The Kindness of Honesty: Conversations at the Edge of Life

“Thank you for doing what you do,” Jenny said. Jenny (not her real name) works at the hospital. She is also good friends with one of my patients – let us call her Kay.

Kay has stage IV colon cancer. After receiving chemotherapy for some time, she decided to take a break. What I thought would be two to three months turned into a year. The tumor markers started to rise. No surprise – she stopped treatment when there was still evidence of cancer in her body. The repeat CT scan showed progression of disease.

During our follow up visit, we discussed her CT scan results. With the cancer growing, I recommended some form of systemic treatment.

There was a pause. I waited patiently.

“Am I going to die?” Kay asked. Her eyes welled up with tears. Her voice was a bit shaky. I have known Kay for quite a few years and she feels anxious easily. I cannot imagine how she was feeling at that time. In the back of her mind, she probably knew that the cancer would keep growing if nothing was done about it. At the same time, she was reluctant to get more chemotherapy because of transport issues, scheduling and potential adverse effects.

She meant if she was going to die from her cancer. “Yes, you will die from cancer. If it is not treated, the cancer will continue to grow and spread to other parts of the body, which it has already,” I replied.

That visit ended with waiting for molecular testing results to see if there were more therapeutic options for the patient.

A couple weeks went by when Jenny stopped by my office. “Thank you for what you do,” she said. Before I could come up with what she was referring to, Jenny started to tell me about Kay.

Kay shared with Jenny about our discussion, about how I told her that she would die from cancer. Jenny quoted Kay, “Can you believe she said that?”

While I was thinking, of course I said what I said – that was what Kay wanted to know. Jenny shared with me that, having worked with many doctors, she has seen many of them dance around the subject when asked. Many doctors would somehow change the subject or use words which unknowingly mislead patients.

One of my values is to be truthful to my patients. In the world of oncology, I believe that is very important to be honest and to the point. There is no need to use words or phrases to minimize the severity of the situation. There are different ways to deliver bad news. My approach is to be gentle in the way I speak, while using the sentences which are clear to understand. Ambiguity may cause misunderstanding, which may affect the doctor-patient relationship in a negative way.

Everyone will die at some point. We just do not know when the exact time will be until it happens. Sometimes it is more comforting to know there is an estimated time frame on earth. It allows the patient and the family to get things in order.

Being truthful helps the patient and the family face the truth. Often they know the course of the disease but they avoid facing it. By being open and talking to them helps them face the situation rather than running away from it. You are minimizing the doubts. Yes, there are still so many unknowns, yet you are pointing them a direction to go.

Helping patients is more than just treating their physical ailments. It is also to help them face the situation head on, knowing that the medical team, with you as the leader, is on their side. This special relationship starts with being honest, telling the truth with kindness.