As family physicians, we devote our careers to taking care of patients “from cradle to grave,” during some of their happiest and most difficult times. Over the years, they invite us into their lives, and we bond with their families. In turn, they ask about our kids and admire any new pictures or drawings we post on our exam room walls. Yet, during their final days, arguably the most important ones, we are frequently absent.

A TALE OF TWO PATIENTS

I had taken care of Jack for more than a decade. He was one of my favorites. When he turned 80, I told him that he was still one of the coolest guys I knew. Our conversations were frequently about his love for the beach and his support of local theater. Our clinic visits were both medical and social in nature. I also took care of his wife before she passed away from metastatic melanoma. His daughter and granddaughter remain my patients to this day.

Jack was diagnosed with primary biliary cirrhosis decades ago. But like many patients, his daily ursodiol kept the disease under control — that is, until his liver could not handle all of the years of subacute damage, which finally led to liver failure. He began to experience encephalopathy and confusion. He had problems with balance and frequent falls. There was some discussion of vascular dementia. During one visit, I could tell that Jack was not able to recall my name. He had always called me Adam.