases. A frail, dying, elderly widow's voice becomes so hard to hear against all the noises of contemporary private practice.