I just learned that a friend is not doing well. We all know what that means: She is dying. The cancer has returned and has taken over her whole body. I do not want her to die. I also don't want to see her dying. But I have to. I want to show her I am not afraid of her dying, and I am not scared of what the cancer has done to her. She is melting away: muscle, sinew, shape and form. It is this wasting that scares me more than her actual last breath. It is the cachexia that makes cancer or other terminal infections like AIDS or TB so frightening. The diseases produce wasting molecules or turn on internal machinery that consumes the whole being. It is why TB used to be called consumption. It literally, like some cancers, will end in a patient being only skin and bones. This is what I do not want to see. Of course it is not what I want, but if knowing I am not afraid would be of any solace, I would like to think I had the courage to do that for her and her husband.

Courage is not just testing myself against by own fears of death and dying. I want to talk with her. I want to thank her for her kindness, her goodness, for her friendship. I want to tell her how she made me happy being with her and her husband. I want to say how nice she is. It would not be very profound. Maybe it would be too ordinary to say to someone who is dying. Maybe others more knowledgeable of her talents and life accomplishments would be better suited to reminisce with her about all the wonderful things she has done, her children, her family.

Otherwise, the other option is to ignore her. In that case, I would have to forget her joy and enthusiasm. To ignore her would imply that I didn't care about her or her husband. It would be easy to escape, but it would not be true. But when overwhelmed, I have been known to run and hide or even fib about a lot less important stuff.

I could make excuses, because we do live a whole 50 minutes and a county away. I am busy caring for the living, so they would understand how hard it is to get away.

Then again, they may not want me nearby. It is exhausting to welcome well-meaning visitors, and maybe there are others closer who could invoke a memory or a shared experience that could bring comfort. Besides, if people like me who have not been extremely close came by, we could be seen as the circling.

I am nervous even to start. Do I call and make an appointment for the vigil? Do I just drive down and stop by, not knowing if she is awake, sleeping, or in pain? Having cancer doesn't mean a person doesn't have pride in their appearance and setting.

It is seeing what a cancer can do to a human body that is hard. Consumption is an apt description. It stirs the same feeling of horror one cannot hold back when seeing pictures from Dachau. But I also cannot submit to that dread. I have to tell them that like the prisoners of the Holocaust, she will not be forgotten. You can tell them that their family will also be remembered, but in a more active way of calls or visits beyond the neural process of memory that you have promised her.

Courage in the face of death is often the human reaction to the pain of the cancer but also the loss of the human form. Courage is also what the rest of us must grow as we see them consumed. Courage is what we must call upon when our friends or family are not doing well.

Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for more than 25 years and an adjunct professor of pediatrics at the University of Utah. He can be reached at jgcramermd@yahoo.com.