“I’ll catch you later,” I uttered as I placed a kiss on Laura’s cool forehead. It was a gut feeling that this would be our final exchange. I circled around the base of her hospital bed to Sherry, instructing her to remain seated as I leaned down for a heartfelt embrace, one where my face nestled into her sweater. The scent of her laundry detergent filled my senses, and she wept and trembled in my hold. Though my twisted back ached in this position, I stayed still and felt her tears slide along my neck. Her earrings chimed softly as she cried.

For days, I had been aware that Laura was nearing her end. Each day, I layered in more information to prepare the family. “I’m concerned those spots on the CT scan—the ones right here—are really cancer.” I had stated this a week prior, subtly indicating that I understood the reality of her condition, and they would soon comprehend it as well.

Even before the biopsy results arrived, I advanced the discussion and ruled out CPR as an option. “Let’s focus on managing your pain, anxiety, and difficulty breathing, Laura—let’s handle those, but let’s avoid CPR or an ICU visit.” I expressed this on Monday by her bedside, in a conversation with Laura resting and her stunned husband, Chuck, hunched over on his chair’s edge. I framed it not as a question, but more as a grave announcement. The words lingered in the silence, and I watched them until they nodded.

I reiterated the terms “comfort” and “goals,” discussing a process wherein I would be supportive and present. I had always recognized my role as the storyteller in this narrative, and now they were aware too. After being Laura’s doctor for fifteen years, I anticipated—hoped—to be there when her final moments came. There had been an abundance of hospital stays, tears, and letdowns leading to this point.

The next day, adult children arrived, and I took extra time to address their questions and foreshadow the impending disaster. I repeated sentiments of comfort and gratitude—for their inquiries, their presence. They appeared astonished, shocked in a manner that was both distinct and, concurrently, just like every other sorrowful family in my hospital. I had once stood in their shoes and recognized the glassy-eyed look, the vacant gaze, the thoughts and words that never quite materialized.

By the time the Hospice team arrived on the second floor, Laura’s family had reconciled with what lay ahead, which lifted a significant weight off my shoulders. I don’t judge family members in these scenarios who cling to the notion of “just one more treatment,” or ask, “Can’t we attempt that surgery?” While understandable, could I recall even a single occasion when any of those treatments positively impacted the outcome or resulted in more quality time? I felt relieved for Laura that I wouldn’t have to expend precious emotional energy navigating such futile discussions.

Two days after she departed from the hospital, Laura passed away at home, as she desired. And I felt a sense of fulfillment, knowing I had respected her wishes. Like many patients before her, I wished there had been more serene days, but I ceased mourning those missed chances long ago, aware that most of my patients needed to become critically ill before considering end-of-life decisions.

I didn’t shed a single tear during Laura’s hospital stay, which was the expected outcome of being entirely focused and engaged in the interactions described above. At some point in my career, I embraced a position of moral leadership in the painful, sorrowful, and desperate circumstances of my patients and their families—instances that required me to pause, speak the truth, and refrain from tears. When I pushed myself into this mentality—no, this existence—I entered a realm that starkly contrasts with the soft-hearted, sentimental man I, in reality, am.

These emotional gymnastics are intricate and awkward, and I am certain I misstep often each time I contort myself into this unfamiliar stance. I know someday I will weep for Laura, and it’s likely to occur on an ordinary Tuesday when I’m alone and unneeded. Or perhaps I’ll be caught off guard while fueling my vehicle, or in some other mundane moment. In that instance, without my armor, I too will recall her sweet smile and all our discussions about diabetes, rheumatoid arthritis, professional wrestling, and life’s meaning. I too will remember how deeply I care for her.

*Ryan McCarthy is an internal medicine physician.*