By Gwen Darien
Something to Talk About
By Gwen Darien
Like many cancer survivors, I remember with extraordinary clarity my doctors’ words and actions around the time of my diagnosis. I had been feeling increasingly sick—there was the cough that wouldn’t go away, incredible fatigue, and acute pain in my shoulder. I was relatively young, 35, and my internist didn’t take my symptoms very seriously. When antibiotics failed to clear up the cough and I developed shortness of breath, my internist’s partner saw me for an emergency visit. At first, he chatted with me easily. But when he listened to my chest, I felt him step away—both literally and figuratively. I knew then that I had something more serious than a bronchial infection.
I underwent a chest X-ray, after which the technician cavalierly asked if part of my left lung had been removed. (I later learned that it didn’t show up on the X-ray film because it was filled with fluid.) With virtually no discussion, my internist’s partner handed me off, sobbing, to a pulmonary specialist. By early evening, I was in the hospital.
The next morning, with no further information, I pressed my mother until she told me the doctors suspected I had cancer. Later that day, my internist arrived at the edge of my hospital room. He told me a hematologist-oncologist would come to see me and rushed out the door.
Sixteen years later, I still remember my early conversations with the hematologist-oncologist. He used the good news–bad news cliché: “The bad news is that you have cancer; the good news is that it’s highly treatable.” He turned out to be a caring and extremely competent doctor, but I’ll never forget the flippant tone he used to tell me I had non-Hodgkin lymphoma.
Even the most well-intentioned health care providers may not always fully understand the impact of their words and actions—both for good and for bad. One of the recurring themes in this issue of CR is the role of effective communication in cancer care—and the important relationships between health care providers and those with cancer. Bladder cancer survivor Elizabeth Cropper sought out doctors’ opinions until she found a physician, urologic oncologist David Chen, who she believed would deliver the care she wanted. When Chen suggested a course of treatment, Cropper was pleased to discover, he asked her how she felt about it.
In those first days of testing and diagnosis, what a difference it would have made to me had someone bothered to ask how I felt. In fact, according to one study described in this issue, just 40 seconds of physician compassion can ease patient anxiety. Nonetheless, few doctors express this unless they are specifically trained to do so. Also troubling, fewer than half of oncologists regularly give terminally ill patients an estimate of their life expectancy. Importantly, research suggests that avoiding these difficult talks can result in disparities in end-of-life care and costs.
But things have changed and continue to change since the time of my diagnosis. There is increased attention to communication training for oncology professionals. And many doctors and nurses—like my current internist—express empathy and build close relationships with their patients. They know how to balance the personal and medical issues affecting their patients to deliver the most effective holistic care. And, they have learned that connecting with their patients can be extremely fulfilling, rather than overwhelming. In “Up Close and Personal,” oncology nurse Katie Zahasky talks about the cancer patients with whom she works. “I came to understand that I don’t bear their burden,” she says, “but I walk alongside of them and stay engaged with them wherever their journey takes them.”
(photo credit: Danny Wilcox Frazier)