We were intimate.

As intimate as a doctor and patient can become.  He had long outlived his wife and there were no children, no family, just friends.  When he first came to me he was lively and active, but the years took their toll.  Our visits became more regular.  Every six months.  Then every three.

His memory started to slip.  Occasionally he would look at me suspiciously when something went wrong.  His mind no longer able to wrap around the intricacies of medical care, he grasped at what was left.  If he forgot to pick up his prescription from the pharmacy it somehow became my fault for not calling it in.  Like family members do, we had our ups and downs.

But every time I walked into his hospital room after one mishap or another, he always looked relieved and his lips would curve into a giant grin.  The last such occasion, he had had a stroke.  Although his limbs were working well, the muscles of his throat had been afflicted.  Each time he tried to eat he would choke and sputter.

His stay in the nursing home was disastrous.  His weight plummeted and he lost interest in living. We had long conversations about what could be done.  Although I hated the idea of a feeding tube, this simple surgery would bypass the problem and allow him to live comfortably.  It all made such great sense except that he wanted nothing to do with it.  He was 90-years-old and didn’t want a tube sticking out of his body.  He was ready.

I consulted hospice and we arranged his discharge.  A week before leaving he presented me with a neatly wrapped box.  I opened it to find his favorite bolo tie.  He wore it often with a short sleeve button down shirt and a cowboy hat.  He wanted me to have it.  I accepted it reluctantly, full of pride and yet mortified at the idea of actually wearing it.

I saw him a few more times in the nursing home before he left.  Each time his disappointment was clear.  He wondered why I wasn’t wearing his tie.  And the truth is, I have no rational explanation for my actions.  It clearly would have looked ridiculous on me, but I could have put it on before entering the room and taken it off after leaving.

Decisions don’t always make sense.  It’s like that when your intimate with people.  You periodically disappoint them.  You can’t always explain why.

He returned home, and died a week later.  From time to time I come across his bolo tie when rummaging through my drawers.  When this happens, I feel such longing and also a bit of shame.

It’s not that he died, or that my medical care was subpar.  We were both quite comfortable with his decision.  It’s the fact that I could have done something so simple, so straightforward, to make him happy.  And inexplicably, I didn’t.

I have become fairly comfortable with the premise that occasionally being a human being exposes my shortcomings as a doctor.

It devastates me, however,  that sometimes doctoring reveals my failings as a human being.

Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion.