Before her illness she had been a student with a diagnosis of bipolar disorder, dutifully swallowing an antipsychotic medication; then a mild rash and swollen lips turned into toxic epidermal necrolysis syndrome, the one-in-a-million, dreaded pharmacological complication that caused her skin to bubble up and melt away. She was in her early 20s — younger than I was — but nobody knew if she w ould live ; nobody remembered seeing a case this severe. Her only chance was for us to keep her alive until her body could regrow the layer of skin that she had lost.

I thought often, during those days, of Dax Cowart, a Vietnam veteran who suffered devastating burns after a gas explosion in the 1970s, and who endured 14 months of agonizing treatment that he did not want. His case, a mainstay of medical ethics seminars, was notable for the fact that he tried to refuse treatment — rationally, persistently and articulately — and was denied that right over and over again by his doctors. He survived, married, went to law school and continued to argue that his doctors should have respected his desire to decline treatment, should have allowed him to die. His case was used in the burgeoning patient’s rights movement to promote the primacy of autonomy among the principles of medical ethics.

In my estimation, my patient’s situation was even worse than his. Throughout the time I cared for her, she remained sedated and on a ventilator, meaning that she would have been unable to even vocalize a desire for us to stop trying, a desire I felt sure I would hold in her position. At the end of my month on the burn surgery service, her status, in the words of my attending, “stably unstable,” I fled. I did not check her chart or press colleagues for updates the way I had done for so many patients I’d cared for before her. I was certain that she would die, just as I was certain I had helped make her last weeks on Earth an unbearable, undignified, unrelenting horror show.

Three years later almost to the day, at another hospital in the middle of an otherwise uneventful night on call, a familiar name appeared on the emergency room dashboard. Though my patient’s appearance had changed — she was at once smaller and larger than I remembered — I recognized her in an instant, and when she wheeled herself in and stood on shaky legs to make her way to the exam chair, I told her who I was. I said I knew she wouldn’t remember me but that I had been one of her doctors during her first month in the hospital, and told her how overwhelmed I felt bearing witness to how much she had recovered.

“I think I’d like to hug you,” she said in a gentle and musical voice, and when she did so her new skin was soft and shiny, like satin.