Another Elephant

 

 

 

I did a virtual home visit this week to meet a new patient and her daughter. The patient was an elderly woman with very advanced cancer.  When the video opened, her daughter was front and center with a warm and welcoming smile.  I introduced myself as one of the doctors on the team with the goal to help make her Mom 'the best that she can be...given the circumstances'.  Her facial expression changed.  

"Umm," she said.  "So, now what?  Do you need to speak with my Mom or just me?" she asked.  

I gently suggested that this decision was up to her Mom.  The daughter squirmed.  

"Well, my Mom is hard of hearing and speaks mostly Italian. How about you just speak with me?" she said.  

I asked to introduce myself to the patient.  The daughter carried the phone over to her so that I could say 'hi'.  I asked the patient if it was okay for me to speak about her care with her daughter.  She obliged, and before I could say anything else...I was virtually whisked into the other room and the door was shut behind us.  The daughter was no longer smiling.  Her voice was hushed and she was hunched over speaking closely into the video.  

She burst into tears.  "I just don't want you to say anything in front of my Mom.  I haven't told her the results of the last scan that the cancer is spread and now stage 4," she admitted. 

Once again, I find myself in the middle of a charade. There is no doubt in my mind that the patient knows her cancer is worsening.  She is weaker, sleeping more, eating less and spending most of the day in bed.  Her daughter thinks she is keeping this reality from her Mom, to protect her.  But both of them 'know'.  Both of them protecting each-other.  This is the quintessential 'elephant' in the room. As the charade continues, a 'cone of silence' grows between them. 

People assume that facing mortality is associated with hopelessness and 'giving up' on life.  However, this has not been my experience.  Most people feel more grounded when they are brought 'into the know' about the realities of their illness.....especially if this starts right from the diagnosis.  Open, honest, reality based communication along the entire illness journey is the best medicine.  It allows people to 'walk two roads' of hope and planning simultaneously.

I will make a home visit to see them next week and try to invite more open communication.  Like so many times before, I anticipate that they will be relieved when I gently dismiss the elephant.  It's just unfortunate that this re-calibration comes so late in the illness.      

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