A female patient was diagnosed with triple-vessel disease, requiring coronary artery bypass surgery in 1985. After a 10-day length of stay, she was discharged to home and started on a regimen of cardiac medications. Within months, a complete recovery from surgery was achieved. Subsequently, a visible necrotic lump appeared on the patient’s left breast. A mammography diagnosed a malignant breast mass requiring further evaluation. A bone scan revealed metastatic disease with a diagnosis of stage IV breast cancer. A left mastectomy was performed for prophylactic infectious reasons.
In an attempt to protect this patient from her fatal diagnosis and wanting her to maintain a positive attitude to fight for her life, I minimized her diagnosis to breast cancer requiring a mastectomy only. When questioned about the results of her bone scan, we informed her that she was “alright.” Keeping the true extent of her disease from this patient was not my only challenge, for I had to convince her physicians to do the same without lying to her. I spoke with her primary physicians as well as calling her consultants at Sloan Kettering prior to her appointments and explaining the situation.
As difficult as this may have seemed, the patient never questioned the physicians, leading me to believe she did not really want to hear what she may have already known. Young, naïve and scared, I remained at this patient’s side throughout her illness, from sleepless nights at the hospital with her to receiving the dreaded results from her physicians.
As expected, a multitude of complications occurred within the year. The patient continued to maintain her composure and was constantly apologizing to me for her needs.
But, you see, this was not just another patient to me. This was my mother, a strong-willed woman wanting to protect her family from the emotional devastation of loss.
Many opportunities were given to her, in quiet moments, to answer any of her questions or to discuss her illness, but she chose not to and I respected that. It confirmed to me that my protective actions were correct in not confirming what I am sure she already knew. Then came the night my mother became unresponsive, and she did not respond to any verbal or tactile stimuli. This was the beginning of my emotional breakdown, kneeling at her bedside in her home, hugging and crying uncontrollably. To my surprise, she responded by saying, “Honey, be good, I’m alright,” and she never responded again.
The following day, my mother passed away in the comfort of her own home with her family encircling her, and finally out of physical and emotional pain.
As for me, I have no regrets and I will take with me this learning experience of offering patients the opportunity to discuss their illness and ask questions, or to be comfortable with the fact that they might rather leave things unsaid.