After 3 days of tests and transfusions, he was discharged without a diagnosis. He returned within a few weeks. Although I was no longer involved in his care, he asked to see me. He looked as cheerful as ever.

"They're not sure what it is," he told me, "but I'm feeling great." He had just received another transfusion and seemed quite jaunty.

A few weeks later, just before Christmas, he returned again for more transfusions. He was hospitalized with an ill-defined autoimmune process.

The nurse paged me. "He has a gift for you," she said.

This time the bed seemed larger, and he was pale. I met his wife. She appeared troubled and did not smile.

"Here," Mr. Smith beamed, thrusting a wrapped package into my hands. It was a large paperback book about growing orchids at home. I had mentioned to him during his first admission that I was developing an interest in them.

"I hope you have better luck than I did," he said enthusiastically. The book, published 40 years earlier, was yellowed with age and had stains on the cover. He introduced his son and one of his daughters. Neither they nor his wife said anything after the introductions. He seemed too cheerful, talking of nothing in particular. I began to feel awkward, because his family members seemed distant. They stared unsmilingly at the floor, while Mr. Smith, oblivious to the tension, chattered on pleasantly. I could not stay, and Mr. Smith's son accompanied me as I left after this polite but strained visit.

His son wanted me to know that the gift had caused much resentment in the family.

"My dad never gave any of us kids anything." His bitterness surprised me.

"Here," I said, handing him the book. "It's just a book, and I really shouldn't take it. Please take it for yourself or one of your brothers or sisters."

"You don't understand," he said, with tears in his eyes. "None of us care about orchids. We don't want that old book. He wants you to have it, and you should have it. We just want you to know that he has given you more than he ever gave his family."

Mr. Smith returned to the hospital a few weeks later. He now required blood every 3 days. He smiled and waved feebly as I entered the room. He looked terrible.

"I think I've turned the corner," he said with spirit. "I'm so happy to see you." He asked if I would speak to his wife, and she accompanied me into the hall as I left. She began sobbing quietly. I explained as gently as I could that he would not last much longer. She nodded.

When I stopped by 3 days later, the nurse caught me before I entered the room.

"No one has addressed Mr. Smith's CPR status," she whispered with concern. I certainly had not; we had talked only of orchids and such. There had been, after all, more important matters to discuss.

He was now unresponsive. It was the first time I had seen him without a smile. His wife and children were there.

"We must think about how aggressively he would want us to try resuscitation when his time comes ..." I said to his wife in the hall. I was struggling. Mrs. Smith seemed purposeful.

"Everything is to be done," she said calmly, with tears in her eyes.

"Everything?" I was stunned. I tried to explain about defibrillation, intubation, chest compressions, broken ribs—about prolonging death instead of prolonging life. I wanted to talk about dying with dignity.

"That son of a bitch," she said softly. "He never gave me anything. I want him to suffer."

I arrived late when CPR was initiated a few days later. The room was full of sweaty people pumping Mr. Smith's chest, drawing blood, and shouting at one another. He was intubated. The attempt was, of course, futile.

I found his nurse in the hall.

"Where is Mrs. Smith?" I asked.

"She hasn't been here for 2 or 3 days."