I felt slightly terrified when my supervising doctor told me
that I’d have to speak with his patient and wife alone. The patient, a man in
his early middle age, had come into the clinic the week before complaining of
dark urine and fatigue. A CT scan confirmed that he had advanced pancreatic
cancer. Whereas he had been planning a vacation with his family only a short
time ago, he would now be contemplating his own death.
Knocking on the clinic room door, I felt my heart pounding
out of my chest. What do I say to someone who’s just been diagnosed with a
terminal illness? After greeting the patient and his wife, a woman with long
brown hair and a gentle expression, I pulled out my pad of paper and plunged
into a series of biomedical questions: What
colour is the urine now? Do you have any nausea? When is it worst? Every
time there was an awkward silence, I would quickly fill it with another
question.
When the interview was nearly over, I looked up and saw the
man looking despondent while his wife just stared at the floor. I had
completely and utterly failed to make any connection at all. I realized that I had
kept cutting him off when his answers began to veer into the emotional. Even
out of the clinic, I sometimes feel guarded when talking with people I don't know well, and
yet here I was expected to talk to a total stranger about his impending
death.
My heart pounding, I put aside
my pad, looked the man in the eye and asked, “How
are you personally coping with this diagnosis?” The man started to speak but
then lapsed into silence, a silence that seemed to stretch on and on as the
clock ticked loudly onward. What do I do
now? Did I say something wrong? I wondered. But I shoved these anxious
questions aside while my stomach tied itself into knots.
After what seemed like an endless interval, he resignedly said, “I just don’t know what to do.”
I had suddenly made a connection. The man opened up after that, explaining how frustrated he felt to be diagnosed with cancer at such a young age. He described how he envisioned the final chapters of his life; he didn't want extensive surgery or chemotherapy, but rather to just be at home with his family. Whenever he would struggle for words, his wife (now engaged with the conversation) would help him out. By the end of our interview, I felt like I had gained a much deeper understanding of his suffering. In turn, I think he appreciated that someone just listened to him.
I had suddenly made a connection. The man opened up after that, explaining how frustrated he felt to be diagnosed with cancer at such a young age. He described how he envisioned the final chapters of his life; he didn't want extensive surgery or chemotherapy, but rather to just be at home with his family. Whenever he would struggle for words, his wife (now engaged with the conversation) would help him out. By the end of our interview, I felt like I had gained a much deeper understanding of his suffering. In turn, I think he appreciated that someone just listened to him.
By putting aside my script and connecting with the patient
on a personal level, I saw him as being much more than a series of symptoms. I better understood his illness in the broader context of his life, an understanding that can help shape the course of medical treatment and improve the quality of care. As time goes on, I'm becoming better at ripping up my script in favour of
the spontaneity of genuine conversation. Maybe this conversation is more awkward and uncomfortable, but it is undoubtedly a much deeper source of insight than scripted responses could ever be.
