"Don't worry, you'll meet people."

Despite those telling me that travelling alone would afford many opportunities to do so, I wasn't so sure. I knew it would certainly be a new experience. I had planned a few particular activities and tours but knew there had to be a good deal of flexibility; I welcomed that change compared to my usual trend of micromanaging my vacations. I was going for the laid back approach to focus on enjoying myself rather than worrying if I was having enough fun or doing enough day by day.

"Can you see the new patient?"

I looked at the admission diagnosis and frowned. Even as a novice student a few months into clinical rotations, I knew the weight that "painless jaundice" carried. It always raised the concern of a pancreatic tumor quietly growing til it announced its presence by blocking flow through the liver and infusing skin with a characteristic yellow hue.

"My daughter has the same name as you."

"Oh, really? How old is she?"

"Seven and a half."

I didn't expect that. I thought she would have been older, because you were almost the same age as my mother was when she had the same disease. I foolishly applied the lens of my own experience and assumed your daughter would have been a teenager like I was. I paused, recovered, and finished the exam. I gave you a tight-lipped smile as I left your room.

"I can't believe you remember that."

My memory is a blessing as well as a curse. I wish that I could turn it on and off at will but it's pretty random. Antibiotic dosages slip my mind but I will recall the name of someone's boss only mentioned in passing. I struggle with memorizing passages but in my mind's eye I can visualize embarrassing childhood events with surprising accuracy. Sometimes I will forget someone's name right away but I can remember the name of their childhood pet months later.

I remember the good and the bad experiences - sometimes it seems that it's more of the latter than the former, though. Despite my eidetic recollections, there's months (if not years) of my childhood that I can't recall, or time periods that blur together in an indistinguishable reel of disjointed frames. I'm not sure why that is; maybe my mind tries to protect me from remembering some of the worst times.

Patient Zero: "You were just a child."

"Ami has cancer," he said to me. "But don't worry, she's going to get treatment - it's going to be OK." A decade and a half later, I still remember how he said that so matter-of-factly with the confidence unique to teenage boys. I was taken aback and confused. The concept of cancer to me, at age twelve, conjured up images of bald children in hospital beds and fundraisers. It didn't fit in with how I saw you. You were my mother -your role was to be steady and constant, especially given how recently you had become a single parent. You were not supposed to be sick.

"Do you know how I got hepatitis?"

"No."

I could feel your eyes on me as I arranged the tray by the beside to prepare for the procedure. You weren't a patient I was following; I had been asked to perform a paracentesis on you by a colleague. Your swollen, distended abdomen made you look heavily pregnant and the sheer weight and pressure of the fluid impaired your walking and breathing. The discomfort was evident which is unsurprising given you were hauling around several litres of fluid in your abdominal cavity. I knew your ascites was due to liver disease and I assumed it was attributable to a history of alcoholism or something of that ilk.

"There's going to be a poke and some stinging," I warned before injecting the freezing. You flinched and I felt the familiar twinge of guilt. The paracentesis needle, long and sharp, finally pierced your peritoneum and straw coloured fluid started draining out. I've always found it a bit ironic that ascites resembles beer. You breathed a sigh of relief and I did the same, feeling some of the tension recede from my shoulders. I hate causing people pain, even if it is in pursuit of therapeutic benefit. This wasn't your first paracentesis and it certainly would not be your last.

With the technical part complete, I refocused on your question. You regarded me with a certain intensity as you told me your story: a mugging, a gunshot wound, a tainted blood transfusion. "They caught the guy who shot me and he went to jail. But I was stuck with a life sentence."

I was quiet with shock as that certainly was not what I had expected. I was ashamed of myself for the assumptions I made about the etiology of your disease. I wonder if you knew that's what I thought; I imagine that people jumping to conclusions was common for you. A series of unfortunate events, none of which were in your control, led you to your current day predicament.

We chatted as more and more bottles were filled up at the bedside. You were transfused with albumin to prevent fluid from rushing back into your peritoneal space to replace the eight litres that were removed. I watched the IV drip and considered how thoroughly this blood product was screened to prevent the type of incident that brought you here to begin with.

At the end of the procedure, you thanked me for helping you feel so much lighter, but it should have been me thanking you. You taught me a lesson about keeping an open mind and to approach every patient with a fresh perspective. I need to let every patient tell their own story rather than writing it myself. Thank you, Mr. G.

"Im afraid I have bad news."

I rarely sit down for good news. There is no perceived air of indifference if I am standing at the bedside and relate that a CT scan shows improvement, or if I poke my head in to notify that bloodwork is stable, or stop by in passing to relate negative biopsy results. The delivery isn't as important as the content since the receiver is usually reassured and relieved by the information.

When I ensure that I am sitting down, it often heralds bad news. The more effort to set the stage usually corresponds with the gravity of the conversation. Because it's not solely about the information - it's about how you communicate it and deal with the outcome. There's a reason that there are sessions in school devoted to teaching these skills. They don't really prepare you for real life, though. Unfortunately that skill is refined through experience.

I was glad your wife was there. I pulled a chair up so I was at eye level with you both. I swallowed the lump in my throat that had formed there when I read through the CT results. They were far worse than I imagined. It was late in the afternoon and I could have gone home and discussed the results with you the following day, but I felt obligated to disclose them then. I had a special affinity for yourself and your family - you were always incredibly pleasant and lovely to deal with.

Before I began, I think you knew something up due to the difference in my demeanour. I remember how your face changed, smiling optimism to shocked disbelief, as I explained the scan results to you. Your wife's face furrowed with worry and tears formed in her eyes. I wished that I could have had different information for you, but unfortunately, the imaging demonstrated progression of the disease and new spread to your brain. I didn't expect that, Mr. H. The latter part worried you the most. "I don't want to lose my mind", you said before you dissolved into tears. I vividly remember how the sobs wracked your frail body as your wife clung to each other; I quietly left the room to give you both privacy to process the bombshell that had just been dropped.

The lump in my throat returned and I brushed tears away as I looked at the results again. I knew what this meant, and I felt helpless in my impotence. I was surprised to see B come in - I was there much later than I should have been and expected him to have gone home a long time ago. "Why are you crying?" "Mr. H is dying and there is nothing I can do about it."

"Is he less of a man because he's dying? Is there nothing you can do because he is dying?"

I didn't have much of an answer for that. I think I made a dry remark about B being more of a father figure to me than my own, with all of the deep questions and life lessons he discussed with me. For some reason, it was always him around when I cried. I acknowledged he was right and we discussed some of the finer points of palliative care. I think that is one of the pivotal points that helped me understand the importance of the philosophy of palliation. Cure was not an option but, as B explained, there was a whole lot that we could still do for you and your family.

Treatments were initiated. Your radiation mask was decorated with emblems of your favourite hockey team. You became more frail than you already were. Weakness and fatigue prevented you from getting up. You were plagued by pain and nausea. Medications were started, stopped, adjusted; true to your wishes, we endeavoured to help you keep your mind clear as well as we could. But you faded.

You had told me several times about your home in the country. That was your ultimate goal; to die at home in your comfortable, familiar environment surrounded by your family. You went home. I said goodbye knowing that this would be the last time I would see you again.

Thank you, Mr. H, for teaching me about the opportunities we have to care for someone at every step of the way. You died at home, just as you wanted. It was bittersweet as I was sad about the outcome, but at the same time, happy that we were able to help you accomplish your final goal. Rest in peace.

"How did you miss that?"

I stared at her with incredulity as she related what had transpired since your transfer a few days prior. The etiology of your recent stroke was discovered to be a vegetation perched on your heart valve. It was sending out a shower of infectious emboli which passed through your circulation wreaking havoc. One of these splinters took your speech; another robbed you of the movement of your right side; en masse, they ended up taking your life. Indeed, how did we miss that?

I didn't understand how that could happen - what went wrong that such a grave diagnosis could have been missed? I pored over your chart looking for answers. A single fever. There were no repeat blood cultures as it didn't quite meet that arbitrary temperature cutoff. The infectious disease team had already signed off following the adequate treatment of your prior bacteremia. The stroke happened over the weekend and whomever was covering initiated the basic workup. I flipped through the bowels of the chart and found it. An echo which drew attention to the ticking time bomb on your valve. This hadn't been acknowledged until your transfer where fresh eyes were laid upon your case. Was it the cardiologist's fault for not calling in the report over a weekend? Was it the nurse's fault for not seeing the result when he returned from the test? Was it our fault? Was it mine?

They told me your family was taking it well; they were singing hymns at your bedside at the end. I remembered the crinkling of your eyes and your deep laugh as you joked with me at your bedside. I knew you for a few short weeks but I could tell that there was a real kindness about you. You were a very matter-of-fact man. After all, you had told me you were not afraid to die.

In retrospect, I realize I was looking for someone to pin the blame on as a way to exonerate myself. But there was no specific responsibility - it was on everyone and no one at the same time. The stroke may have accelerated your end, but your preexisting comorbidities were always there. Initiation of antibiotics sooner after discovery would not have changed the outcome. If not the stroke, the cancer would have done it. There was no negligence. Your clinical course fundamentally did not make a difference in what happened. But it did humble me by demonstrating that errors and omissions are inevitable - it's not an 'if', it's a 'when'. And we aren't defined by our mistakes but more how we deal with them.

Since then, I always look for the echo report.

"I was going to give this to my sister, but I want you to have it."

He handed an onion to the neurologist. It was freshly picked from his garden with the leaves still intact and bits of dirt clinging to the roots. The neurologist hesitated a moment before gently taking it.

"Can you tell my family? I can't do it."

I couldn't say no to your request, especially since I had just turned your world upside down with the diagnosis. "Is this going to kill me?" "It's not curable." I knew my response was avoidant but I didn't yet have the ability to look into someone's eyes and tell them they were going to die. It was not a skill I expected to hone. I wonder how our conversation would go if it were to transpire today; I have certainly refined my approach.

As per your request, I relayed the news to your son (who did not take the news as gracefully as you did). I understood his shock - after all, this was his mother who had been entirely healthy up to this point and was now confined to a hospital bed. You would not be able to overcome this  - aggressive as the disease so often is, it had already spread diffusely. He asked me the dreaded question of prognostication and I recall my hesitation in providing a timeline.  An experienced physician once told me that regardless of the prognosis given, there will always be disappointment - whether a patient exceeds or falls short of your prediction, you are almost always wrong and the family will be unhappy.

"Weeks...maybe months." I remember the look of incredulity on his face. That was not news he expected and it was almost like he was trying to negotiate with me to get more time. I told him we needed more information but the outlook wasn't good. I did not want to take away his hope. He clung to the notion that maybe more tests would yield a better prognosis.

It didn't...you declined progressively. I still remember your warmth and kindness. You were always pleasant; never wanted to "bother anyone" despite your illness stripping you of your autonomy. Your son was short with me and I understand now that it was not directed at me personally but rather his frustration at your illness. Day by day, I watched as you slowly slipped away and, despite our best efforts, we couldn't turn it around.

I didn't want to be right, Mrs. I. I prayed that I would be wrong and that things would improve. But I was correct in my estimation of weeks. I remember pronouncing your death. Confirming with my stethoscope the absence of a heartbeat; listening for breaths I knew were not there. You looked peaceful; the lines of exhaustion and illness had fallen away from your face. I hope that you continue to rest in peace and that your family is able to cope. Thank you for teaching me about honesty and the reality of mortality.

"You don't care about me...I'm just a number to you."

I struggled with conveying to you how untrue that was; how I worried about you when I was at home, how I checked every morning to make sure you hadn't gone to the ICU overnight, how I tried to exhaust every option for your care. My explanation didn't mean much to you - after all, half the days you refused to talk to me or let me examine you. I know it was your mental health diagnosis and the frustration of your prolonged hospitalization but it stung to hear that.

One day, your name wasn't on the board and my fears were confirmed. When you came back to the ward days later, things were even worse. Despite the onslaught of antibiotics, pouring blood products into you, and so many interventions - things were getting worse and the end was approaching. The hematologist told me that we simply could not continue like this.

I heard the unmistakeable announcement overhead and prayed that it was not your room number - my stomach dropped when it was. I don't know how I made it through my training without witnessing a code blue on one of my own patients but somehow I had. And this time, stakes were higher - I had been following you for weeks and was thoroughly invested in your care. As I was fresh out of school I still harboured hope and naivety that death was a failure of medical intervention. Despite your perception I didn't care about you, I was still trying to do everything possible to turn things around.

Adrenaline surged as the frenetic activity of a code exploded at your bedside. I felt myself panicking, unable to remember anything from ACLS, but most of all I remember feeling useless. I felt so ashamed of myself, especially after the anesthetist asked me to put the brakes on the bed and I couldn't even do that. I can vividly remember how the nurses' compressions jarred your poor, cachectic body and my instinct was to tell everyone to stop, to leave you alone, to let you die in peace.

I called your brother back - it had been scarcely two hours before that I had spoken with him to arrange a family meeting, but a code blue doesn't pay attention to schedules. "Your brother went into cardiac arrest and it doesn't look good. Do you want us to continue?" Your brother was taken aback; told me to "do everything" and that he was on his way. I told the code team of his family's wishes and then I left the room.

I felt like a coward for running away. I felt useless and stupid and somehow, in an utter twist of logic, that I was responsible for the outcome. I cried in the back room. Not an attractive, elegant way of crying but intense, body-wracking sobs where it felt like I was shattering inside. I felt like an incompetent failure.

You were whisked to the ICU after miraculously getting a pulse (artificial as it was). We knew, though, that there was no coming back from this. I learned about the compassion and resilience of my colleagues when my embarrassment about breaking down was met with support and validation. I learned that my softness is strength rather than weakness and it's better that than being numb.

I met your parents the next day. It broke my heart to see the frail, elderly couple in matching wheelchairs clutching each other and sobbing about the imminent loss of their son. It seems so unnatural for a parent to outlive their child and there is no comparable grief. Your brother told me how life support was going to be withdrawn in a few hours. You died very shortly after.

They say "you never forget your first". Your death has stuck with me. I dreamt about you for a few weeks. I broke down crying during a class at the gym a few days later. Vivid images of the traumatic code and clips of your parents crying popped into my mind unbidden. I ran through the clinical scenario a myriad of times in my head to see if there was anything I missed; anything I could have done that would have changed the outcome. But there wasn't. Your life was never in my hands. We did as much as we could for you, and you helped me learn a hard lesson that despite our efforts, people die. Regardless of the advancements in medicine, we are not in charge of the outcomes. From Him we come and to Him we return.

"There should be more [health care professionals] like you." When your brother said that to me, I didn't take it as an ego boost but rather as a reminder of why I do this. I will never forget you, Mr. A. I hope that before the end, at some level you realized that you were (and never will be) just a number to me. Thank you for the lessons and the influence and perspective I gained from you.