But when I think about that night, I know that I added to my patientвЂ™s pain in the last hours of his life. In most contexts, it is a doctorвЂ™s responsibility to tell our patients the truth, to help them to understand even the most devastating realities. When I told him that he had only a few hours to live, I allowed my frustration to obscure the reality of his suffering. This man was scared and he was going to die of a disease that might have been cured.

But I also responded to him with my own anger, at the avoidable nature of this tragedy, at how denial had turned deadly. In the most generous version of that night, my goal was to give my patient the information he needed so that he could reach out to those he loved, to say whatever he would want to say with the knowledge that his time was short. And as I revisit that night, I wonder about why I responded as I did and how we doctors react when faced with people who are dying because of bad decisions about their health. I try to recognize the emotions in front of me without drowning in them.Д«ut in that moment, I was not gentle. In the intensive care unit, we have the honor of caring for people at their most naked and frightened. I pride myself on being gentle with my patients and their families, even the вЂњdifficultвЂќ ones, who demand interventions that we cannot offer and believe steadfastly in a recovery that will never come. And as soon as the words left my mouth, I realized how cruel it was to try to take this defense from him in the final hours of his life. Denial was my patientвЂ™s only defense mechanism. What had I hoped to accomplish? As a doctor and purveyor of science, it can be difficult to accept that sometimes the вЂњtruthвЂќ is not what a patient needs. I never had the chance to talk with him again.ДЇor the next few days, I kept returning to that moment at the bedside. By then he was fading away, but they turned the hospital television to the game he had wanted to see and watched together as he died. Later that night, I learned, my patientвЂ™s family arrived - a long-estranged sister and son. He yelled, вЂњGet out!вЂќ with all that his failing body could muster. To tell him that sometimes we are wrong and that maybe he wasnвЂ™t dying after all, but it was as if we were frozen. I think each of us wanted to take the words back. The resident doctors looked toward me, trying to disguise their own surprise. The room was silent but for the sound of his heart rate monitor.

I donвЂ™t think you will make it through the night.вЂќ He turned his head away, as if to avoid my words. I spoke loudly so that he could hear me despite the mask. вЂњI wish there were something we could do, but the cancer is too advanced. What I do know is that I stood over his bed, distanced by my protective gear, and I told my patient the truth. Even now, months later, I am not sure why. But there was a part of me, standing there receiving his anger, that wanted my patient to know the reality of his situation. I might have reassured him that things were going to be all right. I might have told him that we were going to do everything we could to get him home, even though I knew it would be impossible. вЂњLet me go,вЂќ he moaned, pulling at the lines that ensnared him. вЂњI have to leave,вЂќ my patient said again, louder this time, seemingly unaware of the medications that ran through his veins, acting directly on his heart to raise his blood pressure. вЂњI wish that the antibiotics were helping, but I worry that your loved one is dying,вЂќ we say.Д«ut doctors can be far less equipped to deal with impenetrable denial from a patient. We learn language to show that we are on their side, while also making it clear that things are not going to be OK. I know how it feels to sit at a bedside and in windowless conference rooms, talking with families who cannot or will not let themselves acknowledge what is unfolding in front of them. He had things to do: a game to watch on television later that night.ДЄs a critical care doctor, I am familiar with denial in its many permutations. All he wanted was for us to treat his pain so that he could go home.

There was nothing wrong with him, he insisted. As I remember the events of that night, as soon as the doctors in training and I gathered at his bedside to explain his prognosis, he lashed out. When he arrived in our unit one night last winter, his cheeks were gaunt, his body wasted and abdomen protruding. Now he was back, but there was nothing the surgeons could fix, and so he would remain in the intensive care unit until his death. A diagnosis of colon cancer that might have been cured had he not disappeared from medical care to return, nearly a year later, with cancer so advanced that it had torn through his intestines.Д¬olleagues at the hospital had called him to schedule appointments, to get follow-up and to start chemotherapy, but he never responded.

Doctors in training are dying