“Always write angry letters to your enemies. Never mail them.”
-James Fallows “He should never have agreed to treatment! It was the worst thing he could ever have done! I can’t believe you doctors did this to him!”
My patient’s cousin, whom I had never met before, was very angry and I was her target. Unfortunately, she chose his funeral as her opportunity to unload on me.
At one level, it was hard to disagree with her. He had been a gentle, hardworking, and quiet man. I had actually met him on occasion before he had developed cancer since his profession brought him into the hospital on a regular basis. In his mid-40s, a large cancer had developed in the sinuses that extend between his eyes. Despite aggressive surgery and radiation, the cancer had recurred just a few months after its initial treatment. Chemotherapy had been unhelpful, and, in the weeks before he died, he had been miserable. His vision had deteriorated, his cancer had a penetrating, noticeable odor, and it had been very difficult to find a balance between pain control and over-sedation. He told me more than once that he was ready to go.
Still, the cousin’s diatribe had taken me by surprise. I tried to think of a response, but could not. “I’m so sorry,”
I said. “He was a wonderful person.”
She glared at me and said nothing.
I thought to myself …Would we have done anything differently had we known ahead of time that his tumor would be so unresponsive? I was uncertain. By searching the medical literature, we can predict how groups of similar patients will do, but there are wide differences in individual outcomes. He might just as easily have sailed through treatment and had a complete response.
One of his sisters, whom I had known well throughout his ordeal, saw what was happening and stepped in just as the angry cousin stormed off. “We know you did all you could. Thank you, Doctor.” “I’m so sorry,”
She, too, said nothing at first. Then, “We all will need some more time to heal.”
The following is feedback received for this blog:
Another great post from you. It is hard all around when things go like this. You were good to go to the funeral. I feel sure you did your best. It's tough (and often hard to accept) when that is not good enough.
- rl bates