I walk up the steps of the front porch. Halloween decorations adorn the steps and door. A witch, Jack o’ lantern, and a big spider on a web are placed just perfectly so, and ready for the festivities of the coming day. I enter and hear the tapping of a dog’s nails as he trots across the room to come greet me. His tail wagging; his fur is soft. I feel the dog licking my hand and I smile. I walk through the foyer and into the living room. The kids are sitting on the couch and watching TV. The familiar sound of “Blippi” fills the room, with kids’ laughter following. The three-year-old comes up and starts excitedly talking about Halloween and her costume, with joy across her face. The five-year-old asks if we can make cookies. It feels like a good day for cookies. The 10-month-old is crawling around the floor and sharing his crackers with the dog and smiling.

This feels like it could be my house. The sights and sounds and people that fill it are similar, but it is not my house. It is the house of another doctor, who is my patient and who is dying. I go see him in his bedroom and he is noticeably worse than my last visit 2 days ago. He is minimally responsive, jaundiced, swollen and in pain; being tortured by a disease that has no business taking the life of a 39-year-old dad, husband and doctor. He has dedicated his life to trying to save people, and yet at this young age, here he is. Standing by him, his wife, easily one of the strongest women I’ve ever met. She’s managing the kids, extended family and friends and taking amazing care of her dying husband. Her nursing background clearly prepared her for this, but it’s not fair this is the way that she has to use her skills. I adjust his pain pump and we discuss other ways to optimize his comfort for the ensuing hours and (maybe) days. I say goodbye and retreat from the bedroom back into the living room with the kids. The same familiar sounds and sights envelope me again. I feel especially privileged to have taken care of this fellow doctor and to know his family, but there are a lot of questions that come with this privilege. I wonder what the kids will remember about their dad? How will this wife manage 3 kids by herself? Will Halloween ever have the same joy for them that it brings to other kids. And, I wonder how this is fair? The answer is that it’s not. I see a lot of people die in home hospice care and I feel emotional about losing a lot of my patients, but this one hits a bit too close to home.