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At our last office visit, I told Mrs. B., my 88 year-old patient of 18 years, that she was doing very well. Her blood pressure was controlled, her vaccines were up to date, and her mild COPD was well adjusted. She was still an active volunteer for the local VFW, tirelessly preparing food and hellping with events. I encouraged her to keep up the good work and said that I looked forward to seeing her in a few months. She died the following week.
 
It had been a long time since I'd lost a patient so abruptly, without watching the decline of a progressive disease. One day she was in my office, and then suddenly her death certificate appeared in my in-box. Gone--just like that.
 
After more than two decades of internal medicine practice, I have had many patients die from one affliction or another, from accidents, from suicide or just from old age. Somehow Mrs. B.'s death hit me harder than the rest--perhaps because it was so unexpected, perhaps because we had known each other for so long. But I wonder if it is essentially because a few years ago I stopped seeing Mrs. B. simply as a patient and began to see her as a person whom I liked and cared for.
 
My sadness for her loss is not a burden; it is balanced with feelings of deep reward that I have only recently learned to appreciate in my career. The price of admission to the place of profound meaning is simply to be a human first, a doctor second.
 
Jeffrey Millstein
Moorestown, New Jersey