Pulse- “Did you sell the business yet?”
I marvel at my patient Jack: despite his breathlessness, he’s somehow managed to greet his wife Sara with a complete sentence. Given his condition, it’s truly amazing.

Most of his lung function has been devastated by his forty-year, pack-a-day smoking habit; the rest has been demolished by cancer. The easy, automatic breathing he once took for granted is just a memory. He can’t even lie down without feeling like he’s suffocating. Propped up on pillows in his hospital bed, he struggles for every breath–pulling it in, forcing it out–his brow creased in a perpetual frown of concentration.

Sara and Jack have been married for thirty-five years, since before he took over his father’s small shoe concession and turned it into a thriving business.

For the past five years, Sara has been watching Jack deteriorate–first slowly, then more rapidly. He was admitted to the hospital’s critical-care unit a week ago Tuesday. Now it’s Thursday, and Sara and I both know that his decline is accelerating.

I think back to yesterday’s conversation.

“How much longer can he go on like this?” Sara asked

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