How often have I heard those words or some version of them? The location of the conversations varies. I might be standing outside the curtain of an emergency room bay or sitting on a worn chair inside a cramped waiting room adjacent to the ICU. Possibly on the phone in the dark of my bedroom at some pre-dawn hour. Those words, coming from the mouth of a spouse, a child, ...

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The patient in front of me is trying to die. Elderly and frail, he is lying in bed. His ribs outlined under the skin that should be smooth. His temples are concave where they should be flat. Both are an outward display of internal damage from his lung cancer. More striking than his cachexia are the strained muscles in his neck and his pursed-lip breathing. He is working hard for ...

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I pause in front of the door. On the other side, you all wait. A spouse, sons and daughters, sometimes with their own small children in tow. Today, it’s your husband and father you have come for. Yesterday it was someone else’s mother. You have come from near and far, across the street and the country. Your weary eyes are unable to mask your sadness. Over the past week, you ...

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Walk with me, why don’t you? It’s time, don’t you think? We have been avoiding this for quite a while. But it's best to bring this out from the shadows and into the light. Let’s take a walk through part of my day. Be careful. You won’t like what you see. I don’t like this much, but I just keep moving forward, one foot in front of the other. Don’t stop. Can’t ...

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What do you do when you know someone is going to die? I’m not talking about death when it comes at the end of a long protracted illness or a terminal diagnosis. Or the final act at the end of a “good” life, when the body and mind have ultimately given way. I’m talking about when you realize the twenty-five-year-old woman in front of you, who you met five minutes ago, ...

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I knew the moment when my career in pediatrics was over.  I was in the fourth year of my med-peds residency, taking overnight call in the pediatric ICU.  Nights were busy, stressful and I was alone.  A young boy came in as an unrestrained MVA after his father hit another car. Dad was OK (although severely distraught), but the five-year-old towhead boy in front of me was not, with his head immobilized in ...

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