The patient had a severe pneumonia of advanced AIDS. He’d been lying in our intensive care unit for three weeks, a breathing tube thrust into his raw airway, his face a mixture of pain and resignation. His weakened lung tissue had popped in several areas, requiring chest tubes to drain the pockets of pressurized air. He looked like a sea creature with multiple tentacles.

My co-attending doctor in the I.C.U. had tasked me with keeping the patient alive for the weekend. “I’m going to try and get the tubes out on Monday,” he explained. Knowing the prognosis, I asked him if he’d told the family the patient was going to die.

“No. I can keep him alive for now,” he replied. With that, he left.

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Soon after, the patient’s family arrived. I took a deep breath and told them what I knew they hadn’t yet heard: that his lungs had been permanently damaged and were steadily getting worse, and that he would probably never come off the breathing machine. In short, I said, he was dying.

His family took in what I said. I left them in the conference room to process this information, and a short time later his brother found me and asked that the patient be taken off the ventilator and made comfortable. He died peacefully on Sunday night.

I doubted my co-attending doctor would be surprised. My residents tell me some of my colleagues call me Dr. Kevorkian. Specializing in the seemingly divergent fields of intensive care and palliative care, which focuses on the relief of pain and suffering of patients, I frequently find myself in the position of undoing the life-prolonging work of my I.C.U. colleagues.

I believe in letting the dying determine how and when they die, as opposed to coaxing their organs along at all costs. As one of the only doctors I know who straddles these two worlds, I am struck by how many of my colleagues are surprised, even disturbed, by this pairing. I was once accused by a renowned professor of medicine of deceiving my I.C.U. patients by also practicing palliative care, as if it was somehow a conflict of interest.

The I.C.U. is a final common pathway for many of the dying. One in five people in the United States currently dies there, and this number is on the rise. Studies show that many of them suffer significantly before they die.

Many patients come to the I.C.U. already suffering from critical illness. And many recover. But for some, stretching out their life like an elastic band does nothing but prolong their anguish.

Palliative care medicine, sometimes called hospice and palliative care, is a sub-specialty that is only five years old. It advocates medical care that focuses on the overall well-being of the patient as opposed to just the optimization of organ function. Patients who receive palliative care tend to suffer far less, die at home and even live longer than those who don’t receive consultation.

Yet even though the I.C.U. is exactly where palliative care is most needed, it has proven difficult to merge these two disciplines. One reason is that there is only one palliative care physician for every 20,000 patients in need. This deficit is predicted to widen drastically as the population ages.

There have been some legislative efforts to increase the number of palliative care specialists. But it would most likely take many years to educate enough physicians to meet the demands.

And even if we suspend reality and envision a future with a saturated market of palliative care specialists, it may still not be enough. This is particularly true in a place like the I.C.U., where a Wild West culture makes it a challenge for palliative care to get a foothold. It’s hard to slow a wild horse, particularly one that believes it can outrace death. If an I.C.U. physician like myself experiences resistance from her colleagues, one can imagine the challenges a palliative care physician, or the nurse practitioner or social worker who typically work on a palliative care team, would be likely to face when making recommendations.

Recently, the palliative care community has made efforts to breach the I.C.U. walls, starting The Initiative to Improve Palliative Care in the ICU (IPAL-ICU) in 2010. It is a repository of information and guidelines for clinicians to successfully integrate the practices of palliative care and intensive care. Separately, a colleague and I initiated the first special-interest group for I.C.U. physicians at this year’s assembly of the American Association of Hospice and Palliative Care Medicine. But more is needed.

Most important, the training of I.C.U. physicians must change to incorporate a patient-centered approach. That herculean effort will take time. If I am ever dying in an I.C.U., please make sure my doctors consider my needs as a person, not a collection of organs. And it wouldn’t hurt to call a palliative care consult.

When Monday morning came around, my colleague approached me in the I.C.U. In response to my attempts to convince him I had done well by the patient, he smiled and shook his head. “If you had just kept him alive for the weekend, I could have kept him going.”

He pointed out I had lost the battle with the patient’s lungs, and he was right. But I believe the true winner here was the patient.

Jessica Nutik Zitter is an attending physician at Alameda County Medical Center in Oakland, Calif. She is board certified in both critical care and palliative care medicine.