I did not know that the first time I met Viejo was the last time I would see him as himself. At the time I was a medical student on a rotation that gave me junior physician-level responsibilities, and with it the chance to prepare for my upcoming transition, one I had worked for years to attain: becoming a doctor. A trusted healer. A source of comfort and competence. A cooperative team player. I was painfully aware of my own shortcomings—not enough knowledge or experience—but deeply devoted to the acquisition of both, and to the creation of meaningful connections with my patients.

Viejo, as his wife lovingly called him, was my first patient. His bright eyes glowed behind wide, plastic-rimmed eyeglasses, his handshake firm, his smile trusting. But Viejo’s story was an all too common tale among the low-income population my public hospital serves. Unable to afford regular preventive healthcare services, he had presented with mysterious new “back pain” that, through a CT scan, revealed itself to be late stage cancer, already metastatic to the bone. Viejo and his family—his dear, devoted family—came to us hoping for a timeframe for recovery, and instead received an estimated expiration date. Continue reading →