Ten values reprised.

H OW DEATH OCCURS and how it is managed by physi-cians—their presence or absence, their words said and unsaid—can dramatically affect the grief and bereavement of patients and family members. I still remember the phy-sician's words to me: " Our hope is that she'll go home, albeit with her arm amputated. " Pamela, the mother of my 2 daughters and a woman with whom I spent 30 years, lay dying, kidneys and heart failing, left arm and right hand gangrenous, pete-chiae painting her skin, eyes closed halfway to heaven, and she was going home after amputation of her arm? Really? Oh how me and my 2 daughters wanted to believe that, we really did. Mom was coming home, some semblance of normalcy was returning. But she did not come home—she was dead within 72 hours. I should have known, but patients and families analyze words, and that is what I did, I analyzed 12 words that resonated with my heart: " Our hope is that she'll go home, albeit with her arm amputated. " Looking back, my emotional fool-ishness was profound, but a bewildered insanity is common when watching a loved one die. Others call it denial. It is protective and adap-tive, a subconscious ministering in dealing with difficult news. But there is no denying its staggering strength, the overwhelming want to hear what one wants to hear, no matter how unbelievable. Its pull can be overwhelming , even intoxicating. Yet as a physician, how could I be so irrational , so out of touch? My answer was easy, I wanted her to live, not die. I was not ready to let go. It is fight or flight, do whatever it takes to live. And so the obscure blinders remained in place, although deep down, I must have known the truth. But knowing and acknowledging are contrary confessions, and I chose with my heart. However, after her death, and after grief had settled into a daily routine , I scribbled what I had learned from her experience in the hospital and from her death. I titled the piece " Ten Values, " and it was published 3 years ago. 1 But since that time, and amidst my 5 years of grief, I have re-prised these values with a maturity of loss and a closer scrutiny of medical care from the other side of the bed— the side of the patient …