The blood tests were all deranged and matched what I had found on examination. She was dying. I maintain a no surprises policy. I don’t want my patient or their loved ones to be surprised by sudden deteriorations which could lead to death. They needed to know. I had to tell my patient and her gathered family what I feared was happening.

“I’m worried that everything is getting worse. If this continues I think there might not be much time left, maybe only days. I’m sorry to have to discuss this. I think you are dying. I’m going to try my best to keep you comfortable. We haven’t tried the steroid treatment before. I’m hoping that it will help you feel more comfortable.”

My patient was too weak to talk, her face was covered by a towel. Her family said they understood and thanked me for telling them what was happening.

“I’m sorry this is happening, I wish I could stop it.”

I was surprised when my patient reached her hand out to grasp mine.

She said, “It’s okay. Thank you for helping me.”

I swallowed hard and promised I would keep on trying to make her comfortable.

As soon as I left the room the family made arrangements for her child to come in from school. They had to prepare him for what would happen.

She died less than 12 hours later.