As much as I protested to my attending physician, she wouldn't let me get out of going into that room. “I don't know what to say,” I protested to no avail. “Don't say anything, just listen,” she replied, leaving me to check in on a patient without her help for the first time.

Working in the palliative care unit hadn't been so bad so far. I knew to expect a lot of dying people, but death didn't really scare me. I'm young, after all, and most of them are old. It's easy to associate dying with wrinkles, bad teeth, and a constant smell of sterility. Most of the oldies in the hospital accepted their fates, anyway. They “lived a good life,” whatever that happened to mean to them. They were ready to move on. Their current lives were such a shadow of their former existences that most of them seemed ready to be eclipsed.

My patient, however, didn't seem like the others in his situation. I overheard chatter between a nurse and tech talking about how they felt bad for him. Pity, I had learned fairly quickly, was something best left for someone in a different job than this. Usually, it was reserved for a young patient with a young family, not a 75-year-old man. He, by all estimations, should have lived a good life–or at least a long one.

When I walked into the room, he barely stirred. I could make out only one or two black hairs lost in a world of gray. His transition past the three-quarters-of-a-century mark had left visible ruins across his body, including a host of unwanted wrinkles wherever his skin peeked out. He seemed a tall man in his prime, but now his 6′2″ frame hunched forward in his plain hospital bed. He was quiet and pensive—a bad combination I would come to realize. Usually, the ones who have accepted their imminent deaths can't wait to talk to anyone they can get their hands on. He, on the other hand, didn't seem to be in the mood for talking.

“Hello, I'm a medical student working with the physician today. I wanted to come check in on you and see how you were doing. How's everything going?”

Silence. A stupid question; everything doesn't seem to be going very well for him. I tried to let the words echo in the room until he formulated a response, but it didn't seem like he noticed me. Sometimes these guys are hard of hearing, and sometimes I'm a little too soft-spoken. I tried again, a little louder this time:

“HELLO! I'M A—”

“I heard you the first time, son.” I got my answer as I stood there embarrassed.

“I'm sorry, sometimes the older patients are a little hard of hearing.” I tried to amend my error, relying on my instinct to be overly apologetic to patients.

“I understand, son, but if you wouldn't mind, I'd like some time alone.” He turned slowly toward the window trying to prevent me from seeing the emotions sprawled on his face. The air in the room tightened as he mustered up his remaining pride to conceal his body's defeat. Pity began to crawl up my veins, but I too filed away my feelings to do the job I came in for.

“Sure, but do you mind if I just ask a few questions before I go? Then you won't have to be bothered by the nurses or physician until it's time to take your meds.”

He sighed. I waited for a response as I watched his eyes fixate on the window. It seemed like he wasn't even looking outside, but just at the glass itself. “Go ahead.”

“How are you liking the medications?”

“They're alright.”

“Would you like to change any of them?”

“Not if you don't.”

“Are you feeling any pain?”

He took a deep breath in and grimaced throughout, “Nope.”

“It's okay to change the meds. We want you to be as comfortable as possible.”

“Comfort is a state of mind, son.”

“That's deep,” I blurted out. “Er—is the food okay?”

“Fine.”

“How are you sleeping at night?”

“Like a baby. Like a baby with a tumor the size of a grapefruit blocking its colon.”

“That great, huh?”

“Heh, I guess so.” A chuckle. I'll take it.

I began running out of easy questions to ask. Time for some more personal ones. “What did you used to do before you retired?”

“Is that a required question?”

“No, yes—Well, no, not required, but I thought it might help me get to know you better.”

“Fair enough, son. I worked construction for 42 years. I was an engineer on job sites.”

“Did you like it?”

He seemed amused at the question, “Well … I suppose I did. Had some good buddies on the job.” The corners of his lips began to curve upward and his eyes closed for an instant before he snapped back to the scene.

“That's good. It's nice to like what you do.”

“You like being a doc, son?”

“Well I'm not a doctor just yet,” I said, looking at my shoes, “but I like it so far.”

Looking straight at me he said, “you seem all right for it,” but before the compliment registered he added, “you had me thinking you'd only ask a few questions, but now you want my whole life story.”

“Just the relevant parts.” With confidence building, I decided to press on to some deeper questions. “Do you have any family coming to visit?”

The air stood still. It was an uncomfortable question, I knew, but one we needed to know the answer to. The old man returned his gaze to his spot on the window and paused for a while. It seemed like he was deciding whether or not he wanted me to know. That, or it seemed like he was deciding whether or not he wanted to say it out loud.

“N-no, no family coming …” He trailed off.

My tendency to apologize resurfaced, “I'm sorry … That … must be tough.”

“I'd like to take that alone time, if possible, son.”

It went against every bone in my body to leave him in such a vulnerable state, but I couldn't think of anything more to say. “Okay,” I managed. “Thanks,” I whispered inaudibly. I got up to leave the room, and with me it seemed the air left too.

I inched slowly down the hallway to my attending's office to deliver my findings, trying to drag the seconds out, so it seemed like I spent more time in his room. Summarizing what we had talked about, my mentor didn't seem impressed: “You mean you didn't find out about his family!?” How was I supposed to? I thought. The man clearly didn't want me to be there anymore.

She seemed to have read my mind: “Look, I know it gets heavy in there, but what is our main goal? Acceptance. You can't help someone accept their mortality without understanding who they are. That includes finding out about their family, their relationships, their spiritual views, and their life—all of it! I know it's hard, but you're going back in there tomorrow, and you're getting the info. These aren't just boxes we like to fill out on a medical history—it's a story. It's what makes that person who they are, and we aren't good healers until we work within their life to get them where they need to be.”

She wasn't even glad that I made him chuckle. As I walked out of the hospital that evening, trading the familiar scent of sterility for the livelier city air, I wondered how fair it was of us to ask these things of our dying patients. Could I accept my own mortality? Without an answer, I drowned my day's thoughts in dinner and Netflix before heading off to bed. Tomorrow I'll do better, I resigned.

“Hello again, I'm here to check in and see how you're doing today. How's everything going?” I said with a cheery face as I grabbed a nearby chair.

“Fine.” The old man's temperament had not changed since the day before, seeming as though time had forgotten to pass.

“I know yesterday I asked a lot of questions, but I was hoping I could ask a few more today. I'd really appreciate it, and I think it will improve the quality of your care here.”

He could sense I wasn't going to take no for an answer, so he reluctantly agreed.

“I'd like to start by asking, do you consider yourself spiritual or religious?” My upbeat tempo carried through the words I was saying, but when they reached his ears they crashed into a brick wall.

The atmosphere shifted, and the room heated up as the old man propped himself upright in his bed. He turned squarely toward me, face reddening and exclaimed, “Spiritual?! Religious?!” Any attempt to quell his emotions had henceforth departed from his list of priorities. “Let me tell you about my religion, boy. Never in my 75 years of living have I seen God.” His voice got louder: “Never in my 75 years of living has God talked to me.” His voice even louder now: “Never in my 75 years of living has God sent me a sign!” His voice turned to a scream: “I'm pretty damn sure that in the last weeks of these 75 years, God won't send me anything new!!”

His old body had taken on life again as the veins in his neck repopulated and allowed color to return to his face. He was breathing heavily now, and the outburst had left me wishing for the pale, pensive Jekyll to return. Any attempt to stave the fear from my eyes failed miserably, and once the old man noticed, the visiting color began to leave his face. He returned to his slouched position and sank once again into the pillows behind him.

Still reeling, I gripped the pen in my hand as tight as I could and resisted the urge to apologize. Instead, I waited out the storm, trying to process the burst of emotion from what seemed to have been a defeated man. Now was my chance to start hearing about his story, one that must have led him angrily to his conclusions about God. Being a religious person myself, I was deeply troubled by his resentment, but I thought back to what my mentor had said. The goal is acceptance for the patient, but acceptance is also our tool. We, as healthcare providers, aren't tasked with changing the patient, but we need to accept them as they are and try to move on.

The only next move I could think of, however, was to suggest he talk to someone with more experience in the God department: “It seems as though you might have some issues with religion,” I restated as politely as I could muster. “Would you like me to find a clergy member you could talk to?”

I crossed my fingers hoping and praying I didn't walk myself into another storm, but the worst had already passed. “Clergy? What for, so they can tell me God still loves me and give me a hug?” Sarcasm was more welcome than anger, but the message was clear.

I fumbled with what to do next, until I thought back to a technique my mentor had taught me in eliciting a spiritual history from a patient. For people who don't identify with spirituality or religion, she suggested asking generally about meaning in their life.

I gathered my courage once again and asked, “What do you think gives your life meaning?”

The question almost instantly transformed him into the introvert I had come to know. He turned his vision back upon the same point on the glass window. I imagined he was trying to make out a reflection of himself. I settled further into my seat, anticipating a long wait for an answer, if I were to receive one at all.

After a long time, he quietly stated, “I don't know.” He paused again to collect his thoughts. “I still draw breaths, and they're still mine. That's all the meaning I have left.” He sighed, the edges of his eyes began to glisten, and he turned his face fully away from mine.

The pity began to overwhelm me now, and I could feel the heat coming from my own eyes. This time, I allowed it in and I had to try and fix him: “You said you had good buddies on the job. Maybe you can derive meaning from those relationships or your job?”

He let the words bounce around the room before choosing his response: “You're right, son, I did have friends there, but they were just work friends—people I passed the time with. And it's not like I built people's homes, I just supervised building of offices and banks—places for other people to just pass their time with their work friends.”

“What about your family?”

I could hear muffled sniffles now as he still refused to face me. We approached the elephant in the room. He found enough time between sniffles to say, “You don't want to hear a sad story from an old man.”

I audibly scooted the chair forward and said, “Try me.”

He began by telling me of his childhood, sparing no detail. He grew up in a “normal” home—I imagined a white picket fence and puppies—but he said he never felt at ease there. His parents and younger brother were religious, but he never felt the same. He was constantly getting into trouble, hanging with a bad crowd, but school, he admitted, always came easy to him. He managed to get his degree, but along the way alienated himself from his family by falling into bad habits. He drank more with every passing year, adding other drugs as he saw fit and gambling away the remaining money he didn't spend on substances. He tried settling down with a girl he dated for a long time, but a few years into their marriage he became unfaithful. His days consisted of working to get money and at night finding ways to spend it. It was a miracle he was never fired, but he had been gifted with a sharp enough intellect to hold down his job.

His only bright spot, in a life of selfishness and satiating his own desires, he said, was his youngest niece. The limited contact he still had with his brother's family allowed him to get to know her. “I saw her being born,” he said, beaming, “my angel on earth.” He continued on talking about how kind, beautiful, smart, and good—how good—she was. “She was so good that she made me want to change who I was,” he began, but the light from his face turned dark. The happiness in his voice departed.

“I was trying to stop everything—the drinking, the drugs, the gambling, but—” I braced myself. “But, I learned my lesson too late …” He stopped and gathered himself for a while. He continued on to tell me how when his niece got older she started to recognize the scars of his bad habits. He brightened up for a moment, saying, “She wanted to accept me, always gave me the benefit of the doubt,” but quickly his expression dropped once again, lower this time.

“She found me in my favorite bar …” the story began. “She found me one night, I don't know how. I was drunk, drugged up, but the sight of her—” He paused. “The sight of her was the most sobering thing in the world.” The words came out slower now: “I didn't … want … her …” I fastened my grip on my chair. “… to … see … me . ..there …” He couldn't face me, and looked down instead. “She offered to drive me out of there, but while driving, she—we …” The few tears that had adorned his face previously turned into a downpour. “We got hit …” was all he could manage before his words mixed with a wail and everything became inaudible.

I could piece together her fate from the guilt that he wore now. The sobs turned to silence, only attenuated by his occasional sighs. As if his own guilt weren't enough, he told me soon after that his family refused to speak to him after that day. His brother forbade him from coming to the funeral, and he hasn't spoken to any of his blood relatives since.

At the end of hearing his story, I was tempted to say, “It's not your fault,” but I wasn't sure that I believed that. I could see the weight of each one of his wrong decisions weighing down on him as if they were embedded in the wrinkles of his skin. He hadn't “lived a good life” in a traditional sense, and it didn't seem like he was looking for validation. My only consolation was knowing that this was probably the first time he shared his story with someone who wanted to listen. He remained quiet for a long time after that and then whispered aloud, “I just wish I could've said, ‘Sorry.’”

“To who?” I answered.

“My mother … my father … my wife … my b-brother—” His eyes jerked, but there was no water left in him for tears. “My n-n-niece,” he sobbed. In that moment, you would have thought the grief was killing him and that cancer was the cure.

My gaze fell to the floor. There's no way I could have stayed tearless if I kept looking at him. The room began to feel moist as though the air were providing him with the tears his body lacked. I thought deeply about what to say next, and finally looked up at him to say, “I think your niece would accept your apology, wherever she is.”

His eyes caught mine, and for the first time I noticed how deeply dark they were. He let the words ring, allowing them to fully settle before he responded, “If anyone is in heaven, it's that girl.”

I smiled. The words seemed to comfort him. He wiped the remnants of the tears from his face, and his dark eyes glistened for just a moment before he asked, “Do you believe in God, son?”

I hesitated for a second, wondering about if it were right for a medical student to share his own views. But after all he had shared with me, I didn't have the heart to withhold the real me. “I do,” I said.

“Tell me about your God,” he insisted.

I paused again, but continued on: “I think God is merciful and forgiving. And that He accepts anyone as long as they—”

“That's nice,” he said as he returned his stare back toward the window. I couldn't tell what he was looking at this time, but decided I would come back and visit him some time tomorrow. I quietly got out of my seat and walked toward the door.

“Thank you, son, I—” the old man stuttered, “I appreciate it.”

“My pleasure,” I smiled once again and left the room.

I walked back to meet with my attending, allowing what just occurred to fully settle. The whole time I traveled through the hallways, I couldn't lift my eyes from the floor. “So did you get his story?” she asked.

“Yeah,” I replied.

“Good.” The exhaustion must have been plain on my face because she spared me any further questioning. “You did well, I'll see you tomorrow.”

Relieved, I left the unit and when I got home went straight to sleep. I came back the next morning to see how my patient was doing, but I learned that they had already pronounced his time of death at 4:45 a.m. I went to the room he was in and found only nurses cleaning—covering up where he had been just hours before. The window was freshly shined and the sheets changed. I heard the nurses talking about how they heard the old man talking to himself throughout the night, quieting down only in the early hours of the morning. I asked if anyone had heard what he said, but they only replied that it was probably gibberish.

I couldn't stop thinking about my patient that day. When I went home. I sat awake at night wondering what he was saying, who he was talking to. I thought about his life—whether or not he found meaning. I thought about his niece—whether or not I thought she was in heaven. I thought about his final thoughts—had he accepted his fate? I never got the answer, but I continued to hope, and pray, that it all worked out for him.