“How much time do I have now?”
His voice on the phone was calm, almost casual. We had discussed the sudden cold wave, his family, his niece’s recent grand wedding, Jasprit Bumrah’s lethal bowling—everything except his illness. Then, out of the blue, he asked that question.
It’s a question I hear often. Families ask it when hope starts to fade. Patients ask it when they’re gathering the courage to face reality. Sometimes, they don’t ask at all—fear keeps the words trapped. They want to seem strong, to keep fighting. Or maybe they notice the doctor’s haste and hold back.
Doctors avoid the question too. We circle around it, pretending optimism. We dismiss their anxiety. We brush off their worries and offer promises that may never be fulfilled.
Predicting the future is never easy. As Lauren Rissman, a palliative care physician, once described it, prognostication is “an imperfect art of foreseeing what lies ahead—like piecing together a puzzle while knowing that some pieces will always be missing.
It’s true—predictions fail more often than we’d like to admit.
Not long ago, my residents treated a young man who had ingested a lethal pesticide. His brain was swelling, his heart barely pumping, his lungs rigid and infected, his liver failing, and his kidneys completely shut down. Twice, he went into cardiac arrest—just a straight line on the monitor—and each time, the residents managed to revive him.
I was convinced he wouldn’t make it. Almost certain.
Two months later, he walked out of the hospital.
And then there was the man with pneumonia. His recovery seemed swift. We removed the ventilator, and soon he no longer needed oxygen. The tubes came out, and he began talking about going home. We believed we had triumphed.
But we were wrong. He died suddenly—likely from a clot in his lungs.
Once again, I had misjudged.
During our MBBS and MD training, we were never taught how to talk about death. In my early years, we avoided these conversations altogether. Breaking bad news was often left to the junior doctor—without guidance or preparation.
Now, back to him.
He was in his late seventies. Years ago, surgeons had discovered cancer in his abdomen. They removed as much as they could, followed by three rounds of chemotherapy. The treatment took his hair but not his resolve.
His hair grew back, as did his determination to fight. Blood tests, chemo sessions—nothing fazed him anymore. He studied his reports with quiet acceptance. Though he ate less than he should and felt increasingly tired, he never voiced a word of complaint.
He was the picture of resilience
“So, how much time do I have?” he asked again, his tone steady.
I hesitated. Did he truly want an honest answer, or was he looking for comfort?
“Maybe a year or two,” I said softly.
He laughed.
“One year?” he said, still laughing.
His reaction caught me off guard. I expected sadness or frustration, but instead, he seemed… relieved.
“You know,” he said, “there was a time when every extra month felt like a victory. I truly believed I could beat this. I thought I’d win.”
He paused, his voice gentler now.
“Not anymore. I’m tired. I don’t want to keep fighting. I just want peace. Don’t try to prolong my life—just help me go peacefully.”
He probably wasn’t familiar with living wills or advance care directives, but his experience had taught him something invaluable—how to recognize when to keep fighting and when to let go with dignity
After decades of practicing medicine and teaching residents, I’m still learning how to navigate these conversations. In the palliative care ward, I spend a lot of time with families. I’ve learned to sit with their tears and silences, to feel their anger, and to bear their grief.
Doctors are expected to provide hope. Patients look to us to fight for them. No one wants to be the one to sever that thread of hope.
But moments like this remind me that truth, though hard, can bring a different kind of comfort.
“Honestly, I don’t really know. It could be a few months, or maybe a few years,” I said. “These biopsies, scans, and labs—they don’t always give us the answers we expect.”
He laughed again. “So, you were lying earlier. Now you’re being honest.”
He was right.
It is really tough job of a Dr to reply such quarry. I think Dr is one of the best actor in the world who can assure a person on death bed that he will survive for a long. Person who hear it and who are around also believe words of Dr.
Thought provoking writing.
I learned this from Dr Karunakar Trivedi in third MBBS, when you don’t know the answer you will always be right when you say you don’t know. I have usually been up front when this question is asked, in my line it is often, and I always say I don’t know without beating around the bush. It gets more challenging when another colleague has given some finite time. I understand patients and their families want to make plans, one can make qualified crude estimates in advanced refractory illnesses where clearly therapies now are ineffective… maybe few months if vitals are stable or few days if one is seeing the patient in hospital ward with unstable vitals and one has decided to stop therapies except symptom palliation. Yes, these conversations are not easy and I keep reminding myself to be a witness to their struggle and provide kind words without impatience. Best is to be sitting than standing near the door as urge for flight is strong.
Again you have done a splendid job in addressing this challenging topic and very well written.
Brilliant Dr Kalantri
I really admire your write ups!
Again a brilliant write up…
Fabulous write up.
An expert (I don’t know if it is the right word in such a context) I have heard is Dr Nagesh Simha – Medical Director of Karunashraya – a Palliative Care institution in Bengaluru.
He trains doctors, nurses and more on these topics – breaking bad news etc
A touching story that beautifully captures the harmony between science and humanity in medicine.
While we may cure 50% of diseases, control 30%, and remain uncertain about 20%, we can offer 100% of our patients something far greater: a listening ear, reassurance, and the promise of unwavering support to keep them comfortable, especially for those battling life-threatening illnesses, our presence and compassion can bring comfort amidst pain and uncertainty.
Very well and appropriately worded. All your blogs must be categorised, compiled and converted in a book form.
Sir pls do publish a story book with all these stories .Your writing style will have an exclusive follower list .I am definitely one amongst them .
From history taking to communication with patients, it is all about narration of a story . The newer generation needs to learn this art of story telling( I include myself in that ) .
Wonderful write up … and more than the art of writing, it’s the topics that you select and the entirely different aspect of medical care , that you so nicely and impressively describe , is not just beautiful, Wonderful, amazing etc , but so vital in medical practice !
Hence a new thought struck me while reading this article… it must have germinated long back , while reading your earlier articles , but it surfaced today!
I don’t think anyone talks of this important aspect during medical teachings, in any college …
Hence I feel a collection of your articles on this aspect should be available, on line and in print too .. and it should be part of the syllabus, after completion of M.B.B.S., during internship and should be a part of PG entrance exam…
What you write is neither internal medicine, nor even Social and preventive medicine-
But it is a very good medicine ,and needs to be taught to all !
Very very realistic account of a very very difficult predicament……I’m glad I am not a clinician.🤔
As a healthcare provider, I ask every patient about their living will and encourage them to assign a Power of Attorney at every visit, it’s now a Medicare requirement. It’s not just paperwork; it’s peace of mind.
Prognostication helps families prepare, but stories resonate. I share personal experiences hardest thing I did was discussing my mothers wishes for her death and funeral before she died, giving her a good death in middle of a pandemic. It was the hardest, yet most meaningful, conversation we ever had.
One patient, a business owner, later thanked me when I gently told him, It’s time to let your mom go.. another family finally took mom off the ventilator after I spent two hours talking to them. Each person in the family cried and I do not recall what I said, but must have made a difference These moments matter. Have the hard conversations. Plan ahead. It is a gift to your loved ones, patients, caregivers. It is an art too and is not related just to us as physicians but human connections.
Very well written as always.
A very difficult thing to do as a physician esp a primary care physician. When practicing in early years in Massachusetts we had to round in Nursing homes and talked to families about their dear ones doing poorly. Somehow that difficult job i could do well! That is what my collegues used to say!
Happy New Year to you and your family. Hope you are doing well with your cardiac health. Keep writing please! You are so good with your memory of old times and your detailed research. Waiting to buy your book you should compile with your writeups!
Just awesome ! After along time I came across such a touching writ up. Thanks.
I love your writing!
Very poignant and touching, doctors treat but God heals. There are numerous questions but no definite answer