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Jane Schell and James Tulsky

“Mrs. S, has anyone discussed moving toward comfort measures?”

I can still remember the question leaving my lips, followed by the look of surprise and discomfort on Mrs. S’s face. I was a first-year fellow caring for her husband, Mr. S, a dialysis patient whom I had admitted numerous times that year. This time he had been brought unresponsive into the emergency room, and he had been lying in bed for a week, receiving pressors and ventilator support but with no signs of neurologic recovery. As I sat with Mrs. S I felt helpless. How could I begin to explain