2026 JABSOM GHHS Essay Contest - 2nd Place

He was more than just a terminal diagnosis

by Bao Xin “Hailey” Liang, MS4

In the EMR, he was a 39-year-old Native Hawaiian man with advanced gastric cancer. Obstructive jaundice. Failed ERCP in Hilo. Now transferred over to Oahu for higher-level care. Two additional procedures were performed to relieve obstruction in his bile duct and duodenum. A patient with poor prognosis.

On paper, he was a problem list.

In medicine, it is easy for a person to become a paragraph, compressed into lab values, imaging findings, and procedural outcomes. The language is efficient and precise. But it is also distancing. Reading his chart, I understood the severity of his illness. I did not yet understand him.

That changed the afternoon my palliative care preceptor and I sat down with him and his wife.

The room was quiet. For a moment, all I could hear was the steady beeping of the monitor and the soft murmur of the television in the background. His wife held his hand as we introduced ourselves. He was thinner than I expected. Dark circles pooled beneath his eyes, but he greeted us politely. As the conversation unfolded, the clinical details began to fade, and something else took shape.

He was not simply a young man with metastatic disease.

He was a father. His son was twenty– old enough, he said, to start taking care of the family too. His voice carried both pride and something heavier. His daughter was fourteen and loved gymnastics. He smiled faintly when he spoke about how disciplined she was.

He was also a hunter. He used archery and kept ten hunting dogs. He spoke about caring for them, about being out on the land, about providing food for his family. His wife described him as a “fighter.” Not in the cinematic sense, but in the steady, dependable way he showed up for his family and community—well mannered, grounded, respectful of the ʻāina.

In that conversation, the distance dissolved.

Face-to-face, fully present, I felt what had been missing when I read his chart. His illness was no longer an abstract tragedy. It was a father calculating how much time he might have left. A husband wondering how his partner would carry the weight alone. A man grappling with the possibility that strength, in this season, might mean preparing rather than preserving.

When my preceptor asked what mattered most to him in the time ahead, the room grew still. He did not speak about chemotherapy or procedural risks. He spoke about his children.

“I don’t want this to stop them,” he said quietly.

He wanted his son and daughter to keep moving forward with their lives, even if he could not be there to see it.

It was in naming that fear – not of death itself, but of becoming an anchor on his children’s futures – that the conversation shifted.

We discussed what aggressive interventions would look like if his heart were to stop. We talked honestly about resuscitation in the setting of advanced cancer. We explored tube feeding, what it could and could not offer. For the first time, these were not abstract medical options, but choices measured against his values.

He chose to change his code status from full code to Do Not Resuscitate. He declined tube feeding. Not because he was giving up, and not because he was no longer a “fighter,” but because he was fighting for what mattered most—preserving dignity, sparing his family prolonged suffering, and focusing his remaining time on being present with them.

The prognosis did not change. But the plan did.

Before we left, my preceptor gently offered resources to help parents talk to children of different ages about terminal illness. We discussed how to approach those conversations with honesty and reassurance. His wife nodded, absorbing every word. In that moment, palliative care was not about death. It was about equipping a family to face it together.

I realized then that empathy is not only about feeling for a patient. It is about creating the space where they can articulate what matters enough to guide their care.

From a screen, suffering can feel conceptual. We see bilirubin levels, obstruction, staging. We think about the next steps. We operate in a world of interventions. But in that room, conversation was the intervention. By sitting down and listening, we aligned his medical care with his identity: father, husband, provider, community member. His shoulders seemed to relax after his priorities were spoken aloud. His wife’s grip softened. There was grief in the room, but also clarity.

He remained gravely ill. Yet he was no longer only a patient with advanced gastric cancer. He was a man whose life extended far beyond the tumor that threatened him. He was a father encouraging his children to step forward, a husband preparing his partner for what lay ahead, a hunter who loved his land and his dogs.

I left that room feeling inspired. Moments like that remind me to be intentional about how I enter every patient encounter. The electronic record is indispensable, but it cannot replace the human exchange where dignity is restored and decisions find their moral compass.

As Dr. Sherry Turkle has once said, “face-to-face conversation is the most human – and humanizing – thing we do.” It is where patients become people again in our eyes. It is where empathy develops not as sentiment, but as action. And sometimes, it is where a father finds the clarity to shape how he will care for his family, even as he prepares to leave this world.

In the chart, he will always be a 39-year-old man with advanced gastric cancer.

But to me, he will always be more than a diagnosis.