Quality of life should be valued as highly as longevity when advising patients and their families. Clinical decisions are not made in a vacuum; they shape how patients live, not merely how long they survive. One experience from my years in practice reinforced this principle in a way that guidelines alone never could.

While practicing in Manhattan, I cared for an 85-year-old Korean-American man who had been hospitalized in Flushing with a non–ST-elevation myocardial infarction (NSTEMI). He requested transfer to my hospital so that I could oversee his care. When I met him and his family, we discussed treatment options candidly. Given his age, the family wished to proceed with cardiac catheterization and possible stenting but declined coronary artery bypass surgery. Angiography revealed a severe proximal left anterior descending artery lesion, which I successfully treated with a stent. The result was immediate and gratifying: he told me he felt markedly better, and in retrospect admitted that he had been ignoring chest discomfort for quite some time.

During these conversations, his wife and daughter expressed concern about his fondness for foods they considered unhealthy—particularly cheese and ice cream. They asked me to instruct him never to eat them again. While I understood their concern, I hesitated. Instead, I suggested moderation and a general reduction in animal fats rather than absolute prohibition. After this discussion, the patient smiled brightly for the first time since I had met him, appearing relaxed and relieved. I scheduled a follow-up visit in my Flushing office.

At that follow-up appointment, however, I was startled by the change in him. He appeared older, withdrawn, and markedly different from the man I had seen in the hospital. Concerned about possible stent-related complications or post–myocardial infarction depression, I questioned him about his symptoms. He denied any chest pain and reported feeling well physically. When he asked to speak with me alone—despite his wife and daughter accompanying him—I grew even more concerned. After asking his family to step out, he quietly confided that his life had become miserable. Either his wife or daughter accompanied him to the kitchen at all times, ensuring he did not eat ice cream. What he described as his “only pleasure” had been taken away.

I was relieved that his distress was not medical in origin, yet troubled by how profoundly his quality of life had been affected. I reassured him and invited his family back into the room. I explained that while a prudent diet is important, so too is the ability to enjoy life. Given his age and the joy he clearly derived from ice cream, I recommended moderation rather than complete elimination. This suggestion was met with visible discomfort, particularly from his daughter, who warned that my advice could hasten her father’s demise. At the time, guidelines emphasized strict dietary fat restriction for patients with coronary artery disease, and moderation was not yet widely endorsed.

I acknowledged their concern and I also admitted that, ideally, he should avoid high-cholesterol foods. However, I explained that I strive to recommend lifestyle changes I would make for my own family. Seeing him as a peer of my own father, I would want not only years added to his life, but life added to his years. Gradually, their stance softened. They agreed to allow him his favorite treat in moderation and to work with him rather than against him.

As they left the office together—smiling as a family—I felt a deep sense of fulfillment. Shortly thereafter, I moved to another state for a new position and never learned how his story continued. Still, I hope that after our last meeting, he enjoyed both meaningful longevity and the simple pleasures that made his life worth living.

This experience continues to guide my practice. Medicine must aim not only to prolong life, but to preserve dignity, autonomy, and joy. True healing lies in balancing evidence-based care with compassion.

Mun K. Hong, MD, MHCM, FACC