The Need for Honest Communication Between Doctor and Patient

Warning: Rant on death, doctors and communication ahead.

I have a friend who is (was) metastatic / stage 4 same as I am. Last week, she traveled 2 hours to see a specialist for a second opinion, since she was having horrible side effects from the newest chemo she had. She and I were PM’ing back and forth for a few days leading up to the specialist appointment and also the day of the appointment.

They did several scans, some she hadn’t had in a while. She was scared at all these scans, wondering if something was horribly bad and no-one wanted to tell her. I reassured her as much as I could, suggesting other reasons for all the scans (getting a baseline, comparison to those earlier scans, etc). She met with the specialist who also had discussed her case with the doctor she had been seeing locally.

She told me the consensus was that she stop chemo and allow her body a break from it to see if she could heal, in her words, “No chemo medicine is available for me to take. At this point it is the chemo (sic) thats going to kill me. So I am on the quality of life plan. He said that my body cant take chemo anymore. So all I can do is take good care of myself. The tumor on my liver is large. It grew since September. Maybe if my body is in quality mode it will slow things down. But, chemo is over.”

I realize not everyone can handle what I consider to be an honest discussion. But if you’re going to tell someone to take a break from chemo and let her body heal because the tumor on her liver is growing on chemo and there are NO other chemo options, PERHAPS you might want to set a hospice consult. Or at least a palliative care consult. Instead, she was told she didn’t need hospice, and no palliative care consult was offered.

She died 8 days later.

I spent 14 years in the medical community in the US Navy. While serving at my first duty station, I spent several shifts on “death watch”, a duty in which a corpsman was at bedside for those inpatients expected to die soon. I understand the Hippocratic oath, which includes, “First do no harm”. I don’t understand the apparent dislike of the medical community to discuss death and dying. Do medical schools no longer use cadavers to learn anatomy and physiology? Perhaps the medical community thinks that talking about death will only hasten a person dying?

From the moment we are born, we begin to die. If you are 40 years old and have never lost someone close to you to death, then you are extremely lucky indeed. Earlier this year, I wrote a post on planning for death. Trust me, I know what’s going on within my body, I know what it feels like inside me. I have hope for my future, mediated by the numbers, scans, lab results, and knowing that none of this is in my control. As a cancer patient, a human being, I want and deserve honest communications from those around me.


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