I assumed many things that morning.  For instance, I thought it was likely that Ronald’s fatigue was from lung cancer that had metastasized to the liver.  Or that he decided to stay in his room in the nursing facility because the decision to elect hospice had finally taken its toll. I was sure that he was both physically and emotionally spent.  I reasoned that I wouldn’t want to get out of bed either.

My visit, however, was much more optimistic than anticipated.  Ronald was jovial and inviting.

And he was spent.

The holidays brought an onslaught of family and friends to his little corner of the skilled nursing facility.  Children and grandchildren travelled half the country.  Acquaintances, both intimate and not so, appeared from corners and crevices around the world.  They all came in with smiles on their faces, and flowers in their hands.  They wanted to talk, and drink coffee and reminisce.  Ronald smiled so many times that his cheeks hurt more than his chest or abdomen.  His voice was hoarse from laughing, and his belly was full of coffee cake and donuts that he truly had no interest in eating.

Who knew that dying could be so tiring?

We both chuckled for a moment, and then became more serious.  I sat down and began to tell him a secret that is many times lost on those in his situation.  The dying often have a few basic wishes: to be free of pain, to enjoy whatever time is left, and to know that their loved ones will survive and eventually thrive after they are gone.

The process of dealing with physical pain, and trying to improve quality of life, is exactly what hospice providers are adept at.  The emotional suffering of those that remain after death, unfortunately,  is frequently difficult to manage.

The final gift of the dying is allowing family and friends to be present.  To be patient as they stammer and sputter.  To rejoice when they show up at occasionally inconvenient times.  And to let them play a role no matter how insignificant.

These were things that Ronald could offer.  These were moments that could bring peace to his loved ones long after his own personal suffering ended.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician.