Dr. Jeff Kane: The honest conversation
Tommy was semi-comatose, declining from cancer in a hospital bed. His lungs were riddled with tumors. Now his kidneys were failing. His exhausted wife, Ellen, sat beside him.
When the kidney specialist, Dr. L, came to check on Tommy, Ellen asked her, “What’s going on with his kidneys?”
Dr. L replied, “His BUN, creatinine, and GFR are all off. His glomeruli aren’t working like they should.”
Ellen asked, “What does that mean?”
“They’re not filtering like they should, so toxins are accumulating and his electrolytes are at abnormal levels.”
“Is there anything that can be done?”
“Well, we could put him on dialysis.”
Ellen said, tearfully, “Dr. L, do you put patients on dialysis when they have tumors all over their lungs?” She motioned for the doctor to step into the hallway with her. “This is hard,” she said. “What I’m asking is whether Tommy’s going to die soon.”
“Well, that’s hard to say.”
After a few more exchanges, Ellen realized she wouldn’t get any yeses or nos from the doctor. Yet any third-year medical student would know that Tommy was dying. Why couldn’t Dr. L say that in some compassionate way?
Speaking about it months after Tommy’s death, Ellen observed that Dr. L. was young and relatively inexperienced, so maybe not confident expressing uncomfortable truths. Or maybe she didn’t want to dash the hopes of Tommy’s loved ones — or Dr. L’s own hopes, for that matter. And then, one always wonders if there’s an implicit notion among doctors that death connotes medical failure.
I feel for Dr. L. When I was young and untutored in communication, I had no idea of the impact of illness — or the impact of my statements — on patients and their families. So I suspect Dr. L was being as honest as she knew how to be, considering her education’s limits.
Imagine undergoing medical training over four, six, or eight years, exposed to only one single, exclusive view of illness, which is physiologic dysfunction, period. In this mechanical perspective, the emotions of patients, those around them, and even practitioners themselves are irrelevant, so virtually ignored. When Ellen asked Dr. L her questions, the doctor interpreted the issue as organ decline, and not the overflowing grief of someone about to lose her mate.
If we intend to truly reform healthcare and not just its financing, we’ll have to revive what it means to care for human beings.
Jeff Kane is a physician and writer in Nevada City.
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