I Did Not Give Away My Shot

As another academic year has passed, I find myself facing a quiet reckoning after almost 3 decades in palliative care. What once felt like a routine chore—cleaning out an inbox, answering yet another request to lecture or consult—now carries a different weight. Each unopened message could be the last invitation from a colleague or the final patient-family conversation I’ll be asked to lead. Anticipatory grief for a career, a passion, a calling, and an identity has settled in. I wonder: Will there be one more person who asks me to teach? One more clinician who seeks my counsel? What will it be like when the phone no longer rings with official calls?

Søren Kierkegaard observed that life can only be understood backwards, even though it must be lived forward. Looking back, what does a seasoned palliative care clinician see? What have the decades taught me about serious illness, about people, about meaning—and about myself?

First, serious illness brings out the best and the worst in people. I have borne witness to extraordinary courage and unbearable cruelty, to tenderness and to blame. Families rally and fracture. Clinicians rise to creative, generous feats and sometimes fall short when fatigue or fear overtakes them. Bearing witness to these extremes has changed me—made me both more resilient and more vulnerable. I have learned to expect grace and to prepare for grief.

I am grateful for the leaders—clinicians, educators, and researchers—who have sacrificed and committed themselves to advancing palliative care. Their work has lit the path for many of us. But gratitude does not mean complacency. There is still much work to be done: to teach better communication, to integrate palliative principles across healthcare settings, and to advocate for policies that honor patient goals and relieve suffering.

One of the harder truths I’ve learned is that immediate gratification is fleeting. We plant seeds—teach a trainee, counsel a family, and change a plan of care—and often we are not there to see the harvest. The “sowing” clinician may never witness the ways their small teachings ripple outward. That can be disheartening. Yet it is also sustaining when I remember that influence is not always immediate. The quiet choices we model—sitting in silence, naming a fear, clarifying a value—shape future encounters in ways we cannot always measure.

There is more than enough suffering to go around. That reality can be numbing. Still, I remain painfully attuned to suffering that goes unchecked—when pain remains uncontrolled, when conversations are avoided, when systems fail families in their most vulnerable hours. Those moments cut deep. Even when I can understand the anger or blame directed at me, it still hurts. And yet, this pain has shaped empathy; it has deepened my capacity to hold distress without attempting to fix everything.

Learning is lifelong. I am still a student—of medicine, of human behavior, of grief. Clinical skills evolve, but so does wisdom: knowing when to speak and when to sit with silence, recognizing that a well-timed question can change the trajectory of a conversation.

As I age, another question pervades my thoughts: who will be my palliative care provider when I need one? The prospect of being on the receiving end of the care I have given is humbling—and, at times, unnerving. As collective years of experience leave active practice, we risk losing not only workforce numbers but also the accumulated wisdom that informs nuanced, compassionate care. This is not a call to cling to roles indefinitely; rather, it is a plea to mentor, to document, and to teach deliberately so that knowledge passes on.

Would I do it all again? Without hesitation, yes. This work has allowed me to meet people at their most honest and essential moments. It has taught me I am capable of more than I thought—more patience, more honesty, more tenderness. I have formed and deepened friendships and professional relationships that have enriched every part of my life.

If there is an ache in letting go, it is tempered by the conviction that in the words from the musical, Hamilton, I did not give away my shot. I showed up. I listened. I learned. I sowed. The work matters because people—patients, families, trainees—carry forward what we give them. My hope is that the next generation will take these gifts and keep attending to pain, to dignity, and to what makes life worth living, even as they confront the realities of illness and loss.

And when the inbox finally grows quiet, I trust the sum of those years—conversations, teachings, imperfect interventions—will whisper back that the work was not in vain.