She shook her head. "I do not need anyone."

"Mom, yes!" Interceded his daughter, eyes full of tears. "You can not handle it anymore. He is too fat to press on you. He is too sick. It could fall and you could not get it off the ground. I have to work during the day, so I can not be there. Why do not you let the doctor get you help?

She shook her head, resolute. "I met this man when I was 14 years old. We got married three years later. And I promised to take care of him through sickness and health until … "She paused for a moment, choosing her words. "Well, until the end. I do not leave a stranger at my house to help him. I made a promise. "

" You take care of him, "I say as softly as I can" It will not stop with palliative care. "

She folded her arms and thought about what her daughter and I said, then she turned to her husband

"What do you think about the hospice?" she asked her.

He opened his eyes to the sound of his voice, I did not know how much he had listened to this conversation. "Whatever you say," he replied and he closed his eyes again. not how to interpret that, but his wife knew it.

"We will think about it," she said, in a way that really meant: "We are going to convey the "

They left the examination room and walked slowly down the hall, my patient's wife pushing her wheelchair, her daughter wearing her coat and her bag . Hand

C & # 39; is the last time I & # 39;'ve seen. The following week, he suffers a cardiac arrest at home and dies without the presence of his wife.

Of all the barriers cited to the establishment of the hospice, delays of doctors with insufficient resources, this – the dedication of the wife to the husband or the child to the parent and their reluctance to host another are the most difficult to quantify. She later told me that the death was about as good as they would have hoped, all told.

I think even her husband would have found him on this side.

Dr. Mikkael Sekeres (@MikkaelSekeres) is the director of the leukemia program at the Cleveland Clinic.