[This is one of a continuing series...]
While visiting with a patient last week we reached that awkward point in a conversation where both parties have exhausted their supply of neighborly small talk. As I stood up I really couldn't think of any other issues to discuss. The patient's problem, as they say, was obvious - it was the solution that had stymied me. He had been recently diagnosed with cancer and had plenty of troubles related to this. The complications of his malignancy could be relieved. The cancer itself although treatable, was incurable. This fact weighed upon me, producing a tiny feeling of dread like the first rumble of thunder rolling down the seashore during a summer nap. I promised him he'd start his treatment as soon as he had recovered from his latest setback. He looked at me and said he wanted to ask me a question. I nodded my approval, and he said:
"Am I going to get well?"
RULE NUMBER 7. NO DOCTOR IS EVER THANKED FOR BEING CALLOUS TO A PATIENT.
I answered him with the following story:
"You're fighting a disease that is difficult to live with. Some people hold up longer than others and I can't predict how long you will live, but my goal is to beat this tumor into submission so you can return to a more normal life. If you think of this battle as building a pyramid, where the top represents ultimate success, you've got three blocks in place and a thousand to go. Every time you do something positive for yourself, whether it be maintaining your nutrition, or keeping active around the house, or taking your treatment, you put another block in the stack. The higher you build this pyramid, the better the view is from the top - and the closer you are to becoming a long-term survivor. No one knows how long you can keep up this work, but this is your task; I guess I would call it a monumental task to build a monument to yourself, so that the world can see your strength and glory in the face of a despicable illness."
"My task is to make sure you show up for work each morning."
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What a way to describe the task set forth this man. There aren't many Dr.s like you.
My goodness, I am building the same pyramid! What a great way to put this! My doc often seems rather hang-dog with me, but I keep telling him I plan to live life to the fullest. Ah, maybe if I show this to him, he will get the idea...
Ooh, I like that analogy. I'm an oncology advanced practice nursing student (almost done with the formal education part) and always struggle when asked that question. You've given me a new way to think about talking with my patients ... thanks!
Ah, Cheerful Oncologist, I think I ran into your patient last night at the hospital. I suspect I require further explanation of Rule Number 7. While I will be the first to admit that doctors are not gods (reminds me of a joke) and no one knows time of death (expiration dates for people?), yesterday I had a patient who was clearly dying ask me, "am I dying?" Per family outside the patient's room, she had a discussion with the oncologist earlier in the week, but they couldn't much believe it either when they heard it today: "how long does she have?" We (Americans?) spend so much time denying and ignoring death, what do we rob ourselves of when we deny the tasks of dying? You raise the word "callous," but your story illustrates hope. Different issues, different stages? I don't want to be callous, but I don't want to lie, equivocate, or encourage someone to fight if that's not really what they want to do. Maybe I'm just mourning the leukemics that spend the last six weeks of their life in a semi-sterile 15x15 room.