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contrary to hospital policy, no one had ever contacted the plaintiff to explain what had happened and to give her an opportunity to have her questions answered. Acquiring this information allowed the hospital representatives to go back and figure out exactly where the system had broken down. This mediation lasted seven and a half hours spread over two consecutive days.9 The participants included the plaintiff, her son, her attorney, defense counsel, the chief of medicine, the director of risk management, and a representative from the hospital’s insurance company. Similar to bioethics mediations and unlike conventional mediations, our experience in medical malpractice mediations suggests that in some cases it is helpful to begin with a physician explaining the medical events to the family or patient (Dubler and Liebman 2004). This structure also gives physicians the opportunity to offer an immediate apology. In medical malpractice cases we mediated, the physician spokesperson was the chief of medicine. It is not clear how this approach would have played out had the spokesperson been a physician directly involved in the event. If mediators decide to follow this order, we recommend letting all parties know ahead of time so, if they are familiar with traditional mediation in which the plaintiff speaks first, they will not be caught by surprise. It can also be helpful to coach the physician and his or her lawyer about the type of factual, non-defensive presentation that is most likely to be helpful. Ordinarily one starts mediations in the morning so there is an opportunity to capitalize on the momentum established during the day. In this case, however, the schedules of participants allowed for a relatively brief two – hour initial session. As it turned out, having time overnight to digest new information, absorb differing perspectives, and get additional answers to one of the plaintiff’s questions seemed to aid the resolution process. Some mediators teach that once progress toward resolution begins, it is best to keep going to maintain momentum. Our experience in this case, limited though it is, suggests that time for reflection may be important in settling some cases. While we would have preferred that the physicians involved in the events participate in the mediation, they chose not to. Their non-participation raised questions for families who were looking for indications that the doctors cared about what happened. (4) The plaintiffs’ lawyers were willing to take the risk of trying a new process. Neither of the lawyers for plaintiffs had previously participated in mediation but both recognized the potential benefits to their clients and were willing to advise their clients to participate. In addition, they were able to join in problem-solving during mediation, listening to their clients’ concerns, and putting aside (with only occasional relapses) the litigator’s adversarial approach. (5) The plaintiffs had the opportunity to “introduce” the deceased patient to the other participants in the mediation. In these cases the central figures in the dispute had passed away. In other cases the patient may not be able to participate. In such situations it is often helpful to give family members the opportunity to describe their loved one to the mediator and hospital representatives as something more than just a “patient” or “victim.” Doing so humanizes the discussion and shows respect for the injured person. (6) Both sides had the opportunity to acquire important information The widows had the opportunity to ask questions, sometimes repeatedly, about things that were important to them though not always relevant to the legal case. They acquired information which seemed to be critical in helping them understand what had happened and cope with their loss. The information facilitated settlement of the lawsuits. At the same time, hospital representatives learned about “real life” practices that strayed from their vision of quality care. (7) The plaintiffs were given the opportunity to express their anger and grief to those ultimately responsible for their loved ones’ care. Mediation gives participants a forum in which their feelings can be aired and they can tell their story in a way that is meaningful to them, without the constraints of courtroom evidentiary rules. Similarly, hospital leaders were able to respond to the plaintiffs’ anger and