I gingerly perched on the stool, trying to balance on the roller-happy wheels, and glanced around the crowded room, positioning myself to face the patient. His family members tracked my every move; his daughter sat on one side, pensive, while his son stood behind the wheelchair and his wife hovered on his other side, stiff and focused.
While I was seeing him for routine follow-up before his chemotherapy treatment that morning, there were multiple comorbidities that needed to be discussed before proceeding. Two oxygen tanks sat next to his hunched frame. The nurse had already brought the second in because his home tank was running low. I asked how his persistent shortness of breath was today. Not good.
Looking up he slowly, deliberately, asked, “what happens when it runs out?”
I paused, “when the new oxygen tank runs out?” Maybe he was worried about taking the clinic’s tank home.
“No.”
His simple answer told me all I needed to know. He wanted to understand what happens when his body runs out of oxygen, completely. After a recent increase in his daily need from 5 liters to 8 liters, it was evident his pulmonary fibrosis was progressing. Three faces turn towards me expectantly. They all know what he is asking. And they all know the answer.
Often our gut recognizes the truth but requires a form of confirmatory response before we can fully accept the facts. As I sit with this patient and his family, I want to do anything but explain what happens when the body runs out of oxygen. The only word going through my head was simply “death.” He stared at me and I stared back at him. A few seconds passed, settling on us with a weight more similar to that of hours.
In the field of oncology, death is no stranger, but I am. Only three months in, I lack the repertoire of responses which accumulate with experience. Regardless of how expected these questions are, I have to slowly navigate my way through each conversation. “Death” is not a sufficient answer. Nor is it a kind one. There are many ways to sugarcoat the reality of mortality. It is tempting to sidestep around these questions, to form a string of vague sentences long enough to pretend to be an answer while only pulling the attention onto the next topic. But I am beginning to realize that this is not the way oncology works.
There are many ways to sugarcoat the reality of mortality. It is tempting to sidestep around these questions, to form a string of vague sentences long enough to pretend to be an answer while only pulling the attention onto the next topic. But I am beginning to realize that this is not the way oncology works.
Truth can be a painful reality, but it exists nonetheless. When a patient is diagnosed with cancer, one of the main things discussed with them is the intent of their treatment. Some are treated with “curative intent,” meaning it is the goal of the medication to cure their cancer. Others are treated with “palliative intent,” in which case their cancer will not be cured, but quality — and hopefully length — of life will be improved. There is no room for sidestepping the truth in these conversations. The patient deserves to know what they are up against.
If diagnosed with a stage IV, metastatic disease, many of us would go through the five stages of grief that accompany life altering events: denial, anger, bargaining, depression…and hopefully, eventually, acceptance. How difficult would it be to have navigated your way to the endpoint of acceptance, only to realize your doctor did not tell you the full extent of disease in an attempt to protect you? Back to the denial stage you would go, restarting the journey all over again. It is therefore imperative that we are honest with our patients, explaining the details of their diagnosis and the expected outcomes of their disease. Our timelines may differ, yet our endpoints are the same. Each of us would want to know the truth.
I know what happens when our bodies run out of oxygen. I know my patient knew it too. But he needed a verbal confirmation from me. In those few seconds of pause, I mentally instructed myself to be straight with him. Mustering up the courage to meet his gaze, I answered him slowly, honestly. I can only hope my words were spoken with a gentle clarity that would eventually usher in that final stage of acceptance and peace.
Thank you for being here,
~Cheyenne
Honesty, I find, is typically the best policy. I find it true when patients ask hard questions, or even when my little kids ask me tough questions. There are rare occasions when it's not, but usually it's the best policy.
Looking forward to reading more of your work! I like your intentional style already.
Cheyenne, I’m new here. This is a powerful and well written post. Quite impressive, both in style and content. Is this written by you, or by someone else? Curt