Dear Tom and Ray: My boyfriend drives a 2000 Ford Taurus station wagon with 112,000 miles. He’s an MD and specializes in palliative care medicine, which is to say he helps patients, families and other doctors navigate the scary time around the end of life. Almost all of the patients have a definitive diagnosis. Critical to his practice is having a reasonably firm prognosis from the treating physician. That is to say, in order to make decisions, the family and patient need to know, “How long, doc?” Paul’s station wagon is worth less than $2,000, the transmission is shot and it would cost more to repair than the car is worth. What happens is a slipping, shimmying grinding between first and second gears. For the most part, we dance around it by letting off on the accelerator at about the time the car shifts. We’ve been driving the car this way for years. But lately we’ve been going out of town on road trips three to five hours long. We feel like we have an acceptable diagnosis: The transmission is broken and needs to be fixed (and it costs more than the value of the car!). What we want is a prognosis. More importantly, what are the car’s final moments going to look like? Will she go fast, lurching to a stop God knows where? Or will she begin to show some sign that the end is near, such that we have time to get to safety? I know you’re thinking he’s a doctor and should just go buy a different car, but when I started dating him five years ago, he only owned a bicycle, and I had to coerce him into getting a car. We’ve looked for a used car, but he was too picky (i.e., cheap!). He has been gracious enough to upgrade our AAA membership (and at the same time, he added bicycle coverage). — Code Blue

RAY: This is a classic case of the cobbler’s family wearing shoes with holes in them. Paul is able to provide a wonderful, necessary service to others, but he can’t do it for himself. This car needs palliative care!

TOM: Actually, it needs euthanasia, but tell him you’ll settle for a little forethought and a “do not resuscitate” order.

RAY: The whole purpose of palliative care is to help people face an unfortunate reality in a kind and caring way. That gives people a chance to make good planning decisions together, gives them time to say goodbye and, overall, helps them handle a terrible situation in the best possible way.

TOM: That’s exactly what your boyfriend needs, vis-a-vis his dying heap of a Taurus. He probably knows from his work that the first thing a dying patient and his family have to do is face the reality that the end is near. Your boyfriend is doing just the opposite: He’s whistling past the junkyard.

RAY: Once the sad reality is accepted, then you can decide how you can best handle the coming transition, for everyone involved. You have time to make plans — like, in this case, shopping for an adequate replacement car before you’re stranded five hours away from home on a 95-degree day.

TOM: And the prognosis is lousy. This car is like a guy who’s had eight heart attacks and is still eating three cheese-steaks a day: It could expire at any moment. And when it goes, it’ll be without warning, and most likely the engine will just rev up but the car won’t move. That may not sound terribly dangerous — unless you happen to be making a left turn across traffic or crossing a railroad track.

RAY: So my advice to you, Code Blue, is to sit him down, put your hands on both of his shoulders, look straight into his eyes and say, “Hon, we have to discuss a very difficult subject.”

TOM: And if that doesn’t work, YOU buy a car, and charge him the IRS-approved 55.5 cents a mile to ride with you.

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