When I first met him he was still trying to be as independent as possible. He could’ve rung the bell and asked for water but instead, he walked to the family kitchen area to get the water himself. He refused to use the walker deigning to use only a simple cane. It took him 20 minutes to walk outside for cigarettes but the nicotine and his willpower continued to push him along. This was despite severe pain which was worsened by movement. He was determined to do things his way, the way he had always done things. Why should he change just because he had a terminal illness? He knew he was unwell and time might be short, he wanted to continue fighting as long as he could. He knew he might die but he would try his best not to. He was more worried about his partner. He had been trying to persuade her to see the counsellors but she was reluctant and wanted to concentrate on work. He was worried that she wasn’t aware of how unwell he was. He was still trying to look after her and wanted to prepare her for all possible outcomes, even the ones where he wasn’t around.

When I next reviewed him, two days later, he looked terrible. His pain had worsened, he had developed a bad headache, he was having fevers and couldn’t catch his breath. I was worried about him and I wasn’t sure if he would recover from this major deterioration. There seemed to be too much going on at once. Everything pointed towards worsened progressive disease. I talked about my concerns and that I would treat all of his symptoms aggressively. I told him that I would try my best to reverse things as much as possible but no matter what happened I would aim to make him comfortable. I offered to talk to his partner and I needed her to come in.

When she arrived I talked about what had led to his admission into hospice and updated her on his worsening situation. “Things keep on changing, the illness continues to worsen. I will try to reverse what is going on but I am worried that things might not improve. If things continue to deteriorate there might only be days to weeks left for him to live. We always work on a no surprises policy here.” He reached out his hands as he looked into her eyes and said, “I’m sorry love.” They hugged each other and the tears flowed.

I was asked back later when their closest family members came in. I met each of their siblings and their siblings-in-law. Their core support team throughout his whole illness. I shared the bad news with all six of them together. They asked about the rest of the family, some of whom were overseas. They asked, “Should we get them to come back as soon as possible?” I replied, “I’d rather people come and see you too early rather than too late. Working in hospice I see too late far too often.” They said they would make some calls.