“I’m crying right now because you’re sitting there.”
“I’m sorry,” I said, trying to jump up.
“No, please stay where you are!”
This is our first meeting. “There” is at her feet, pushed to one side of the hospital bed to make room for me. She has been questioned and pursued by all types of doctors. “The moment you saw her, you knew she needed you,” her last expert told me.
Oncologists like me are not satisfied with such statements. Being called to see a patient at the end of a hospital stay is to deliver the worst kind of bad news. Or, more precisely, to assemble the pieces of bad news into a convincing explanation that confirms what everyone has suggested: that the disease is serious and the prognosis is dire.
She’s a wife, a mother, and a friendly person who you could easily imagine delivering freshly baked cookies to a friend or caring for a neighbor’s baby.
After weeks of testing for recurrent cancer, she is depressed.
A surgeon put her on the operating list. The second young surgeon was not convinced, but kept his mouth shut. The third surgeon scheduled to perform the surgery canceled the surgery, and now I know why. Although surgery is technically possible, the most predictable outcome is an extended hospital stay at the risk of wasting the precious time left in her life.
Although she clearly understands her impossible situation, it still feels punitive to fill in the gaps. I told her that the surgeon was right to avoid unnecessary surgery.
We discuss that chemotherapy does not help. She asked how long it would take, then added that time was short. I touch her arm, swallow, and nod.
And she’s crying. Tears fell from her eyes, slid down her cheeks, and onto the back of her sleeves. I look around for tissues. In tears, she joked that we were in a public hospital.
But here’s the problem. It’s not like she’s crying. I just admire her unparalleled calmness. She’s not crying about her prognosis or about not seeing her grandchild grow up.
She said she was crying because the kindness melted her.
A surgeon was sitting there, pointing at the window sill and frowning, she said: He spoke rapidly and loudly from his perch, announcing that she was dying and apparently wanted “the whole world” to know. In the middle of the conversation, he answered the phone. She found that his frivolity could not be tolerated.
In contrast, she claims the junior surgeon was professional and kind. He pulled back a chair and looked her in the eye. His honesty and warmth were so comforting that she remembered his name. Her eyes light up and so do mine. That happens to be how she describes my friend.
I first met him when he was unsuccessfully trying to persuade a dying patient to forgo surgery. He arrived just then, waited until I was finished, then gently took his hand and said, “If you were my father, I wouldn’t want you to have surgery.” His gentle tone solved the problem, and I remember thinking that if ever there was an example of healing, this would be it.
My patient is crying again. She told me that she is now crying as she remembers the one event that defined her stay.
One morning, a large group of doctors stood by her bedside. Everyone stood there in silence as her boss bombarded her with constant bad news, and she felt suffocated with fear. Then, at the back of the crowd, I spotted a young man crying. “And suddenly I felt better.”
He returned, introduced himself as an intern, and said how much the bad news affected him. He sat down and talked about her health, her children, and her shredded hopes. Here was the person with the least initiative and the most time. To her, he stood out as the best doctor. (I’ll find an intern later and tell them.)
I was deeply moved, but part of me can’t help but think that the surgeon who canceled the surgery deserves some credit. I offered that he made the right medical decision but that maybe he was having a difficult conversation and felt anxious, but my explanation doesn’t hold up. She was not informed about the decisions made behind the scenes and only saw how she was treated.
Her account highlights important patient attitudes that doctors often overlook. We often think that patients judge us by our medical acumen, but in reality, patients judge us by the words we say, the empathy we show, and the empathy we offer. I am observing your kindness. This is a lesson so rich that it is difficult to absorb.
This shows that there is a continuing gap between doctors and patients about what really matters in healthcare. Doctors are trained not to overthink and feel too much. Patients know we think enough, but they want us to feel more. As technology, machines, and bureaucracy overwhelm us, the essence of good medical care remains an open secret.
A few days after the appointment, the loose ends are cleared and the patient is finally preparing to go home. She reassured me that she was leaving on a lighter note. It seems impossible in this situation, but it’s a testament to her character. She will always remember the warmth that I and others showed her. It is so telling that even though we were far from prolonging her life, her general reaction was one of gratitude.
The ancient philosopher Seneca knew this and said: They are still in his debt because of his kindness. ”
