Is it contemplation of the differential that silences the practiced physician mid-conversation with the woman hooked to austere apparati, snaking lines and collection bags, or observation of her haggard gaze despite days of uptrending labs, improving x-rays, and discussions of anticipated discharge?

Perhaps it is the patient’s own words muttered casually: “I smell like death,” that he holds in his mind, turns it up to the light at odd angles, considers it from every direction, like the x-rays he examined just that way, in an effort not to miss any subtlety.

For all the years in practice, all the data run across his mind, the cumulative pattern recognition, there is nothing quite like the patient who knows from within, she is dying.