The Knot You Can't Untie: I've been running short of time lately because of the demands of my hospitalized patients. All of them are either critically ill or newly diagnosed with a terminal illness. This is unusual for my practice. But sometimes, things just come in bunches like that. The hardest part of these sorts of cases is dealing with the family dynamics that come to the fore in times of extreme stress.

One of the patients who has taken up most of my time with a lot of hand holding and family conferencing has lung cancer. Yesterday, he decided to have chemotherapy. His wife did not approve. She has a very forceful personality, and throughout my encounters with her during the years I've known them, it's been my impression that she always gets her way. If she doesn't, there's hell to pay. Well, yesterday, she reacted to his decision by throwing a temper tantrum. She yelled at him. She yelled at the nurses. She yelled at the oncologist. He told me it made him sad to think that she wanted him to just "go away and die," but he cancelled his chemotherapy. Now, he's got to go home and live out his final days with her.

This morning, I found this jaw-dropping note on the front of the chart. "Wife concerned that patient is depressed." And I'm supposed to fix it?