Dr. S was from Korea, where he had been a physician. He had gone to medical school in the United States and then returned to Korea. He eventually became the head of a large hospital in Seoul. When the Communists occupied Seoul during the Korean War, he was tried in a "people's court" and expelled from the hospital. He and his family fled the city and lived as refugees for several years. During that time, Dr. S organized medical services for other refugees. After the war, he returned to Seoul and directed the rehabilitation of his hospital, which had been plundered and damaged. When the restoration of the hospital was completed, Dr. S retired from medicine.

The elderly physician calmly told me of these events at our initial visit, with obvious pride in his accomplishments and resignation over the events that had disrupted his life and his career. He seemed upbeat and optimistic, however, as he continued his story. Dr. S had emigrated to the United States after his retirement and had become a naturalized citizen. His wife had died several years before we met, and he was living nearby with his daughter. He had two sons, one of whom was a physician in the U.S. military, and two other daughters, one in Korea and one in Japan.

I found a pulsatile mass in his abdomen that day. Ultrasonography showed an aortic aneurysm that measured just under 5 cm. During the next year, the mass grew another centimeter. What to do? The size of the aneurysm exceeded the cut-off for surgical intervention. Dr. S's general health was good. Was it prudent to perform a long and dangerous operation on a man almost 90 years old? The gerontologist with whom I consulted offered only that his approach was not to look for abdominal aneurysms in octogenarians in the first place. I gathered as much information as I could find on the risks of surgery and Dr. S's prospects if the operation was not done. Our best vascular surgeon recommended surgery, pointing out that he had done several successful aortic operations on 80-year-olds recently.

Dr. S and I discussed the data at great length, sometimes as patient and physician, sometimes as two physicians. I wrote him a long letter summarizing the information available in the medical literature. He talked to the vascular surgeon himself and discussed the surgery with his physician son. Despite all of this, he was not satisfied. Before he could decide what to do, he needed to know why this abnormality had arisen. He demanded respectfully to know the pathophysiology of his enlarging abdominal aorta. What was the actual defect, the specific cause of this problem? After all, he reminded me, he was not hypertensive and had no other risk factors or evidence of atherosclerotic disease. When I could only offer that the wall of his aorta may have weakened over time because of some inherited or acquired predisposition, he was disappointed. My attempts to convey Laplace's law and the likely progression of his aneurysm were no better because I was merely predicting the course of his problem and not explaining its origin. I grew frustrated as he calmly contemplated the time bomb within him.

A couple of years passed. He came for periodic office visits, always asking to review yet again what was known about aortic aneurysms. I came to believe that he had made a de facto decision not to have surgery. Then, one day, a call came from a different surgeon asking if I would visit Dr. S post-operatively. He had already had the surgery to repair his aneurysm and had sailed through without major problems. When I saw him later that day, he looked tired, but his eyes were clear, and he laughed despite his fresh incision. He had a slow but full recovery, and reached his 90th birthday as fit as the day that I had met him several years earlier.

During Dr. S's first visit to my office after the operation, I asked him why he had finally decided to have the operation. "Well," he said in his slow, deliberate way, "it was something that just had to be done." Then he laughed his typical laugh, and said nothing more. Perhaps if he could not understand the essential cause of the dangerous aberration inside him, the only thing to do was to eliminate it, whatever the risks or benefits. He struck me as more serene and indomitable than ever, having passed the tests of time and surgery.

Alas, his serenity and invincibility did not last long. He was increasingly beset by the vagaries of old age and minor but debilitating symptoms. His skin itched, he did not sleep well, his back hurt, he had trouble with his balance, and his bladder did not work properly. Now, with each visit to the office, Dr. S looked less like a Zen master and more like a failing old man. Although he still sported his tweed coat and cap, he needed a wheelchair to get from the street to the office, and he had to be lifted onto the examining table.

In the autumn, when Dr. S was 93 years of age, his daughter called in some distress. Dr. S had asked her to travel with him to Korea. She was sure that he could not make this journey, that he would end up sick and confused halfway around the world. His daughter was a senior citizen herself, and although she did not say it, I knew that she worried about her own health during such an adventure.

When he came to the office a few weeks later, we discussed the trip. He had decided to go to Korea so that he could visit the graves of his ancestors. I realized that the reasons Dr. S should not make the trip were the very reasons why he wanted to go. The telltale signs of his frailty meant that the end of his life was approaching, and he wanted to return one more time to the land of his birth and the graves of his ancestors. How could I tell him not to go?

Although too polite to say so, his daughter was angry that I had not forbidden the trip. Several months passed. I assumed that Dr. S and his daughter were still struggling over whether to go to Korea. When I saw his name on my appointment list one morning, I anticipated his visit with trepidation. I did not look forward to refereeing a family dispute or adjudicating his spiritual calling. Coming out of an examining room, I was astonished to see that the dapper gentleman walking steadily down the corridor was Dr. S. Dressed in his usual tweed coat and sporty cap, he was without wheelchair, without cane, without even the supporting arm of his daughter, who trailed behind with a smile. What had happened to restore him to health?

Dr. S had gone to Korea. He had prevailed upon his daughter, who reluctantly agreed to go with him. She said that he seemed to get stronger as their departure date approached, and the 18-hour flight passed without incident. He visited his family's ancestral gravesite and spent time with living relatives in Korea. Even better, he arranged to have a manuscript published by a Korean publisher. It recounted the patriotic exploits of an old friend, a man who had died without recognition because he had married an American. Now his friend's achievements would be recorded for posterity.

As his daughter narrated the travelogue, Dr. S beamed with satisfaction. He had saved the most remarkable part of the story to tell himself. In the midst of his journey to Korea, he had heard of the death of Kim Il Sung, the long-ruling North Korean dictator. The despot associated with the expulsion of Dr. S from his hospital and his home and with the division of his country had succumbed before him, almost literally in front of him.

Once again I glimpsed in Dr. S the same wisdom and equanimity I had felt the first time I met him and heard the story of his life. He seemed satisfied with his life but not ecstatic over the death of the North Korean dictator. The Korean people were not clearly the better for it, he told me, what with the unpredictability and craziness of the dead dictator's son. And the death of Kim Il Sung could not change what had happened to Dr. S before. But the trip to Korea had clearly changed what was happening to Dr. S now. Whether it was the visit to his family's gravesite, the publication of his friend's story, the death of the Korean dictator, all of these factors, or something else, Dr. S was a changed and revitalized man. As he left the office that day, he told me that he had begun to work on his own memoirs.

Inevitably, the change in Dr. S was not permanent. The following year, various maladies recurred. Stomach pains began to trouble him and grew worse despite different foods and medicines. Eventually, he became weak and anemic, and gastric cancer was found. As always, he wanted to know all the details of his disease, to understand the pathophysiology. This time, however, he seemed more accepting of my explanations and readily agreed to palliative surgery. Several months later, he died at home at 95 years of age, still in the midst of writing his memoirs.