Let Sleeping Dogs Lie?

A physician laments his last interaction with a patient.
A physician laments his last interaction with a patient.

I'm sorry!

I really am!  No one deserves breast cancer. Especially the kind that spreads to the liver, lungs and brain. The fact that you lived to your eighth decade does not diminish the sadness. You deserve to live. I can't blame you for not being ready to go.

I apologize that our meeting was so abrupt. I was called in as a consultant to address various issues while you were in the nursing home. I swept through the door and introduced myself to you and your daughter. I explained what the term "palliative" means and why I was asked to see you. Although I saw a full hospice consult noted in your hospital chart, you both stared at me blankly as if this was the first time you had heard of such a thing.

I asked if you were in pain. I asked about your breathing. I watched your chest move laboriously up and down, and saw your dreadfully weak body sunk into the huge hospital bed. Finally, I tried to discuss prognosis.

You mentioned that your oncologist had said, "We can get it all."  You placed great hope in the upcoming brain radiation. When I pushed further, you spoke vaguely about seeing your grandson's wedding next fall.

Your skin was sallow and your breathing heavy. There was absolutely no way you were going to be alive for that wedding. I had doubts about the weekend. When I started to express my concerns that your expectations were unrealistic, the conversation turned. Your daughter shook her head and her glance shot arrows through me. You became angry and shooed me out of the room. I was asked not to return.                                          

I have thought of a million better ways I could have told you such dreadful news. I should have approached the situation differently. I could have introduced these subjects more gradually and gently over the course of many visits and allowed you to come to terms with the reality on your own.

But for some reason, I felt a great need for urgency. Rounding the next morning in the nursing home, I found your bed empty. You had coded an hour after I left you. The ambulance came, life support was initiated and now you lie half dead in the local ICU. Your daughter is left to make the horrible decision of when — or if — to “pull the plug.” You will not recover.

Some may think that I wrote this post to gloat, to say I told you so.  The truth is agonizingly more complex. I wish I could do this one over. I wish I could have left you in your mist of denial and taken a much simpler approach. I wish that I had held your hand, said that I was sorry and let sleeping dogs lie. You were not going to listen to me anyway.

Now, I am stuck with the strong possibility that your daughter will see my visit as the straw that broke the camel's back. And you, your last memory before dying, will be of some young, pompous doctor who walked into the room and told you that he was giving up on you.


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