This article describes experiences with problematic patients whose care taxes practitioners clinical skills & compassion. 90 patients (aged 23-82) were followed by a supportive care program for more than 4 weeks prior to death. Prevalence of pains, patterns of opioid use & routes of drug administration, & prevalence of suicidal ideation (20% although only 4 patients were actively suicidal) & euthanasia are discussed. (36 refs.) A subsequent letter to the editor & response by authors is included.