In the increasingly troubled waters of healthcare, massive crew changes are taking place on our boats. Physicians fight over patients in affluent city neighborhoods, but many small towns still seek even one physician. The nursing shortage has only gotten worse. The passenger list is changing as well. Women in their later years are the primary users of health services. Future passengers are more likely to be older women, often with chronic conditions. This basic demographic change will collide head-on with a healthcare system still in love with the acute. Another profound change is affecting the passenger-crew relationship. The emerging philosophy of patient autonomy and informed consent says that when true options exist, let the patient decide. The result will be a partnership between providers and patients based on trust, mutual problem solving, and faith. Another partnership is coming as well. Universal access to acute healthcare services is inevitable. It will be a little weird, this new healthcare boat. Three navigational rules will help: (1) Even conservative institutions like hospitals can learn from history without being immobilized by it; (2) we must anticipate, plan, and hope, but remember that a big foot might come out of the sky when we least expect it; and (3) we must understand that the burden of uncertainty is a condition of life. The only thing to do is shoulder it.