When I arrived, Jimmy was lying flat in the bed, alone. His roommate had died, and now Jimmy had shingles, so I assumed he would not have a roommate for some time. I worried that he, such a social being, would feel lonely and abandoned. I looked at him a few minutes, observing what I could about his illness. Aside from the lack of cachexia, an IV, or oxygen, I was struck by his legs, which lay uncovered and were turned at awkward angles from the hips. I knew that he had lost the use of them because the tumor in his lung was pressing against his spinal cord. In the months before, coming weekly to my outpatient clinic, he had complained of various aches and pains in a jumble of thought-disordered phrases and ideas, which, as always, had included somatic delusions. Finally, after hearing a consistent complaint of chest pressure, our clinic's nurse practitioner pushed hard for an evaluation. But in the end, it was Jimmy who had taken himself to the emergency room, when he could barely walk any longer.