Can we hear you now?

I have just returned from another home visit with yet another family on the brink of death. It has been a long 2 hours of listening, listening, listening and biting my lips to curb my own talkative nature and allow them to say all that they have needed to say for so long. Or rather, to allow them to feel heard for the first time in so long because, unless they say it first, they won't (can't?) hear it from me or anyone else.
I descend with them into that first long journey of illness and dashed hopes. I hear over and over again the phrase "no one ever told us anything".. and know that it is not for lack of trying at times. Gently I probe to hear from the wife how she has seen her husband, barely conscious in his hospital bed in their living room, change in these past months. I hear about the radiation treatments and the "good reports" from the cancer center: "the tumors are no bigger" (but, we grimly acknowledge, there are still so many of them and they are all still there..) He is home now with feeding tube and hospital bed, because his insurance covered "skilled days" are over, "the nursing home was a living hell", and "if he can get strong enough he can get some experimental chemo!"   I bite my tongue and wait.
"I worry because he is not a fighter and I just know he could beat this if he would only try!" she says.
I hear about what a fighter the wife is from her own bout of heart disease and surgery.. off the vent in a day, walking in three, home in a week " I was saved for something." she says, "maybe it was this.." She tears up and I know we are closer.
She tells me more about her fears of using the minimal (inadequate) dose of pain medicine ("he sleeps so much now that the kids are asking me not to give it any more"). We talk about the difference between sleepiness from medicine and just plain being so damn sick. We talk about how much patients want to get better "no matter what" and how hard it is to let go.  We observe the signs of pain that show outwardly even when we can't tell others about them.
Finally we gently rouse him, drain 350 ml of amber fluid from the tube left in his ailing lungs, and ask him how he is doing.  He is quiet and slowed in his responses.. "OK". (What did we really think he would say?). I ask him if he has any pain and he looks at his wife, then at me, then his wife again before saying "yes". She sighs and says "He told me "no" before you got here".  "Maybe he didn't want to disappoint you.." I offer. Her husband reaches for her hand and squeezes. I offer to speak to the kids about allowing more pain medicine and they both agree.