Some days in the outpatient oncology clinic can be wonderful. All seems to be going well. Mak-ciks are thrilled that their dreaded breast lumps are shrinking with chemotherapy. The twenty year old girl with a shock of green hair comes in smiling with a new boyfriend, her days of ABVD-induced alopecia long past her. It’s all smiles and quiet satisfaction, and little is demanded of me, except possibly endless signing off on forms.
And some days are more difficult.
“Your cancer has returned”.
Four words that can and will change the lives of some who thought they had escaped the grasp. Now there is advice aplenty on the Internet after emotions have cooled. But even the most stoic of souls betray a tremor at that moment in the consultation room.
Though it be honest, it is never good
To bring bad news; give to a gracious message
A host of tongues, but let ill tidings tell
Themselves when they be felt.
— Antony and Cleopatra, Act II, sc 5.
Certainly for myself and for most doctors, disclosure of relapse is difficult (ranking just below a recommendation of best supportive care!). There is a brew of fear, distress, paralysis and anger in the air, and it would be silly to say that we are not in some way affected by the news we break. Indeed, at times, the anger is directed towards the oncologist, whether passively or aggressively. No doctor likes to talk about unhappy events; it is always much more pleasant to introduce exhausted mothers to their squalling new babies, or to announce to an audience that an aortic aneurysmal repair has been life-saving. Awkwardly done, the entire episode can be deeply scarring, a Caliban struggling to communicate with a terrified Miranda. Two worlds with attendant values and cultures meet at that moment.
Done with skill and professionalism, it has the chance to alleviate the inevitable distress of a difficult and unsatisfactory outcome. It is not uncommon for oncologists to be consulted by their fellow physicians in the communication of bad news. It is a duty and a service that we bear with some grace, and possibly a little quiet pride in the skill.
Be still sad heart and cease repining;
Behind the clouds the sun is shining.
– Longfellow
