The end of summer marked their 56th year together. Soon, they planned to return to their winter home in florida. He spent the last few weeks of summer building a garden wall of loose stones. A new pile had been delivered today. “I’ve got enough to last me for ten years,” he happily told his wife. After a hard days work in the garden, the octagenarians celebrated the end of summer by going out for dinner. Thye returned home early, he opened the garage door with the automatic opener, while she went in the front door with her pocket book to use the ladies room. When he didn’t follow her in, she returned to the driveway. He was on the ground with blood pouring out of his ear.

An ambulance arrived, quickly scooped him up and brought him to the hospital. His face was blue, he was vomiting, medics placed a bag over his mouth and blew oxygen into his lungs. We moved him into the truama bay where I placed breathing tube and examined him. His pupils were dilated, fixed, non-reactive. He was dead, kept alive by the ventilator. I broke the news to his wife. “But just earlier today…” she protested in a thick accent. “Do you have any family members we can call for you?” “No, no one. No one in this country.” She was beside herself with grief. The wall he was building, the garden, their home in florida, what was she going to do? Neighbors arrived to help ease her pain. I called the coroner and notified him that he was not an organ donor. I signed the death certificate. I picked up the next patient’s chart waiting to be seen.