Scott Janssen’s heart was racing. He took shallow breaths. He couldn’t believe what he was seeing, but he tried to hide his shock.

It was a crisp autumn day, and Janssen was visiting Buddy, an elderly client, at his small brick home on a dead-end street in Durham, North Carolina.

Buddy had just lost May, his wife of 40 years. She was bed-ridden and had suffered from Alzheimer’s disease. Janssen, a hospice social worker , had been visiting the couple for nine months. During that time he had never heard May utter a sound and only saw her open her eyes once.

He also was worried about Buddy. The man was his wife’s sole caregiver; the couple never had children. He had spoon-fed, bathed and dressed May for years, with no help. At times, he’d open their bedroom window so his wife could smell

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