So--what will be your answer to the medical student? What should you tell Barbara and her family? That's up to you. But whatever you chose, you can be confident that you will be able to provide for her comfort and help her maximize her quality of life. When you share your most honest estimate of her prognosis and help her reframe her hope, you can increase the chance that she will be able to define and accomplish her last goals, bring closure to her life, and do the work that will minimize the pain of her bereaved family. You are not alone in this work: you can enlist hospice and palliative care teams to help you. With their help, you can promise Barbara the same expert care with or without chemotherapy And then . . . it's up to her.