You explain to a patient and their family that the liver is packed with cancer. The cause for the pain she has been experiencing for the last three weeks is now clear. There is no cure. The primary source is a mystery, it is an ‘unknown primary’. Family members occupy the bedside spaces; three are seated but a young man, the son, stands. He declined a chair. He looks down intensely and when you have said your piece he asks sensible questions about discharge arrangements and follow up appointments. It is he, you feel, who will organise things and communicate to the wider family. The situation is challenging for you, but not unusual or especially complex from a purely medical point of view. Such conversations are required on a weekly basis. The patient is sitting up, passive but fully aware despite a recent dose of morphine. She is taking it all in, but will probably rely on those around her to process most of the information.
You finish and leave the ward. The sadness of the situation melts away as you progress along the corridor. There are other things on your mind, numerous tasks of a different nature. The family? They are still behind the curtains – staring, crying, wondering.
A colleague approaches. He has just returned from holiday. You stop. He tells you a story; one of his children said something hilarious to a flight attendant on the way home. You laugh out loud, letting out a snort of amusement. ‘You are kidding!’ A man brushes past you on his way to the stairwell, mobile phone in hand. The son. He looks round and recognises the doctor who just a few minute ago described in measured, soft tones how his mother would soon die. His expression is neutral, and he turns away to push the door open. You regain your composure.
You are embarrassed.
You wonder –
How wide is the radius of grief within which you should maintain the dignity of one who has just communicated a death sentence? When is it appropriate for you to relax and be yourself again? Should one be embarrassed to accept that life goes on for those unaffected by illness? Just around the corner joy visits the hospital on a daily basis, in the labour ward. For every death, a new arrival. Sometimes you see happy grandparents waiting with balloons or flowers in the same corridor as commiserating relatives who have received bad news.
Yet, yet… you wish you hadn’t been caught laughing so freely. It suggests that the sympathy you displayed was skin deep, that the empathic performance was just a cameo. Was the son offended to see you joking so freely? You hope that he was so preoccupied with his own awful challenges that he does not reflect on the facility with which doctors can change gear. But next time… you will put greater distance between you and the epicentre of grief.
Click pictures to explore