JAMA- My mother in law, Bonnie, stopped eating just after her 88th birthday. A Christian Scientist, she had only seen a physician a few times in her entire life. Bonnie never talked about death because her religion did not acknowledge it. But as 50 pounds dropped rapidly away, she finally acknowledged to my daughter that she was dying.

Still, when I arrived at the emergency department, I was surprised at her motionless, emaciated body. Only yesterday evening, the Christian Science house where she had been living had discharged her to a skilled nursing facility (SNF) because she was too weak to stand. In the morning, her sons had visited and panicked: her legs were grossly swollen and suddenly leaking copious amounts of fluid. Without a physician present at the time, they were advised to take her to the emergency department.

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