The only times I stood in Emily’s room without fear were the day I met her, and the day she died. These days were two long years apart, years of unhealthy snacking and spending most weekends away from my husband and son. When Emily’s name first appeared next to mine as an overnight admission, the resident physician providing the hand-off gave me a clear warning: “Good luck. She is the most vile person I’ve ever met.” Even as an intern, I was already used to this kind of transfer of patient information and had trained myself to ignore it. In fact, my personal statement for residency was about how providers should not label patients; how patients are complex, overwhelmed, and often in pain. I wrote that they deserve our best care. I walked in her room with a smile, and confidently told myself, “you are going to connect with her.”

Emily challenged every possible ounce of this theory of patient care that I so deeply believed. Most times she just refused to speak to me, screaming to leave her alone because I didn’t actually care about her; that I was only a resident, not an attending physician, so I had no knowledge or skills; that all I wanted to do was check off my boxes and spend the rest of the day sitting at a computer controlling her. There was some truth to what she said, and these were the parts of my job that I hated. I thought if I shared this with her, it would bring us closer. But she never let me say more than a couple of words. I even tried pictures instead — pictures of my son crawling for the first time or his face covered in raspberry puree. “How you can have such an adorable baby when you are a worthless human being is beyond me,” she said. I remember going to the closest bathroom to cry. Then I learned to laugh at the absurdity of our interactions. And then I learned to simply avoid her.

I never could go more than a few months before seeing Emily again. I would cringe when I saw her name appear on my list of patients. It was always for an exacerbation of her end-stage chronic obstructive pulmonary disease. I couldn’t escape her. One day I had to go on house visits, and I was assigned to go to Emily’s home. And there she was, chain-smoking, with oxygen tubing covering the floor, surrounded by stacks of decades-old newspapers. No matter how many times I’ve seen her, I can’t even picture her face. I became so used to keeping my distance, staying as close to the door or with my eyes glued to the monitor, which showed her oxygen levels dropping the more she raised her voice. I do remember she always ordered a hamburger and fries. As she predicted, I would go to the computer and order her for inhalers, antibiotics, and steroids. She would decline lab draws and a heart monitor, and I wouldn’t even think about disagreeing with her. In the morning, the night team would often need to say, “Emily called 911 again from her hospital room to say we are providing terrible care.” But no matter how much she yelled, she always clung onto her oxygen. Oxygen was life, and the one thing I knew about Emily was that she so badly wanted to live.

I never once saw or spoke to a family member or a friend. I never saw a visitor. I knew she had a niece that was her health care proxy — she spoke to her on the phone, but we had no need. Emily always had the capacity to make her own decisions. She always received care and was discharged home on her own terms. Often we didn’t think she’d be strong enough to leave the hospital, but she always found a way to get up and walk out the door. She was the kind of patient who makes doctors nervous about predicting life expectancy because she defeated all odds.

Then one day, Emily no longer wanted her breathing treatments or her oxygen. We watched her oxygen drop to dangerously low levels on the monitor, but she was no longer screaming at us. The carbon dioxide had built up in her brain and brought her close to death. There I stood in Emily’s room for as long as I had ever been. I watched her clutching onto her ruby red rosary beads. And then out of the corner of my eye, I spotted a single dandelion in a glass vase next to a card. I had never seen a personal belonging in Emily’s room. Shocked, and terribly curious, I walked across the room and read the card: “I hope this cheers you up. From, Anonymous Annie.”

I couldn’t focus on my work for the rest of the day. All I could think was who is this Anonymous Annie — this amazing human being. I thought of the hundreds of hours I had spent writing information on Emily — from admission and progress notes to prescriptions and discharge summaries. And yet it felt like writing nine words on a floral greeting card had brought so much joy and meaning to Emily’s life. As she took her last breath of life, she was in the company of this single beautiful flower. And as she exhaled, her oxygen gave the flower a little more life.

Now, on my better days as a physician, I try to visualize myself as a blank greeting card. In addition to providing excellent patient care, I can choose, and I try, to fill this card with words and acts of kindness. Rather than to cry, laugh, or avoid their words of pain and frustration, I try to remain neutral and seek moments of connecting. I swing by a patient’s room after they have been discharged to see if they have any last questions. I cut up the pancakes on the breakfast tray for a patient before she asks. I offer to call and update a family member. I ask to hear a story about a loved one who just passed away.  And I hope, like in the words of Annie, that this cheers you up.

Charlotte Grinberg is an internal medicine resident. 

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