For this task, I prepare but never rehearse.
Gathering my thoughts, I walk deliberately down the Day Surgery corridor. In a minute, I will walk through the door of my patient’s room and deliver the news that neither she nor her family ever wanted to hear again. The woman, who had been treated successfully a couple of years ago, has a new cancer. The biopsy today has confirmed the diagnosis.
As usual, I pause outside the door for a moment. Before I am finished with the imminent conversation, we will have confirmed the diagnosis, discussed the plan of attack, confirmed her upcoming appointments, and, possibly, explored some frightening topics. Experience tells me that she will remember few of the details.
In the moment before I slide open the glass partition and enter the room, I am flooded by the stories and faces of patients who have faced similar recurrences; they bang around in my head vying for attention. As I anticipate her thorny questions and concerns, I stock my memory bank with research information and words of encouragement as an archer might select arrows.
I walk into the room and sit down. Our eyes meet and I touch her hand. “What we found explains why you have had more pain recently,”
I begin. “Oh, my God!”
Her voice trails off. Her husband, a husky, bearded man, reddens, stifling a sob. Their granddaughter, a quiet 10-year-old with a wide open expression, grasps her other hand. The woman struggles to clear her head and to pay attention.
The brief family discussion is familiar yet is still different from any other before or since. I remain as unambiguous and straightforward as possible. I intentionally maintain a sense of hope. I briefly cover the next steps and the treatment options. I encourage them to call anytime they need support. We will repeat this discussion almost word-for-word in a few days.
The dialogue is winding down. “What other questions do you have? What do you want to know?”
The patient and her husband shake their heads; they have exhausted their lists for the time being.
I turn to the granddaughter. “And how about you, Brittany? Do you have any questions?”
She wrinkles her nose and regards me quizzically for a few seconds. Her mind had been far away. Finally, a question gels in her head and she wonders, “How long does it take to become a doctor?”
Her grandfather smiles and wipes his eyes. He shakes his large head. “You think you want to be a doctor?” “Maybe.”
The mood has changed perceptibly. I reset my focus and spend a minute encouraging her to work hard in her classes. She nods and tells me how much she loves school. She understands. “Other questions? None today? We are going to get you through this together! Call, okay? See you next week.”
I grip everyone’s hand and head back to the Operating Room for the next case.
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