Not long ago, I took care of an elderly man with congestive heart failure. A few days into his stay in the hospital, he told me he was not going to make it out alive. ‘I am going to die here,’ he whispered, as if letting me in on a secret. I tried to reassure him: on the scale of disease I normally treat, his case was relatively mild. But then he became sicker. His bloated legs dripped fluid, soaking his bed sheets and puddling on the tile floor. His blood pressure dropped. He became delirious. I was perplexed by the precipitous downturn. What did my patient know that I did not? After several days of keeping round-the-clock vigil in the intensive care unit, his wife of nearly 50 years could no longer bear his suffering and requested hospice care. A few hours before he died, groggy from morphine, he managed to summon a few moments of lucidity. Gripping his wife’s hand, he said to her, ‘You’re doing the right thing. Every day in medicine there are examples of patients who know they are about to die, even if no one else does. They often have […]