That's it, he says. It's over. He's on a stretcher, heading into an elevator, talking about our long relationship. I've already called the emergency room to tell them he's on his way. He's set a death date — five days from now. He has no factual plan, no gun, no overdosable medication, no dexterity for the knots on the noose. But he has given away most of his belongings and come to our appointment to notify me. One cannot in good Hippocratic conscience hear that kind of thing without acting. After the ambulance leaves, I pass the facts by phone to a nurse.