I stood at the head of the bed, staring down at his throat, watching as the vocal cords opened and closed as he lay unconscious, waiting to time the insertion of the breathing tube at just the right moment.

The call occurred moments earlier in the ER: “They need a doc for intubation.” In the middle of a busy shift, time stood still. Priorities shifted in a moment, re-organizing themselves.

Intubation: A patient had gone into cardiac arrest and needed someone to manage the airway, secure his breathing, and put him on a respirator.

Five stories up, I went.

He’d gotten a pulse back but was still unresponsive.

And so here I was, the laryngoscope in my left hand, holding his tongue out of the way so I could see the endotracheal tube centimeters from passing through his cords as I advanced when suddenly I hear: “Oh! Wait! his wife is saying comfort care only.”

Comfort care. Stop. Don’t. As I slide the tube back out, my mind clicks into gear.

“Is that in writing?” I ask.

No, it’s not, but she’s on the phone. I ask the amazing respiratory therapist at the bedside to continue assisting the patient’s breathing with the Ambu bag as I exit the room five feet from the nurses’ station.

I take the phone that is handed to me. I confirm. His wife is on the line.

I can hear the panic and grief in her voice.

“He said that’s what he wanted. He doesn’t want to be on a respirator. He wanted only comfort measures if anything happened after this procedure.”

“He” is in his 80s, and I can hear the love and the years together in her voice.

I talk her through what happened and what is likely to happen without extraordinary measures at this time. Is she sure? Does she understand? She says it again, tears in her voice, and I can hear her gulp.

“I don’t want to live without him, but I promised him,” she sobs.

I am in acceptance and in grief with her. I let her know she will have to confirm to a nurse what she just said to me to make it official.

But first, I say with all my heart and soul: ‘Thank you. Thank you for honoring his wishes. Thank you for truly loving him. Real love honors their quality of life and wishes over our desires and pain. That is real love. And it takes courage to do what you are doing. And I honor you for it. I am so sorry.”

And I am. Both grateful that she is not prolonging the inevitable and saddened at the loss of life.

I am reminded of what my mentor, Kute Blackson, often said: “The world is full of inherently contradictory and equally valid realities.”

Grief and gratitude can coexist.

Life. Reality. Truth. It is all about the “and.”

It was the black and white, the “either or,” the making one “right” and one “wrong” that had driven me to burnout.

Three days later, his death lingers with me even as I sit here. Her loss and pain linger with me. And I am grateful for their love that allowed him a grace-filled release.

And I pray someday to have that kind of love. The love that holds me close when I am here and lets me fly when it is my time.

Gigi Abdel-Samed is an emergency physician.