Being Blunt With Patient

I heard the key in the lock and moments later the tread of Lapius, as he trundled into the house and dropped his bags in the foyer.  “Harry,” his voice like a trumpet.  “I’m home.”

I decided to ignore him.  It was unfair, but I was not in a jovial mood, and couldn’t rise to the level of elation that Lapius exuded whenever he returned from a meeting.

Moments later he entered the room.  “Oh,” he said with surprise, “I didn’t think you were home.”

“Hi,” I said, flatly.

“I’m flattered by your boundless enthusiasm.  Would you like to hear about the meeting?”

“No.”

Lapius walked to where I was sitting and placed his hand on my shoulder, “You spoke to Virginia?” he said somberly.

I nodded.

“Bad news, I take it?”

“Well yes, at least not good news, but that’s not exactly the point.”

“Metastases?”

“Yes.  It spread to the bone.”

Lapius looked at his watch. “I’ll call her first thing in the morning,” Now we were both somber.  Virginia had helped Lapius over the years with his manuscripts.  She had been invaluable.  But more important, she was his friend, our friend.

Lapius sat in his large upholstered chair and peered for a moment at his clasped hands. “I see no reason to brood, Harry.  It is bad news to be sure, but she is in the best of hands.  The condition is treatable.  Surely you know that.  Your gloom seems somehow inappropriate.  Is there something more?”

“Yes.  Her surgeon told her the condition was hopeless, and that she had between 60 and 360 days to live.”

Lapius exploded.  “Incredible!  What fool would say that.  Surely that’s exaggerated.”

“Sorry, Simon.  She told me that herself.  It’s true.”

“It’s those articles,” Lapius murmured.

“What articles?”

“And the lawyers.”

“What lawyers?  What are you muttering about, Simon?”

“And the psychiatrists, and the institutionalization of everything that’s printed.  You know, Harry, during the past several years there have been discussions in the literature about how to prepare a patient for death.  The new school is that every patient should be told bluntly what their condition is so they can prepare themselves.  And the lawyers, insisting that patients be told the category of catastrophes that can befall them during surgery.  The net result is that we have become blabbermouths.  We have been pushed into a position where we can’t be discreet about subjects.”

“Generalities about what to tell someone with a serious disease are far from universal truths.  They are not to be bandied carelessly with every patient.  The physician-patient relationship may be the last bastion of man’s humanity to man.  Are we to permit ourselves to be brutalized by outside influences?  Are we sheep, to blindly follow as dictated some ruminations that any so-called expert expresses in a medical article?  How very evil these outside forces that intrude into the relationship between a patient and his doctor.  What psychiatrist from a distance or lawyer in a courtroom can reconstruct the emotional bond between a physician and his stricken patient?  What gall.”

“I guess we have become sensitized to the threat of malpractice suits.”

“True.  To some extent they serve a regulatory purpose, but we can’t panic and keep peering over our shoulder for the omnipresent lawyer every time we treat a patient.  We can’t be disconcerted from the task at hand.  We can’t protect ourselves at the risk of the patient.  Doctors have never shirked plague.  They must regard the law as simply another typed of infection to contend with if they are to pursue their duties.”

“But Virginia’s doctor wasn’t pursued by lawyers.  He has no right to walk around like a Pariah casting spells of doom.  He was not compelled to express his judgment with such brutal finality.  Particularly since his judgment might be in error.  There is still x-ray, chemotherapy, hormone therapy, immune therapy.  The statistics daily are changing in favor of the patient.”

“I guess he felt that by saying what he did he could divest himself of responsibility – walk away from the case.  Some doctor’s feel frustrated and angry when they have been outflanked by a disease, others, perhaps feel guilty.”

“You know what Virginia told me,” I said, “She said that after he got done with her she felt as if she had let him down, as if it were all her fault.”

“Was she shattered, Harry?”

“Virginia doesn’t shatter, Simon.  But she was distressed.  After all, we are all going to die.  If we went around dwelling on that fact all day, every day, we would soon find no purpose at all to life.”

“You supported her?”

“Of course.  Breast tumors may be controlled.  Those that are hormone dependent will regress.”

“She was encouraged?”

“Yes.  And you will speak to her tomorrow.  That will make her feel better.”

“I’m sorry for -.”

“Don’t be sorry for Virginia, Simon.  Don’t call her if that’s the way you feel.”

“For Virginia?  Not at all, Harry.  She is too vibrant to elicit sorrow.  She reaches out.  She embellishes her world with love and affection, and her work with stringent sensitivity.  We have all been enriched, those of us lucky enough to have worked with her.  Certainly she has added dimension to my life.  A woman of quality and stature.  A rare, precious person.  But her doctor never took the trouble to know her, to be touched by her extraordinary gifts.  It is for him that I feel sorry.”