Poetic, thought the primary care doc, when our patient’s mother was able to grant his birthday wish to see the ocean “one last time.” Samuel’s last several months had been confined to the hospital or a rehab center. But for a few brief hours he sat in his wheelchair staring into the ocean. He even took a few steps, maybe ten, feeling the sand between his toes. One last time. The next day he turned 36. And had a very large stroke. And died.

But not before he was transferred to the hospital and put on slow, round-the-clock dialysis reserved for patients too sick to tolerate the regular dialysis people outside the hospital can.

And not before 2 paramedics shuffled him back and forth by ambulance to the dialysis unit 3 times a week when he wasn’t in the hospital in those last 3 months. And not before we approved his requests for more pain medication until he was left drooling and nodding off as I tried to have a conversation with him. And not before we gave blood transfusions even though they didn’t improve his counts and the hospital had a blood drive not so long ago. And not before we hung bag after bag of antibiotics to push into his veins for a problem they could not cure. And not before we checked his thyroid function.

All this even though we knew Samuel was dying. Years of shooting drugs into his veins past losing house and home and all his teeth had led to endocarditis—an infection stuck like a scab to one of the panels of the trapdoor valve in the right side of his heart. The scab so large, the trapdoor could not close properly allowing half the blood to flow the wrong way with each pump of his heart. The scab so friable, bits of it occasionally flicked off into his bloodstream into they lodged in his spleen, his lungs, his brain. No amount of antibiotics could get rid of the scab. And no surgeon would replace the valve; the Samuels had a habit of getting the new one infected and need yet another when they felt well enough to shoot up again.

Yes, we knew Samuel was dying. We just didn’t know exactly when. And Samuel wasn’t ready to die. So we did all we could to keep his used up body going as long as possible. We cared for the patient in front of us, without a second thought to costs or taxpayers or the societal cost of health care. And we attended as best we could to his primary wish—to not die.

Samuel got to dig his toes in the sand one last time and say good-bye to this cruel, cruel world. Without the American entitlement to dialysis he would have been forced to face his mortality and arrange that trip to the beach months prior.

Doesn’t feel poetic to me. Just doesn’t smell right. And it’s sticking to my shoe.