The patient lay emaciated in her own bed, propped up on pillows, with her head lolled to one side and her mouth wide open. I had to look twice to see if she was breathing. The firefighters said they couldn’t hear a blood pressure, and I wasn’t surprised.

Her husband was a wiry and determined looking little guy who only came up to my shoulder, a Popeye without the cartoon muscles. He told us the story. She had been diagnosed with an incurable degenerative condition almost a year ago. As we questioned him further, a picture began to emerge.

My initial feeling was that this poor woman belonged in a nursing home. She had had little or no outside medical care in the intervening months. The home was clean and orderly, but it bore none of the signs of a chronically ill patient. There was no hospital bed, no medical supplies, no chart or folder for the visiting nurse, no shoebox of pills, no commode by the bedside.

What she did have, however, was one incredibly dedicated caregiver. Her husband had seen to her every need, helping her to the bathroom and feeding her for as long as he could. Her degeneration had progressed to the point that he had to carry her upstairs to the toilet, yet he continued single-handedly. I began to realize that while I didn’t see much to the medical side of her care, he had been providing personal care at a level nursing homes can only dream about.

As we loaded her into the ambulance for the short ride to the local hospital, I wondered if she would survive the trip. We brought her husband along in the front seat, and I silently prayed we would not have to resuscitate her within his earshot.

He stayed right by her side as long as possible, all the way into the bay at the emergency room. He joined me in the hall as I made up my stretcher, standing in the doorway and staring back at his wife.

I was there when the doctor came out to discuss intubation, lifesaving measures, and Do Not Resuscitate orders. I will never forget his answer, “Doc, you do whatever is in her best interest.” And then I saw the spark in his eyes begin to fade.

Some necessary medical procedures are best not witnessed by family or friends; when the curtain was drawn across the doorway he suddenly looked like a lost, scared little boy. I led him to the special family waiting room, sat him down in a comfortable chair, and found a newspaper I knew he wouldn’t read.

I shook his hand, wished him all the best, and silently wished I could do more. When I left he was staring out the windows at the ambulances arriving and departing.

I made sure to give a small wave and nod as we drove out

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