A 30-something-year-old male presents for yearly follow-up and physical.

Over the past few years, he shared about his father's battle with interstitial lung disease.

When asked how he was handling the declining health, He would typically respond with,

I'm fine, or I'm hanging in there.

He has shared with you a little bit about his fellowship program

that was toxic and how it didn't really provide any help

or support in the numerous doctor's appointments this father had.

At one such visit, he actually shared with you that they would make him choose between work or

his duty as a son.

Other times he would be afraid to share things because much of what he was trying to avoid and having to discuss

was too much pain for him and he knew that his father would eventually succumb to this illness

as there was no cure. You see this 34-year-old was in health care, a physician in fact in a recently graduate from fellowship.

As a physician he was riddled with guilt with not being able to do more for his own father,

he kept thinking to himself that, if I'm a doctor, how could I not save him?

In fact, today, he is still to some degree.

He tells me that he was just starting his first new job in the fall after completing fellowship,

and his father never even got to see his office.

You knew this patient well because you both trained together in med school and he came to you

for either vaccines, the odd cold, or pre-employment physicals.

It's been a few months since he's come into the office,

and at today's visit, the veneer of keeping things together

or being strong were completely gone.

...