The waiting area was subdued that morning. A scatter of mismatched chairs lined the walls, and the nursing counter, too large for the room, stood unmanned.
A handful of patients waited, with carers by their side. They mostly kept to themselves, absorbed in their phones.
He was hard to miss.
Hameed made his way in, slow and measured. A man of average height, his white shirt neat above a sarong, a skull cap set squarely on his head. His belly pressed tightly against the fabric, swollen with ascites. He moved with a slight limp that he seemed long accustomed to. On his left forearm, a fistula bulged, the telltale sign of years on dialysis.
I introduced myself and motioned towards the chair across my table. Although the room was small and windowless, the dark brown wall cladding gave it a certain warmth. He sat down, placed his hands on his lap, and looked at me steadily.
I had read his notes: end-stage renal failure, a decade on dialysis. Now decompensated liver cirrhosis. A history of intravenous drug abuse with many years in prison. A family he had left behind and returned to with deep gratitude, as they readily accepted him back despite his misadventures.
I was anticipating a difficult conversation.
He spoke first.
“Doctor,” he said, his voice unhurried, “this is a test from God. I am grateful for the second chances He has given me. I will not waste them.”
I set down my pen.
While he had disappeared into addiction and then to prison, his wife Mariam had held the family together. She had worked multiple jobs without complaint, raising their three children alone. He recalled this with deep anguish and regret.
The fact that Mariam had taken him back, he said, was a blessing he had not deserved and would spend the rest of his life honouring. His eldest son was in the army now, married, with two young children of his own. His daughter had moved to another state with her husband and their child.
The youngest, Irfan, still living at home, had recently started a small plant nursery. It was Irfan who brought him to his appointments, sat with him through every dialysis session and became his primary carer.
On the days he wasn’t on the machine, Hameed helped Irfan in the nursery; potting, pruning, arranging. Anything he could manage. It mattered to him, this chance to be useful, to support the son he’d let down for so long. But lately, eventhat was getting too hard. The fatigue was worse. Ascites made his belly heavier, his steps slower. Still, he kept showing up.
“I wasn’t there for them before,” he said simply. “I want to be there now.
However much time I have, I want it to be for them.”
He was not asking for a miracle. He understood his diagnoses. His kidneys were damaged, his liver was failing and his body was being asked to carry too much.
But what he was asking for was something far more ordinary. He wanted to continue dialysis not to escape death, but to buy time. Time to stand beside Irfan in the nursery, to watch his grandchildren grow a little older and to be, finally, the father and husband he had not been.
We talked about what continuing dialysis would mean, about the burdens that might increase, and what that time might allow him to do. It wasn’t a one-time decision. We would revisit it together, guided by whatever mattered most to him as his illness changed.
The weeks that followed were not easy. Hameed continued his dialysis, three times a week, balancing each session between how much his body could manage with what he hoped to hold on to. The ascites accumulated faster than before, his abdomen tightening until the pressure became unbearable, and he would return to us for peritoneal tapping.
Irfan had learned to read his father’s energy, to know when Hameed could manage the short walk between the seedling trays or when he would need the chair by the door.
Mariam prepared his meals carefully, always mindful of his dietary restrictions.
He spoke of her often, always recalling with remorse how much hardship he had put her through, invariably ending in wonder that she still stood by him.
At each clinic visit, he would settle into the chair, his sarong neatly folded at his knees, and give me his honest account. The fatigue was worse. The limping was heavier. He had not been able to help in the nursery this past week. His belly was filling faster.
Each time, I would ask what mattered to him.
Each time, his answer was the same.
“My family, doctor. As long as I can be useful to them.”
Then one morning, he landed in the emergency department. A sudden massive gastrointestinal bleed. The team worked fast, and he was stabilised. But the toll was visible. The man who had walked into my clinic in his white shirt and sarong, slow but with purpose, was now in a hospital bed, diminished. He wasfragile, approaching the end of what he could bear. The silence in the room was heavy with an unspoken question: should dialysis continue?
I went to see him.
He looked at me when I entered. There was neither confusion nor fear in his eyes. Just that same steady, unhurried gaze as always.
Before I could say a word, he spoke first.
“Doctor,” he said quietly, “my time is up. I want to go home.”
We spend years in palliative care learning how to talk about death—what to say, how to say it, when to keep silent—but patients like Hameed remind us that sometimes, the best thing we can do is just be there, simply listening for what they’re already offering.
So, I sat with him.
We talked about the comfort measures we would put in place, the support for Mariam and Irfan, the visits that would continue. He listened, asked a few quick questions, and nodded. He was not afraid. He remained calm and composed throughout our conversation, appearing to have already made peace within.
Irfan took him home.
In those last few days, Hameed mostly rested. Mariam, who had held this family together through the years, now held him too, faithfully as she always had. His eldest son and his daughter travelled back. The family gathered, supporting one another, knowing that time was becoming precious and finite.
Hameed died a few days later. Irfan and Mariam were changing his soiled clothes at dawn, wanting him to be clean for the morning prayers. As the muezzin’s call echoed through the neighbourhood, Hameed breathed his last.
There was no struggle. Just a man, held in the hands of those who loved him,
slipping gently from one world to the next.
I recalled what he had said at our very first meeting.
“This is a test from God. I am grateful for the second chances He has given me.”
He had not squandered a single one. He had spent his remaining weeks showing up for the nursery, his children and his wife. He had made his choices clearly and lived by them until the end. When he was ready, the words came simply, as they always did.
In two decades of medicine, I have sat with many patients facing the end of life. I have learned that the difficult conversations we dread are rarely the ones patients themselves struggle with. Most just want someone who really listens.They don’t need perfect answers. What they need is a safe place to speak their truth.
Hameed never needed me to tell him what to do. He needed to know that when he spoke, someone would listen.
Perhaps that is where these conversations truly begin. Not in what we say, but in how we listen. In that space, patients find the freedom to express what matters most, to make decisions that reflect who they are, and to face the end of life on their terms.
This is essentially the foundation of palliative care: listening as a therapeutic act, allowing patient values to guide decisions, and revisiting these choices as illness progresses. When patients are heard, they can make decisions with clarity.
Our role then is not to lead, but to walk next to them.
I hope I managed that, for Hameed.
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Dr Ruben Vighnesvaran is based at the Palliative Care Unit, Raja Permaisuri Bainun Hospital in Ipoh, Malaysia. He cares for patients with advanced illness and supports families through difficult decisions at the end of life.
He writes reflectively about these encounters, sharing his work in his Facebook page, Always Something More-Reflections in Palliative Care.
https://www.facebook.com/alwaysomethingmore
rubenvighnesvaran@gmail.com
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