Our conversation was initially light and cheerful. The patient’s daughter had recently given birth to her first child, the patient’s first grandchild. She showed me pictures of the newborn and explained the storied history of the child’s first name, which was the latest echo of that name across many generations of their family. The patient’s face fell when we transitioned from this lighthearted chat to the topic of her kidney disease. She described how her relief at entering the transplant waitlist had turned to despair as two years had passed, then three.