I once had a patient - he was young, by inpatient standards, but had lived a life of sex, booze and drugs, resulting in viral hepatitis and hepatocellular (liver) cancer. He came to our hospital because of abdominal pain and his doctors found that the cancer had spread to his lungs. He came to my attention one evening when I was asked to review him for severe pain. By the end of the evening, he had bled into his liver and this leaked (via the cancer) into his abdominal cavity. The surgical registrar came to see him that night. "Sir, you have bled into your abdominal cavity and there is nothing we can do about that okay?" the surgical registrar said gently.
The patient looked up at the registrar. "Not even a transplant?"
"No, that's not going to work."
"Am I going to die?"
"If you continue bleeding into the cavity. But we will ensure that you are not in pain."
We asked if there was anyone he would like us to call. There was no one he said. He was not in touch with the family he had. Later, he gave us the phone number of a friend. We left a message when no one came to the phone. We found out later that the number belonged to a homeless shelter.
He lived another 24 hours. The next evening, I was told that he was crying. He asked for more pain medication, so we kept our promise and kept him comfortable. He died that evening. Life can sometimes end abruptly - what do we leave behind? Who do we leave behind? And does it really matter?