The author, a medical examiner, describes the murder-suicide of his patient and his wife. The author made house-calls for this patient, an older man who had suffered a stroke & numerous heart attacks, and had mixed aphasia & depression. This patient eventually shot his wife & killed himself. The author reflects on this patient’s death, and how so often deaths such as this become a question of failure of crisis intervention (i.e., why did we not see this coming?).