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May 17, 2012

Cancer

Disclosing someone's diagnosis of cancer is a morbid privledge. There is tension that hangs in the air as you sit with the patient and their family, all gathered to hear what news you have, waiting for you to confirm their fears. And you will, but not yet. First, as you've been taught, you ask them what they understand about the situation, what they are worried about, how they are feeling. Then, in an unfailingly abrupt change of focus, you tell them that the news you have is not what you'd hoped. You look around the room and notice how everyone is acting differently, some meeting your eye, some avoiding your gaze, some still, some restless. But no one is breathing, not until you're finished.

"I'm sorry to say that you have cancer."

The news hangs in the air and only then does everyone breathe it in. The news becomes impregnated into their cells and starts changing, altering the person, invading the known and making a new space for itself in the minds and hearts of each. The patient looks down, tries not to cry, tries to be strong. You can hear thoughts steeling for the battle ahead, promising to be victorious but doubting even now. The family moves closer to the patient, maybe asks a few questions but doesn't listen to your answers. Your role here is ceremonial now, you serve no real purpose. You have delivered your message. Now you just sit in the presence of the family and offer mumbles and soft touches of support.

Once, I told a man he had cancer. He held my gaze for a moment before looking away. His cancer affected his brain and I saw him fighting to understand what my words meant. He was surrounded by family, but his 18 year old daughter was not present. He looked for her, reached for her, forgetting that she hadn't been able to get off work tonight.

Seeing her absence, he turned back to me. "When can I go back to work?"

The answer was never, sir, and in fact you may not ever leave the hospital, this room, this bed. But that was not his concern and I missed the meaning in his question.

"When can I talk to the work people? I need money."

The tumors prevented his thoughts from forming words and his words from expressing his meaning. Finally we heard him. He didn't need money. He needed life insurance.

"What about...? What is she going to do...? She.... needs me... needs money..."

His head rested in his hands as he tried but failed to remember his daughter's name. 

"You know who I mean?"

He cradled his arms and rocked them back and forth, slowly, gently, with love. He looked down at the place where his baby's head once laid and tears fell onto his arms.

"What about her?"

The privledge in taking care of people during these moments is in seeing their hearts exposed, raw and bare. When given their death sentence, people always think of others. Their children, usually, and spouses. They mourn the sorrow that they will cause and the pain that will be their legacy. They look to you to heal them, but not always to cure. Sometimes it is enough to acknowledge the pain and recognize the suffering, to comfort the families as much as the patient. I sit on their beds and look in their eyes and hear them, each time leaving a little of my life with them to quiet the disease, each time taking away a little of the impact of illness away with me.

4 Readers rock!:

Pennsy said...

I was blessed My docs were gifted with the amazing combination of frankness and compassion. They told me how bad things could get, and encouraged me to never stop fighting. I never got the "death sentence," but knew it was always just a bad scan away. Your patients are blessed to have your heart and your heart on their side. And over time, I'm sure you will be blessed by your hours at their sides.

Amy said...

I've always wondered how you guys handle these type of sad issues. Thanks for sharing.

Anonymous said...

Katie, this is just beautiful-sad, poignant beautiful

Syed Kazim Ali said...

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