At the stroke of dependence, half an hour past independence (For Angela who responded with such heartfelt need of personal confirmation of self worth that I was glad I wrote this piece.) Carey came into my office every 3-4 months for 10 years. "Are you married?" I initially asked. Carey laughed and replied, "Well, I have this guy I've been going with for 40 years now." Her boyfriend was over 10 years her senior. Carey was 80 when I met her. Her boyfriend just turned 102. Today Carey came into the office after two strokes with her daughter in the lead. I had never met her daughter because I had never needed to meet her. Today Carey was escorted by her daughter because after the stroke Carey veers left when she walks, can't drive, is forgetful and is flustered by frustration. "Ok, up on the exam table," I directed Carey. "You know it's my physical fitness test." Long ago my attending in training told me if a patient could not mount or dismount the exam table it was an immediate indication score for poor long term prognosis. He would go so far as to dare not dialyze the patient because long term they "would fail anyway". Not to as an extreme a rationale, I continued to dare patients up on the exam table to see the mir mount and dismount, to gauge in ways their long term independence. With all the seriousness of an Olympic judge, I watch. Carey walked over to the exam table and approached it on the left then re thought and came instead from the right. It took her five steps to get up and turn around and she sat up without aid. Mount: 9.6 I examined her and then leaving her up there with me close by I spoke to Carey. "Well, your labs say your insides are fine but you look so dejected. I'm afraid long before you die of illness you will die of devaluation of self," I declared. Carey laughed and her smile was crooked on the right. "I'm so disgusted," she began. "They want to all do stuff for me and tell me what to do and I'm so disgusted!"her words slurred a bit. She never drooled. Carey recant a long list of things she couldn't do. She couldn't drive. She couldn't go anywhere alone. She couldn't shop. She couldn't pay bills. She couldn't speak at times. "I see. You are having a tremendous amount of change and have no self worth left. You know what the best way to handle this is?" I offered. Carey sat forward eager to fix her disheartened existence. Her torso was straight and he didn't slouch or lean. "To fix this we must be very strong and do something near impossible," I began. Carey folded forward with firm flexion of her rectus and maintained herself on the exam table steadily. I noted her persistently strong tone and core balance. "We must revalue ourselves," I declared then paused. The words flirted with ridiculous. I continued. "We must take a kind of inventory and reassess our own metric to which we measure our worth of existence," I threatened the norm. Carey chuckled. "I'm serious," I contended. "Listen, dead is dead. Death will come for you. Death is already on the books for us all. Death waits already. When death comes the door closes and you are gone. Right now, you are alive. We are having a conversation and I am fully here feeling engaged. You are alive and engaged. Thus, you have value to me, your daughter, your family, your boyfriend. You exist and thus are of value. You need help. Take it. I know you value independence and value yourself only if you are independent but you need to renegotiate the terms of your existence and realize what makes us of value is being capable of accepting new valuations and enjoying life till death comes. Your family wants you safe and well and happy. You must make safe choices, stay well, and learn to be happy again before you go forever and leave us all sad. Being here is an achievement and staying to stay engaged is of value," I serenaded her soul with gowns of diamond breath and shoes of eager talks. Carey's eye contact never wavered and her comprehension was intact. Showmanship: 10.0 Carey rose to dismount the exam table and I moved to allow her room to do so. She stepped right off and did not turn to back off. She walked back to her chair with a slight limp and veer to the left. Dismount: 9.8 As she walked to her chair Carey said, "I'm less disgusted. I'll try to do as you ask but I wish I was just myself." "You are yourself. In fact, only the best selves can revalue themselves. This is no simple thing I ask you to do. I ask you to evolve. I ask you to adapt. It will be your hardest challenge and a testament to your truest capability," I assured her. We hugged and I sent her out to try to live a little while she still had time to do so. She veered to the left but still made her way down the hallway. The doors of death are final and their heavy hinges will swing and the definite lock will latch. Death is on each of our timelines already. Until death comes are we not to live and love living? Are we not to see that being alive is already a victory worthy of effort and joy? If we can still mount and dismount a day and engage another, have we not purpose and enough weight to have value? Long before we die of bodily dissolutions, we are vulnerable to the death of an ego. It behooves society to champion the graceful exits of our aging kin less we find ourselves nothing before death and dead while alive.