'The elephant in the room is that many of our patients are dying and there is often nothing we can do to change that.'
Physicians are reluctant to have these conversations, even when their patients are severely ill.
As the fellow, I was responsible for leading our team on rounds each day. Sometimes that was easy and straightforward. We would prescribe antibiotics for pneumonia or a transfusion for anemia. Other times, doubt would creep into our little huddle of white coats. “It’s time to send in the angel of death,” our new intern chuckled insensitively one morning, on just such an occasion. The chief resident silenced him with a withering stare but then turned to me with her brows raised. Apparently my reputation, and my unfortunate nickname, had spread further than I’d realized. My behavior was atypical enough for a surgeon that it had started to attract attention.
“Kate! How are you?” she asked brightly as I entered her room, the rest of the team crowded in the doorway, watching.?” I countered, humbled by her concern for my well-being when she herself was so ill. The makeup she was wearing did little to mask her pallor, and while most of her body was painfully thin, her belly was distended. The strip of skin visible between her sweatshirt and pajama pants was stretched tight and shiny.“I’m nauseated again,” she finally murmured.
“What about this new chemotherapy you’re recommending?” she asked. “Will it finally make the cancer go away for good? Or will we need to remove it surgically?”My supervisor had clearly laid out his plan when he told me she was coming for admission. However, I knew that the available data on patients like her suggested that her chances of responding to the treatment were incredibly low. And the chemotherapy would likely make her feel even worse.
I followed her somber gaze as it appeared to wander out the window, through the skyscrapers downtown, all the way to the ocean. I could see frothy whitecaps kicked up by the strong breeze.
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