It's a long time now, over forty years in the emergency department, lingering over case after case, thinking and reflecting on the prolonging of life. Years ago my attorney brother and I were at the bedside of our mother, struggling against the bipap that was supporting her breathing during the sepsis from peritonitis that was taking her away. She said, "Let me go!" and we sadly went to the desk...after we conferred with her and then together...and signed the DNR form that would lead to her being moved to a morphine drip at a hospice called "Tranquility". The typical staff member there had spent twenty or more years as ICU nurses: Years spent helping people check back in. Now they were lovingly helping patients...like our mother...check out with love and grace. I have never witnessed a more loving care by such gentle souls.

            At the end, the peace that passed all of our understanding that came over our mother had no reference that I could describe. In one moment she was sleeping and breathing softly, and then the next moment she lay still, amid a vision she must have been having of an infinity that opened before her. Somebody had told me years before that the first dream you have of a loved one after they pass tells you how they are spending eternity. When my Dad passed after his sudden heart attack in his 80's, not long after that I dreamed that we were all at a party, wearing formal wear, and my Dad, a little smaller in stature but so real in my dream, was the life of the party! I knew that he was doing just fine in the hereafter. '

            After Mom died, I had to look inside with the passing years to find my own comfort with that "view of infinity": The giving over of life to embrace a hereafter that, with those of faith, we aspire for a measure of confidence in our universal continuity that transcends our last breaths, our final heart beats, that is measured in significant part by the love of those who remain behind, and is lodged in our minds as we approach the final adventure of life.

            He was a bit younger then me, lying there writhing with his back pain. A colon cancer survivor, he was now having a moribund, unrelenting lumbar agony that had worsened over the last few weeks. He said, "I hoped it would go away, but it didn't." His pallor, his tachycardia and diaphoresis, his drawn face all murmured to me that this had the chance of not being a diagnosis that either of us would want to know.

            And, indeed, on the CT scan his bones were riddled with metastases, his acute pain caused by the severe pathologic compression of his second lumbar vertebra. This was as bad a prognosis as it could possibly be, and I made arrangements to admit him for pain control and what care our wonderful cancer team could offer.

            I remembered a long time ago that somebody told me, in dealing with patients whose fates hang precariously, "never destroy someone's hope. Sometimes, that's all they have." So, I returned to my patient's side, there in the late evening of the ED, surrounded by the ill and infirm of a large urban emergency center. His sweet nurse came with me, to stand opposite me at the bed.

            Taking his hand, I sat on the edge of the bed and asked if he was feeling better from the morphine. He said that he was, that he was a bit more comfortable. "I'm going to put you in the hospital," I said, "and give you some medicine to make you feel better." "What is it, Doc? What's going on with me?" he asked. I said, "Well, I'm not sure, but I do see some areas in your back that concern me...you may have cracked one of your vertebrae."

            "Is it my cancer coming back?" he asked. I reflected for a moment, about what someone had told me about hope, and about life, and about not taking away someone's will to live.

            "I'm not sure," I said. "It might be, but we won't know that for a bit." Then, wanting to help him move to a place where he might feel some control, I said, "But, I have a job for you. We have to keep your pain under control, because feeling a lot of pain can weaken your strength." And then, I said, "Your job is to monitor your pain and to let us know if you feel more uncomfortable. Then, you need to let us know, and we'll bring some medicine for you. Can you do that?" He said that he would.

            I sat there for another moment and held his hand. We both knew the score, and we just looked at each other for awhile. I squeezed his hand a last time and rose from the bed to stand, still looking at his eyes. And, I swear to you, I could see in his eyes a view of infinity.

            Moving to the door, I headed to the hallway, to the long night in the emergency department that lay ahead.