Today for the first time, I got flowers from a grateful patient.

And I reflect on how rough the week has been, all the things that seemed impossible and insurmountable, and everything that has brought me to this point. The patient is going on hospice, he’s going to die, yet he felt that I made a significant impact that he wanted to show his gratitude. And that almost brought me to tears.

I haven’t been brought to near tears many times this week by my inability to help this man who has a brain tumor that is killing him. I was able to help him a bit, and while I couldn’t do a lot, I realized that what I could do is be present for him. And I realize that for a lot of patients of mine at least, they look forward to seeing me for that 15 minutes of every day. I was their ray of sunshine, their sliver of hope, their light in a bleak world.

The brain tumor guy would light up with a smile every time I walked into his room. He had lost his ability to clearly vocalize, but I would sit with him until I figured out what he was trying to tell me. Most people didn’t do that and just assumed he was nonverbal. He got overlooked a lot and ignored quite a bit. And I would have to reach out to the staff taking care of him to get him what he needed—his pain medications, his broth. He couldn’t swallow, so we came up with this idea where he could dip the mouth swabs in coffee, which he had been dying to have, and he was absolutely delighted to taste coffee for the first time after so long. We also did the same for broth.

So for the last three days of his stay, my question to him was, coffee or broth today? Because nobody else was willing to make it happen for him for whatever reason. Many didn’t have the patience for him to mouth his words. It still breaks my heart that he went into hospice, but there’s nothing else I could do for him.

Another of my patients was an older gentleman who fractured his spine and had received very poor treatment. When he first came into the emergency room, he had had a fever and had fallen, but he got sent back home. He was returned delirious, with a fever, and with bacteria in his blood. So I had admitted him and tried my best for him.

He did improve, but he was very uncomfortable from his fractured T-spine. And the staff’s solution to that was, instead of giving him his pain medication, to restrain him—which means to tie him down. And this made me very unhappy. Because he was the sweetest guy, and he could clearly verbalize what he wanted.

Usually, when I walked in, a conversation would start with me calling him grumpy and would end with him calling me pink because I always wore pink to his room. He spoke of how I brightened up his day, and he was always happy to see me every day. And he was just the sweetest guy. I often saw him towards the end of the day when I’d be exhausted, and he would notice that I was tired and ask me when I was going to get some rest.

So when I walked in on my last day and saw him in restraints and he didn’t know why, and I didn’t know why, that upset me. So I took off his restraints on one arm and talked to the staff and asked them to find an alternative. Already there were errors in his care—he had been given medicine he was allergic to. Fortunately, his son took it very well, because he had been telling his son about his doctor in pink. So when I introduced myself to his son, he knew exactly who I was and was delighted that I was talking to him about his dad.

Not all patients or relatives are that great. For instance, today I had a patient’s family carry on a conversation amongst themselves that had absolutely nothing to do with the patient during the limited time I had to evaluate the patient and talk about care. They were completely uninterested in what I had to say until I brought it to their attention that I was saying very important things to the patient and that she would need to make some hard decisions moving forward.

She was an 81-year-old lady who had basically developed renal failure, and we were not sure why at the time. She had already had one session of dialysis and had a dialysis catheter already in her. And the conversation I was trying to have with her was that if her kidney did not improve moving forward, she would have to decide if she wanted to live the rest of her life on dialysis or not.

The patient’s family, who were more interested in their little conversation with themselves than in my conversation about the patient’s care, picked up and decided to get upset at the fact that I said the patient would have to make some difficult choices moving forward. So sometimes it does get weird.

To be fair, I’ve been offered candy, sweets, even gift bags by grateful relatives—even got the occasional thank-you card—but the flowers from a dying man hit different.

Augusta Uwah is an internal medicine physician.