I sometimes deal with family members who have trouble adjusting to a grim prognosis, especially when the patient's condition changes suddenly. How can I help them through such a difficult time?-C.U., KY.

We need to help families understand what's happening so they can understand the changes and endure the experience with their loved one. Your question reminds me of the Drummonds, who'd just celebrated their 60th wedding anniversary when I met them.

Tony Drummond, 80, was being treated for prostate cancer that had metastasized to bone. Just 2 months earlier he and his wife had enjoyed a cruise to celebrate their anniversary. Now he'd been admitted to the hospital with various complications related to chemotherapy and advancing disease. Unconscious, he was near death.

While visiting one day, his wife began to cry. I walked her out to the waiting room and got her a cup of tea. She sat staring down at her lap.

"It's not him. It doesn't even look like him."

"I'm so sorry this has happened," I said, touching her hands. I gently explained some of the physical changes that had changed his appearance.

She talked about his wishes not to end up "like that." I told her about terminal weaning and the generous application of morphine to ensure total comfort until death.

After we'd talked a while longer, she dried her eyes and walked back to her Tony's side. Unbelievably courageous, she asked me to please lower the side rail. Then she gently leaned into the bed and held her high-school sweetheart for one last time.