I got a page from the nurse: “Dr. Alice, do you think you could come see Mrs. X? She’s very anxious, driving herself and us up the walls. She and her family are demanding to talk to a doctor about her condition.” “Her condition” being metastatic cancer. Sure, I would love to come talk to her.

I took a brief detour past the computer to review what I thought I knew about her cancer. Yes, very short life expectancy. Yes, very unsuccessful treatments. Yes, only a few experimental trials. Great.

We found an empty room to sit down in, and talked. Fortunately, a lot of it was her just wanting to talk about how miserable she’d felt, and how we’d neglected some of her needs. Which we had, so I apologized, and straightened things out with the nurses. But finally, she and her family started asking about what treatments were available, and how soon they could start. I got through it somehow, mostly by promising to go get a more definite answer from the attending; that was one question I wasn’t too afraid to ask him, since he’s very gentle and careful about his cancer patients.

At one point they did ask something about prognosis, and I made some kind of statement involving the phrase “metastatic cancer.” I knew the attending had talked to her family right after surgery, and to her the day after. I assumed he’d used those words, since everyone on the team had known it from the moment the incision entered the peritoneum. Nope. There was a blank look on their faces, and I backtracked hastily. Fortunately (this time) I tend to speak really fast under stress, and sometimes pretty softly. I think most people in the room missed what I said, except for one son who looked far more enlightened than I could wish. . . I asked what the attending had told them, and then stuck to his phraseology: “a little too large to remove with surgery.” I should just play dumb more often. Just because for once I did know the answer, doesn’t mean I have to show off by giving the answer.

I hate being the intern, totally ignorant about prognosis and treatment, being the one available to discuss all this with the family at the time that they’re all visiting on the floor. I hate being in the dark about what the attending said and what his plans are, and being left to trip through minefields, damaging the patient’s morale and their rapport with the attending. I hate cancer; and I really hate metastatic cancer.

Mrs. X is a Christian, I believe. I have prayed with her, just about recovering from surgery. I think it would count as undermining the attending’s plan if I tried to say anything comforting about death itself, since he doesn’t want to go there with her yet.

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