At 69, Bob appeared to be a broken man. He left the hospital the day before and returned to the emergency department (ED) because he wasn’t "acting right." Bob became upset when a second injection to his abdomen burned, and family members were angry that the discharge instructions did not explain this. After four years of receiving treatment for metastatic colon cancer, Bob had reached the breaking point of persecution, but did his vigilant family understand he was dying?

After the physician assistant’s evaluation, I stepped into the room to make my own assessment. Family members appeared to be watch dogs: four on one side of the gurney, five on the other. As they rose to attention, I could feel the angst of having entered unfriendly territory. Most of Bob’s tests in the ED proved inconclusive, but the fact remained that Bob was dying. What were his wishes? Did he want to be in the hospital or at home? Was Bob receiving any palliative care services?

The family’s only goal was to have Bob return to the condition he was last week. They didn’t appear ready to discuss easing up on treatment. His children did not understand what palliative care was and how it might benefit their father. As I explained the "less is more/person-centered" approach, I was virtually tossing Bob an olive branch to use as a baton for self-defense. His family members, like perfectly trained golden retrievers, caught my peace offering of palliative care before he could grasp the concept.

Out of spite for my misgivings, Bob had to stay in the hospital, along with the demand for every possible test to determine why a man with brain metastasis was not himself.  It seemed like the hospital staff owed this family due to our failure to heal the dying. Like Bob, we had no choice in the matter.