What People Actually Worry About at the End of Life

For nine years, I ran a cardiac surgery program at a hospital in Baltimore. I was the internist who managed patients before and after their operations... which meant I spent a lot of time at bedsides in the hours when people were thinking about the possibility that they might not make it.

Most of them did. Cardiac surgery has come a long way. Valve repairs and bypasses are big surgeries, sure. But they're faaaaar better than most people imagine... most patients walk out of the hospital days later.

Patients heading into the operating room don't know that. What they know is that someone is about to open their chest and work on their heart.

And in that state, they talk.

The pattern I couldn't unsee

Over those nine years I noticed something that has stayed with me. When patients spoke to me about death or regret before going into surgery, they worried about the same three things.

God. Family. How they treated other people.

This was true across every dimension of difference I observed. Old patients and younger ones. Patients of every race and ethnicity I encountered in Baltimore. English speakers and patients who needed interpreters. Patients of strong faith and patients with no religious framework at all. Wealthy patients and patients on Medicaid.

The same three concerns surfaced. The proportions differed; the categories did not.

Not their accomplishments. Not their job titles. Not the projects they wouldn't get to finish. Not the houses they'd built or the businesses they'd grown.

The way they had treated people.

A Walmart return desk

The story that sticks with me most came from a woman in her early eighties. Her bed was already moving down the hallway toward the OR.

Her son was walking alongside, trying to keep things light. "Don't worry, Mom. When you wake up from all of this, we'll watch the Ravens crush the Steelers on Sunday."

She looked at him. Then at me.

"I don't know what the hell he's talking about. I don't care about the Ravens right now."

What she did care about... what she could not stop thinking about as she approached the possibility of her own death... was a woman she had mistreated at a Walmart return desk 7 or 8 years earlier.

A stranger. A counter. A minute or two of irritation she had probably forgotten by the next day.

She had not forgotten.

She wished she could just say she was sorry.

What regret actually does

Daniel Pink's book The Power of Regret makes a useful point: regret is not a malfunction. It is a feature. It exists to redirect behavior.

The Walmart story carries that lesson in two directions.

The first is the obvious one. If, at the threshold, people reflect on how they treated others, then the most generous thing we can do now is to act on what they regret in advance. Reach out. Apologize. Thank someone. Say the thing you've been meaning to say.

The second is less obvious — and I think more important.

When the same patient came through surgery and we were talking afterward, she paused and said, "I really shouldn't have said it to him that way."

She was talking about her son. The Ravens. The thing she had snapped at on the way into the OR.

The same pattern that had her in regret about a Walmart clerk in 2015 was running in 2023, six feet from a son who was about to lose her if things went sideways.

That's the part nobody warns you about. How we treat people is not a series of separate decisions. It is a setting. The setting follows us into the most important moments of our lives — including the ones we don't know are important until they're over.

What to do this week

I don't believe in advice that's too big to act on. "Live every day like it's your last" is not actionable. You will not do it. I will not do it.

But there is something smaller you can do.

Pick one person. Not three. One.

• Someone you've been short with this month. Send a two-line apology. You don't have to explain yourself.
• Someone you appreciate but haven't told. Tell them. Specifically.
• Someone who has drifted out of your life and you still think about. Reach out. "I was thinking of you. I hope you're well."

Do it before Friday.

You are not in cardiac surgery this week. You have time. You have access. The people you would want to reach when you didn't have that time are still reachable.

That is the privilege of a regular Tuesday.

When you can't find them

Some of the people you would apologize to are unreachable. The Walmart clerk in this story almost certainly never received the apology the patient wished she could give.

That does not mean the regret was useless.

The patient changed how she treated the next person. The discharge nurse. The Uber driver. Her son.

That is the second mercy of regret. When you cannot repair the original moment, you can change the setting going forward. The world is downstream of how we treat the next person we meet.

Pick one. Reach out.

Or, if you cannot reach them, treat the next person like you wish you had treated them.

It counts.