Sigh. Some day I'm pretty sure I'll have hell to pay for ruining so many people's lives.

I had to do it.

I had to make it clear to Mr. A. that there was no hope. That the poorly differentiated adenocarcinoma likely of pancreatic origin had already metastatized to his abdomen. And liver. I had to tell him that we will not offer chemotherapy, because there was no hope. And I told him with his entire family present. I had been working 31 hours and technically was in violation of work hour regulations (maximum of 30 hours nonstop). But I had gotten to know them best and didn't want to punt this thankless task to someone else.

I had to do it. They weren't listening to the medical oncologist. Or the surgeons. Or us. When someone told him, "Less than 1% of these patients make it to 2 years", he thought "If I try hard enough, I can be that 'less than 1%' ". And the family was torturing themselves with the false hopes.

In the meantime, he's spending what is probably his last 4 weeks on Earth in the hospital, hundreds of miles from home, when he should be with family and loved ones. In the last 3 weeks that we've seen him, he's shrivelled up so.

Life isn't fair, he angrily told me today.

Early 40's. Beloved husband, father of 3, youngest child just a week old.

No, life isn't fair. I didn't tell him about the young single mother with a young child who died of complications of ovarian cancer I looked after. Or the young 20 year old girl in the army, who collapsed one day and spent 15 mins in the base clinic waiting room while her doctors were futzing around, while she was in polymorphic v-tac. By the time she was airlifted to our cardiac intensive care, she was essentially in brain death.

Honestly, this unfairness scares me. Somehow, you think death is something only older people have to deal with. It seems natural... you live life, have kids, grow old, and go. Circle of life. But the reality is different. Young people die. Good people. Lives just opening up.

I'm glad I have the next 2 days off. Maybe I'm feeling burnt out. Or maybe I've just been awake too long. I need a break. I really do...