Dear Mr. Jenkins,

It seems a simple thing to tell a man of 48 that he will not see 50, but I had a hard time of it that night we first met in the ER. You have died by now, I am sure, but I still wonder how good a job I did breaking the news to you that lung cancer was going to kill you long before you had planned to die.

It would have been easier if you knew you were already dying when you walked into the ER that night, but fate left to me the job of shattering the picture you had of your future. You thought your problem was just a nagging cough, but we discovered the cough was being caused by a tumor wrapping itself around your airway.

It would have been easier if you had not been just 48, about my age, and if you had not asked me how long you might live.

“I’m not a cancer expert,” I said, “but I, uh, don’t think you will see 50.” It would have been easier if you had not then held my gaze so long I finally looked away, unable to tell if you just kept looking at me for a different answer or through me into the abyss. Both, probably, and in either case, the truth made me blink.

Life can still be wonderful after your doctor tells you a terrible secret your body has been hiding from you, but it can never be the same. The earth quakes at that moment, I think, and splits your life along a fault line of before and after the news. That’s why I dawdled before telling you what I knew; that your chest X-ray told me of your likely fate as soon as I looked at it, because cancers that large and advanced cannot be cured.

I searched your thundercloud for silver threads with which to weave a tattered lining and thought perhaps a few more minutes without knowing you were terminally ill was a gift worth giving. I also needed the time to put on my game face, so I saw other patients, waited for other tests, and dragged my heavy heart around the ER until I ran out of excuses to run by your exam room door.

Did you know something was wrong the moment I walked through that door with the news? I think your wife did; she put one hand protectively on your shoulder as I came in, and the other went silently to her mouth when I said the word “tumor.”

I think she read my face as though it was a bad book with a sad ending. I had tried to wipe the despair from it, the despair I felt when I first looked at your X-ray and then at your age. Was I successful?

Had I erased any tone of hopelessness from my voice when I said, “It’s almost certain this tumor is a cancer”? Miracles happen, doctors never like to say “never” when asked if patients ever survive cancers such as yours, and because I was hated telling you what I had to tell you.

How could I have you walk in with a cough and let you walk out with a death sentence? Those transitions should take more than the time of short conversations. Besides, predicting such futures is an exercise in errors, and a doctor must choose between the errors of too much optimism and too much pessimism.

Did my manner reflect how badly I felt for you without reflecting how badly I would have felt had I been you? Had I sanded out any edge of anger at the cigarette companies that had hooked you in your teens and killed you in your 40s, when you asked if your smoking had caused this cancer? Did you hear my sadness at the loss of your future to your addiction?

Did I take care of you that night as well as I could have? I ask all of these questions because I cared for you and about you even though I did not know you, and because some day soon I will walk into another room carrying a terrible secret of some other patient’s body.

I will tell another father his child has a brain tumor, another woman she has breast cancer, or another wife her husband of more than 50 years has just died.

It may sound foolish to want to get that right, but I feel responsible for doing one of the most terrible jobs possible as well as it can be done. If nothing else, I don’t want to add to the pain of a painful experience. I do a lot of jobs with confidence and ease, but bringing patients bad news that would devastate me if I was the patient is a job I always feel as though I am doing for the first time.

Finally, I ask because some day some doctor is going to bring me my body’s terrible secret, and at 49 the odds of it happening tomorrow increase every day. It could have been when I had a biopsy done on a mole recently, or the next time I do my monthly testicle check for lumps.

When that day arrives, as it surely will, I want to know what I need from that doctor walking to my door with my secret, so I can look him in the eye and tell him. And at that moment, Mr. Jenkins, I will think of you once again, and really know what you needed from me that night.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.