He carries a book under his arm, just in case I am behind schedule, and his usually tanned skin hangs from his gaunt face with a deathly pallor. He pushes himself up from the chair and gets short of breath from the exertion. I reach for him as his balance wobbles, and he pulls me into a long, tight hug.

“I don’t have much energy these days,” he says. “Good thing I’ve gotten so forgetful; now I can read the books in my library all over again.” I laugh at his joke, as always. His wife laughs, too, like it’s the first time she’s ever heard this clever comment. They’ve been married for 57 years, and as she twirls the wedding ring on her finger, I sit down between them and begin the conversation I’ve dreaded.

Within a few days of developing his cough, Dick went from hiking two miles a day on the golf course to barely able to walk his dog around the block. We were convinced it was a simple case of bronchitis until an X-ray showed otherwise. His lungs were filled with fluid, and a faint mass could be seen hiding in the lining of his lungs. By then, he was so short of breath that he was admitted to the hospital, where the fluid was drained and the mass biopsied. I hadn’t seen him since that day, but we knew now that he had stage 4 mesothelioma. It is a deadly cancer that worsens quickly and comes from asbestos exposure, like in the naval yard where Dick served as an officer many years ago.

“Dick, you know this isn’t a curable cancer, right? The chemo might help improve your breathing, but it might make the rest of you feel even worse.”

“I know, Doc,” he says gently. “I’ll let you know when I’m done.”

We talk for a few more minutes about goals and expectations, about getting enough sleep and trying to drink plenty of water. I remind him that he may feel hungry for something specific one minute, only to be nauseated by the thought of it the next.  I explain that his appetite is going to get worse and that nutrition shakes might help him keep up his energy, but that at some point, food just feeds the cancer. I tell him I’ll call in a week to check on him and squeeze his wife’s hand as I stand to leave. The tears begin to gather in the corners of her eyes, and I depart quickly so that she won’t see mine.

I hurry to my office down the hall, close the door, and lean against it as the tears escape. The advice I gave Dick and his wife was based not only on my professional experience but my personal experience, too. Thoughts and memories pop into my head with vivid clarity.  Doctors are supposed to be detached and objective, but I’ve been in Dick’s wife’s chair, and I remember every detail, each hopeful conversation and subsequent piece of bad news: “Neil, this chemo regimen didn’t work, but there are others we can try.”

I remember my own husband’s bad jokes, told when he barely had the breath to share them. “I need this like I need a hole in the head,” he laughed as they wheeled him away to have his brain lesion removed. I remember how one day we were laughing at life, and the next day we were crying at death: “Neil, I can’t do this without you.”  “Well, you don’t get to choose, Col.”

My eyes are closed as I stand alone in the silent office. It’s been eight years since my husband died, and yet grief has a way of resurrecting itself long after we believe it is gone. Done. Finished. Dealt with. But there is no such thing as ‘finished’ with grief. And equally unwelcome questions pop into my head: should I have pushed different chemotherapy, fought for a spot in yet another drug trial, or prayed harder for a miraculous cure? I’m a doctor, and I couldn’t even save my own husband. Grief and guilt often go hand in hand.

And then I hear the voice of Aaron Burr in Hamilton singing, “Death doesn’t discriminate…it takes, and it takes, and we keep living anyway.” None of us are spared death or the experience of losing someone we love. We all grieve. And my version of “living anyway” is not defined by cures and positive outcomes but by the hands I hold, the stories I listen to, and the tears I help wipe away. In a few short weeks, Dick’s wife will need me even more than he does.

So, I sniffle a few last times and grab a tissue from my desk. I blow my nose, dry my red eyes, and pack my grief back into the little place in my heart where it resides. It is not resolved; there is no rewarding remedy, but the next patient is waiting in another exam room, so I open my office door and head back down the hall.