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The year was 1988. The setting was the oncology floor of an innercity hospital in a midwestern state. I was in the fourth month of my internship, finishing the required exposure to internal medicine and neurology units before moving on to work in psychiatry. One of my patients, a man in his mid-20s with a malignancy in his brain, had just been “coded” in an effort to resuscitate him after his heart stopped beating moments ago. This was the fourth time this had happened in the 10 days since I had started working on this floor. As the senior residents, technicians, and nurses stepped away from his bed I saw the steady rhythm of my patient's heart on the monitor by his bed. I moved forward to look at him and as I did so I noticed a transparent viscous fluid trickling from his nostrils and one of his ears. I had never seen anything like it before. Puzzled, I turned to one of the nearby senior nurses and, perhaps not wanting to recognize what I was seeing, I asked her what the fluid was. “Looks like CSF to me” she replied tersely, bending down to wipe it. “CSF?” I repeated. Why had we just resuscitated a patient who had cerebrospinal fluid leaking from his head and a brain tumor that just kept growing and affecting all cognitive and physical functions? I called my supervising resident who was on another floor and asked him. “I don't blame you for being puzzled,” he said. “The problem is that Dr. Smith (the treating oncologist) hasn't spoken to the patient's family about the patient being put on DNR (Do Not Resuscitate) status. He feels it would make them too despondent.” “Despondent?” I questioned wordlessly. This was a time of despondence. Our job was to somehow help the family to deal with their despondence, not to help them to maintain the fantasy that their son would live even as a team of eight to ten people applied paddles to his chest every few days and shocked his heart into again beating, creating a semblance of life in a dying man. I telephoned Dr. Smith and co