The heavy young man curled on his left side is in the ER for a pain in his backside. The sweaty blue dragon on his chest smells like fear.

“It’s an abscess. I’ll have to open it. It’s gonna hurt.”

“Can you put me to sleep? I hate pain.”

I can. Should I? Remember Michael Jackson? I do.

His neck would make a Hereford bull proud; he’s missing a chin but he’s got a 7-month sized pregnant belly. Intubating him would be a challenge on a good day. This isn’t one of those since he needs to lay face-down for the procedure.

“Sorry, no can do. Putting you to sleep is a bad idea. You may never wake up again.”

The 40-year-old grandma with purple lipstick and a week of left-hand numbness has a hint of beer on her breath. Her doctor sent her to get an MRI. She wants it now, or my Press Ganeys will plummet. So will my paycheck. I’ll have to live on Cheerios for a month. They aren’t low carb.

“I can’t get into that machine. You’ll have to put me to sleep.”

I don’t think so, my friend. The MRI is a bad place to have a code. If you stop breathing while you’re in there, your numbness may be gone forever but so will the rest of you. They won’t even notice that you’re dead. Put you to sleep? Not me, not today.

Then there’s this cute chubby toddler. She hasn’t used her left hand since she tripped and her mom held her up. She’s playing on Mom’s phone. “Her elbow’s out. It’s called nursemaid’s elbow. I’ll have to twist her arm to get it back. She’s gonna scream like a banshee, but it’ll be over in seconds.”

Mom chokes. “Can you put her to sleep?” I feel for you, I really do, but the answer is no. It’s too risky to put her to sleep for a 5-second procedure she’ll never remember to save you this pain. So, sorry. No.

The old folks are the hardest to say no to. They want no part of the life that’s left to them, whether it’s in their own lonely home or at the nursing home where the kids dropped them off. They’re not demented — I can’t remember a single demented patient asking me to kill them. They’re just too weak to kill themselves.

“Can you put me to sleep so that I never wake up? Please? I’m 87, I’ve got nothing left to live for. My wife died last year, and the kids are gone. I’m all alone. I can’t even pee by myself. I hate my life; I hate the nursing home; you can’t send me back there, please, you wouldn’t do that to a dog!

You’re right sir, I wouldn’t do that to a dog, but you’re not a dog. You are a human being and therefore entitled to an unspecified amount of suffering, an endless amount of loneliness, and the privilege of rotting in your urine for as long as it takes you to die in a medically acceptable manner. I can’t take that away from you. Not only would I lose my license, which is important to me, but I’d end up in jail — remember Dr. Kevorkian?

As for the dog, you are correct. It so happens that I have an old dog. Her flowing lupine leaps that I so loved are a thing of the past. She now falls over whenever her back legs fail. Cataracts cloud her loving eyes, and she struggles to find her frisbee. She often needs my touch to remember who and where she is. I watch her. I listen to her. “Are you loving your food?” I cook for three since dog food is for dogs, not for her. Tonight its chicken breast with corn and peaches. “Are you still enjoying your short walk and your even shorter swim? Do you still greet me every morning like I’m the sun, telling me that it’s gonna be a wonderful day since we’re together? Are you still enjoying life?”

When the answer will be no — any day now — I’ll do for her what I wish somebody will do for me. I’ll hold her lovingly and help her through the rainbow bridge as I’m dying inside.

As for you, my old, lonely, hopeless friend, I can’t help you. Unless I’m ready to give up my profession and my freedom, I can’t help you. In America, mercy killing is killing.

Please, please get your advanced directives and talk to your proxy, will you? And never sign up for DNI without DNR.

Hang in, my friend. The end is near.

Rada Jones is an emergency physician and can be reached at her self-titled site, RadaJonesMD, and on Twitter @jonesrada. She is the author of Overdose.

Image credit: Shutterstock.com