I was a second-year internal medicine resident, the first doctor in the family, an immigrant to the medical culture from a family of immigrants. I learned from my family that my grandmother had a brain tumor and was declining, though it was unclear to what extent. I booked a flight to Toronto and met my family at the hospital, but little did we know that we were in for an unceremonious experience in the callousness of the healthcare system. It was an experience marked by lack of communication, lack of compassion, lack of presence, and lack of empathy, all culminating the morning after my grandmother’s death. My sister and I were with my grandmother the night she died and met her doctor the next morning. Hurried, impatient, averting eye contact, she flatly stated, “I am just here to pronounce her, I don’t know anything about her.” And with that, she left. It was the impetus for me to seek additional training in palliative care, with the belief that we can change our health care system and that the first step for me was to learn the necessary tools to do so. My hope is to bring about a transformation in how we care for people, and specifically how we care for people with advanced kidney disease. My belief is that integration of palliative care in the care of patients with advanced kidney disease will advance the goal of improving the experience of living with kidney disease.