Medicine is sad. Usually I have the ability to skip through the emotions that patients cause in me, but not today. I have too many young people who are right at death’s door.

In some cultures – Arab, for example – death is not viewed as so evil. Many Arabs I met while living in Israel were more circumspect about the prospect of dying. “If it’s God’s will, then this is my calling.” We Westerners don’t understand this. Dying is the great evil. If you break down the theme of most Hollywood movies, you’ll find death as the antagonist. I’m primed, therefore, to regard death as evil, or at least deeply sad.

One patient I’ve connected with is so brave, yet he is probably going to die before I’m off the medicine service. He’s also just a cool guy that’s about my age. He’s got spina bifida – a terrible disease where your vertebrae don’t fuse properly. He was born with only 1 kidney. He’s blind and his legs are about 2 feet long. He was here because he has a systemic bacterial infection, and while on one of the strongest antibiotics we have, he got a second infection from somewhere. “He’s gonna die, dammit,” the infectious disease specialist told me after I informed him of the new infection.

“Dude,” I told him a few minutes later, “We found another infection. That’s the reason you’ve been feeling so crappy these past few days.”

“Well,” he replied in even tones. “I’m dead.”

“Yeah, maybe. But you never know how this stuff turns out.”

He started to cry.

“Man, I was just KIDDING. I didn’t really think it was that bad.”

I spent a few more quiet moments with him, trying to provide that delicate balance of reassurance, hope and realism. I also sat there feeling stunned and stupid for having broached the topic of death with him so obtusely. Having just been told he was likely to die by the specialist, I was in no emotional place to pick up on his macabre joke.

Leaving the room, I thought about how I frequently opine that there should be more humor in medicine. It shouldn’t be so serious all the time. Jokes, especially with hyperbole, are almost non-existent. Today, it’s easier to see why the halls of a hospital are so grim.