Friday, December 11, 2009


It never fails to astonish me that some clinicians don’t comprehend that they’re dealing with whole people, not sacks of deranged enzymes.

I hear of—and have seen personally—physicians, nurses, dentists, and others treat vulnerable sick people in styles that fall between insensitivity and abuse.

A couple of examples. I know at least three people with cancer who were told of their diagnosis by messages left on their answering machines—all, by the way, on Friday afternoons, leaving them to quake in anxiety and fear through the weekend.

Another woman, waiting in an emergency department for test results, was asked by a nurse, “How long have you known you have cancer?” Well, she hadn’t known she had cancer. Later, the nurse apologized, and weirdly added, “Gee, I do that all the time.”

A woman with an excruciating nerve irritation was hoping an impending tooth extraction would relieve it. Her oral surgeon said, “No, it won’t make any difference.” Shaken, the woman asked, “How do you know?” The surgeon replied, “If I’m wrong, I’ll put on a cheerleading costume and wave pompoms.”

I tend to believe these stories because I’ve acted that way myself. When you’re a young practitioner, insecure in your role, it feels important to know a lot and to be right. So you often give patients information without considering its emotional implications. That’s understandable, since young adults’ own suffering is usually a distant future abstraction. To them, advanced arthritis means walking twistedly, period. How can they appreciate the disease’s effects on relationships, energy, self-image, hopes? A friend recently told me, “I’d thought getting older just meant getting older. I didn’t know it meant disintegrating.”

So younger practitioners deserve the benefit of the doubt. But how about people who’ve been in practice three decades? Chances are they’ve been sick themselves, have had experience with depression, divorce, financial disappointments, deaths in their families. Most learn through their own suffering to treat sick people as they’d like to be treated. Thus the venerable archetype of the “wounded healer.” My favorite oncologist, when asked by patients whether they’re going to die from their cancer, answers honestly, “I don’t know. I do think you’re going to live with this cancer the rest of your life.”

A fact can be expressed in many ways. Some ways offer the strength to go on, and others can utterly destroy it. When someone says, “I don’t want to offer false hope,” I can’t help but suspect they offer false hopelessness in its place. Hope doesn’t have to be the promise of cure and immortality. As Vaclav Havel, the former prime minister of the Czech Republic, put it, “Hope is not the conviction that something will turn out well, but the certainty that something makes sense regardless of how it turns out.”

What, after all, is The Truth? The longer I hang around, the more surprises the world waves at me. Every year I’m less certain about predicting anything. But one thing I’m very, very sure of is that sick people ought to leave medical encounters feeling better rather than feeling worse.

1 comment:

  1. Where are the thousands of suffering patients who should be reading and commenting on your blog?
    If I know of anyone sick in a hospital, or anywhere, I will recommend your blog...