He has been my patient for several years. My nurse practitioner colleague told me a few days prior that this patient had been diagnosed with terminal cancer. He came to see me today. He looked remarkably calm for a person who knew he had only a few days to live. After my usual evaluation, I sat on my chair. There was a long uneasy silence.

I wanted to say several things. I wanted him to be off all the medicines he was on for long-term benefits. He had a defibrillator that would shock him if his heart were to stop. I did not want him to get painful shocks from the machine when his heart was ready to go in his final moments. I wanted to ask if he wanted his defibrillator turned off. How do I tell him all this without sounding like I had already given up on him? I painstakingly put together some words to convey all that. His response to all those suggestions was quick and matter-of-fact.

Most of the time, when I am finished seeing a patient, I say- I will see you in six months, three months etc. What do I tell a person who is not expected to live more than a few days or weeks? How do I say goodbye to someone I may never see again while maintaining the hope that I just might?

I came back to my office after finishing with him, slumped into my chair, and started staring out of my office window. I had seen him almost every three months. The thought that I will never see him again gave me an odd, empty feeling in the stomach.

I enjoy listening to my patients’ complaints, processing all that data and coming up with some solutions. I had not done any of that to help him today but this visit had taken a lot out of me. Then I heard the thud of a chart being placed on my desk. Time to go see the next patient.
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