I also discovered that the discussions most successful clinicians had with patients involved just a few important questions that often unlocked transformative possibilities: (1) What is their understanding of their health or condition? (2) What are their goals if their health worsens? (3) What are their fears? and (4) What are the trade-offs they are willing to make and not willing to make? These discussions must be repeated over time, because people’s answers change. But people can and should insist that others know and respect their priorities.

Not everyone will feel ready to discuss such subjects, to be sure. But I decided to try the questions with Peg. I asked her what her understanding of her condition was. She said flat out that she knew she was going to die. There’s nothing more they can do, she said, an edge of anger in her voice.

I asked what her goals were. She didn’t have any that she could see were possible. Then I asked what her fears for the future were, and she named a litany: facing more pain, suffering the humiliation of losing more of her bodily control, being unable to leave the hospital. She choked up as she spoke. She’d been there for days just getting worse, and she feared she didn’t have many more. They’d talked to her about stopping life-prolonging therapy and going on hospice, but she didn’t see how that could help her.

Someone in her position who was offered “death with dignity” — assisted death — might have taken it as the only chance for control in the absence of other options. But hearing her fears, I suggested that Peg try hospice. It’d at least let her get home, I said, and might help her more than she knew. Hospice’s aim, at least in theory, I explained, is to give people their best possible day, however they might define it under the circumstances. It seemed as if it had been a while since she’d had a good day.

“Yes, it has — a long while,” she said.

That seemed worth hoping for, I said. Just one good day.

With her husband’s encouragement, she went home on hospice less than 48 hours later. We broke the news to Hunter, then just 13 years old, that Peg could not teach her anymore, that she was dying. Hunter was struck low. She asked if she could see Peg one more time. We didn’t think so, we said.

A few days later, however, we got a surprising call from Peg. She wanted to resume teaching. She’d understand if Hunter didn’t want to come. She didn’t know how many more lessons she could manage, but she wanted to try.

That hospice could make teaching possible for her again was more than I’d imagined. But when her hospice nurse arrived, she asked Peg what she cared most about in her life, what having the best day possible meant to her. Then they worked together to make it happen.