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I too was intrigued by Krista touching on this issue. I too am a middle aged (65) physician. First I was stroke by the reference to aging as being 40's. I have watched the trajectories of professionals over time and it is true that by the mid 40's some people hit a wall. They stop growing. I am not sure that I agree with Brene that people make a conscious decision here. At the same time I think her observations on the nature of that wall reflect a challenge to address the restrictive roles we find ourselves in and the challenge to find our souls. As a geriatrician I was expecting to hear more about ageing in the context of my day to day work as Kate addresses. The acceptance of aging and the ability to find joy in ageing in spite of the adversities is crucial to ageing well. This requires the acceptance of vulnerability. In my small sample of one physician's lifetime in medicine there Is a gender difference here although great individual variations. I have started to collect poems related to ageing and there is a genre I call "In spite of poems" which reflect this acceptance and the courage to live well. Patricia Goodman's "Riding the Reptile with Amy at Jungle Jim's Water Park" is a shining example of this. Kate raise this issue of shame which is major issue for people in our society now with the advancing epidemic of dementia. It is a real barrier as we wrestle with the question early diagnosis. It takes immense courage to face the increasing vulnerability of this syndrome. I was fortunate to learn early in my career the power of exposing my own vulnerabilities to medical students. They often suffer from 'the imposter syndrome'. To understand that their mentors have struggled with challenges, second guessing themselves and failures allows them the freedom to take risk and to care for themselves. With patients and with colleagues I often point out that the hardest person to forgive is ones self.