It was the first week of intern year, and Tish Singer, MD, was afraid of everything. Prescribing acetaminophen felt like a gamble. "What if I caused liver failure?" she recalls thinking. That particular variety of first-year terror, the kind that treats every small clinical decision as a potential catastrophe, is familiar to most physicians who trained in internal medicine. What happened next was not.
A woman in her thirties had been admitted to the medicine floor for failure to thrive. She had lost significant weight and had no explanation for it. Imaging was ordered. It came back showing widely metastatic cancer. Singer's senior resident handed her the report and told her to go deliver the news. Alone.
"Go tell her?" Singer remembers thinking. "Me? I don't think I can do that." Her senior's response offered no false comfort: "Just do your best. It's going to be pretty awful no matter what you do."
She does not remember the exact words she used in that room. What she remembers is holding the patient while she cried. That woman remained on Singer's service every day that followed, and she died within the same month. The encounter sits at the center of how Singer describes her formation as a physician, the kind of case that no rotation assigns and no textbook covers.
The throughline Singer draws is not about diagnostic skill or clinical acuity. It is about a fundamental misunderstanding she carried into medicine, one she suspects is widely shared. Before that patient, she was afraid of death and thought that dying meant she had failed. What the experience cracked open was a different conception of the work entirely: that taking care of people means being present while they live, but also when they die. The two are not separate obligations. They are the same one.
Singer trained in internal medicine before moving into diagnostic radiology, a specialty defined in the popular imagination by distance from the bedside. But the losses, she notes, have stayed with her. "Some losses have stayed with me," she writes, without elaboration, which says something on its own. The patient she first held in her arms during intern year made her, in her words, "someone who has empathy for my patients." That debt to a woman she could not save is, it turns out, what she brought into every reading room that followed.
