K.P. was an 84-year-old man with bright blue eyes and ashen-gray hair. He was a Vietnam veteran, having actively served in the military for more than 25 years. It was my first day of my inpatient Internal Medicine rotation, and it was K.P.'s 180th day at the Veteran's Administration. He had a textbook case of acute myeloid leukemia: prior history of radiation therapy, Auer rods on the blood smear, recurrent bleeding, and pancytopenia.

Throughout our month together, we engaged in the most eclectic conversations, discussing his brotherly comrades and years of military training to his love of country music and our shared passion for gardens. I looked forward to seeing him each day prior to our bedside rounds and immediately afterwards. One afternoon, as we were watching the History channel together, he took out his wallet and showed me a faded photograph. It was of his home garden. I held the photograph in my hand and admired the abundant rows of crimson-stained roses and canary-tinted daffodils.

“That was last summer, before all of this began. I sell them at the local farmer's market. Aren't they just beautiful?” I nodded in agreement, amazed at the incredible energy he had put into caring for these flowers.

Each day, we rounded on K.P. and updated the fishbone drawing on his whiteboard. His platelets and red blood cells were improving since his admission and he hadn't required a blood transfusion in ten days, a new record.

“You've been making some good progress here. One more round of chemotherapy and you could be out sooner than we thought,” the oncology attending stated.

Then, on day 192, K.P. had spiked a fever to 104.5°. With an absolute neutrophil count of zero, he was incapable of mounting any effective response to this infection. The slightest exposure to disease, even to someone with a sore throat, could rapidly devastate his system. I was disheartened, knowing that I would have to tell him to stay in the hospital for at least another week.

“I don't want to be here anymore. I can't spend another day in this place,” he stated as we spent the afternoon playing chess.

“I understand you're upset, but the oncology team doesn't feel that you can leave just yet.”

“Well, I'd rather leave than stay here for a whole year. I used to be someone before I came here, someone who actually did things, you know?" he exclaimed.

“I know and I'm sorry. Your cell counts are too low. It'd be a risk if you left the hospital,” I said, attempting to plead with him.

“You don't get it, do you?” he exclaimed.

He was right. I didn't get it. I didn't understand what it was like to spend nearly a year in a facility that was far removed from the peace and comfort of a home. I didn't understand what it was like to be attached to a chemotherapy-infusing pump for hours on end. And I definitely didn't understand the agonizing loneliness that accompanies social isolation for months.

Over the following three days, he barely talked to me or anyone else on the care team. Instead, he lay in his bed with the sheets brought up to his shoulders and his back turned away from the front door. Unopened cartons of pudding and milk sat on the table. I was hesitant to talk to him, afraid that anything I say would further upset him.

The next day, I came in and learned that he had left against medical advice. I was upset that he had left, risking his safety and forgoing the progress he had made here. I was even more upset that he didn't say goodbye.

While on rounds that morning, the nurse who had taken care of him pulled me aside and put something in my hands.

“He left it for you,” she said.

I looked down at the faded photograph nestled in my palm and smiled. I wonder whether it was selfish of me to want him to stay and to ask that he continue fighting his cancer. I wonder if the physical world, outside of the hospital, will be too much for his condition and I will soon be reading his name in the local obituary. But I also wonder if I may someday see him selling roses at the farmer's market.