Hektoen International

A Journal of Medical Humanities

A time to live and a time to die

Amera Hassan
Minneapolis, Minnesota


Photo by Gaspar Zaldo on Pexels.

“Well to be honest, doc, I don’t quite care whether I do live or die.” He said it so nonchalantly and he was smiling too, a crow-footed wrinkle on either side of his eyes.

When this patient was first admitted to the floor, he was in an undignified state, with flies wafting over his head and a rancid stench seeping from his room into the hallway. I was ashamed, not for him, but for myself, who hesitated to get closer. I greeted him, but no one greeted me back: he wasn’t there. He was inside his body, not with the world. I listened to his breaths, shallow like a pond and shaky like an ocean, chest rising and falling.

As a medical student assigned to him, I saw him every morning and most afternoons. I reintroduced myself though he was always altered, unconscious, or sleeping. I talked to him knowing he wouldn’t say anything back. It was a comfortable conversation in any regards. It went on like that for days. I kept checking in on him, sneaking him back onto my list, even when he was removed from my list to make room for other patients that I could learn new pathologies from. With him, I was still learning.

When he started to wake from his slumber, he didn’t recognize my face or voice, so I continued to introduce myself every time I saw him. One day, he introduced himself back.

“Nice to meet you,” I said. I didn’t have the heart to tell him I knew him already, that I knew what his heart sounded like, that I knew the scars he had on his arms, the clots in his body. That I even had a glimpse of his story from the time I spent on the phone with his family, who shared with me the details of his life. They checked in on him often, and I looked forward to their calls.

“Nice to meet you too,” he replied. I was another stranger, an indistinguishable face. I was okay with that. It was a comfortable meeting.

As the days went on, he improved. I got to talk to him more. He told me about semiconductors, explaining to my confused face the intricacies of these electrical machinations. He liked to tease his doctors and nurses. “You look like you just rolled out of bed,” he told the intern one morning. We laughed about it in the workroom. He liked to walk to the end of the hall where a little inlet of windows let sunshine in all day. The seats were always a little warm when you sat down. One day, I sat in the sunshine with him. He greeted me by my name. When he smiled, he had missing teeth, and it made him look kind. I realized it was the first time I saw him with a full smile.

Closer to his discharge date, I wanted to bring up the reason he was admitted. He had suffered from substance use disorder since he was a young man after life dealt him a difficult turn. He had unsuccessfully been through rehab programs many times over a lifetime with only short windows of success.

The attending physician and I walked into his room together. I stood silently, arms behind my back, head lowered. I wanted to hear this conversation but I couldn’t look into his eyes. I don’t know why. They were too blue and they were smiling. The attending asked if he was amenable to exploring new options for treatment. He could live a longer, healthier life.

“Well to be honest, doc, I don’t quite care whether I do live or die.”

I looked at him. Eyes were still smiling. Why were they still smiling? Was he laughing at the world or his place in it, or some little secret no one knew? We had spent so much of our time and dedicated our hearts to lull him back to health. Tweaking medications, reviewing labs, ordering new labs, consulting other services, and other endless little tasks to bring him back to health. And all of it for something he didn’t even want.



AMERA HASSAN is a rising fourth-year medical student at the University of Minnesota with aspirations to continue her medical career in emergency medicine. Having lived in the bustling Cairo, the woodsy Minnesota, and the arctic Norway, Amera finds enjoyment in nature, culture, literature, and food.


Submitted for the 2022–23 Medical Student Essay Contest

Winter 2023  |  Sections  |  End of Life

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