The Other Side
This is an essay from JAMA, written by a physician who thoughtfully expresses her pain in making life-changing phone calls. She clearly cares a lot and wishes that she could be sharing differnt news. Instead, she knows that she is about to shatter multiple lives as cancer enters another family.
I found this to be well written and sensitive, but I know, and you know, that her side of the conversation is very much easier than the other. I wish she had somewhere said that she recognizes that is is almost a luxury (not the right word, but I am stuck for a better one) of being the news-teller instead of the news-hearer. I am guessing that we each clearly remember the moment that our lives changed. For me, it was in 1993 when I heard of my first breast cancer diagnosis. I had just gotten dressed after the biopsy, and someone (a nurse?, a resident?) said "The doctor will see you in here" and motioned towards a small room. As I walked in, the first and really only thing that I saw was my husband's back. I clearly remember the black and white striped shirt that he was wearing, can still see how it fit the contours of his shoulders before he turned out to see me. I didn't need to see the expression on his face, all I had needed to see was the shirt, and the fact that he was present, and I knew the answer.
Here it is:
THIS IS THE BEFORE. A MOMENT SUSPENDED LIKE A BUBBLE floating on a warm summer breeze gently but inevitably toward the ground. I feel the pop coming, an implosion of the very center of your life. Anticipating what this moment would hold, I nevertheless hoped for something different. To be able to eagerly dial your number and shout out the good news to you in a breathless rush. It's not what we thought. It's not cancer.
Instead I take a deep breath, pressing each number slowly, cautiously, drawing out the moment before the burst. The burst of your plans and your dreams and your future. I stall for time, asking if this is a good time, are you alone, do you have a pen and paper? You set the phone down and I hear you call to your partner, herd the kids downstairs, step quickly back to the phone, and pick it up. "I'm ready."
I want to tell you to wait. Wait just a minute. This moment, this before is the last one you'll have. When I tell you what I have to tell you, life will irrevocably change. The prism through which the light of your life diffuses will be different.
How you look at your children will be different. What makes you smile or cry or laugh or weep will be different.
Everything will be different. Savor this moment when what to make for dinner is your most pressing concern, when the future is certain, safe, secure, and predictable. Don't leap too quickly into what comes next.
Like a life flashing before one's eyes in a split second, multiple possible dialogues go through my mind in the before.
I want to be straightforward but not blunt. I want to be compassionate but remain professional. I slow myself down, remind myself that the words I'm about to say are ones that I've said before, many times, but that the words I'm about to say are also ones you've never heard before.
You wait, breath held in, hands clutched anxiously around the phone, maybe holding your husband's hand. I wait, taking that last moment to make sure that I'm ready and that you're ready. I ease us both into it. I start with the warning:
"I'm sorry." You know now. You know what I'm about to say. Do you hesitate for a moment, wondering if you should just hang up the phone before you hear the rest? Keeping yourself in the before, knowing that you'll fall with the certain words I have to speak?
You don't hang up and I am forced to continue. Forming the sounds around words like "cancer" and "prognosis" and "surgery." You flounder, looking for something to hold on to in the sea of confusion into which you've just been thrust.
Each rope you grab to steady yourself comes loose in your hands. Like a tumultuous sea, the diagnosis swirls around you, threatening to pull you toward the endless bottom. I have no life preserver to toss you. All I can offer is my hand, reaching out to hold you up, prevent you from going under until the sea calms and the path clears.
Jennifer Frank, MD
Author Affiliation: Theda Care, Neenah, Wisconsin (firstname.lastname@example.org).
Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.
A Piece of My Mind Section Editor: Roxanne K. Young, Associate Senior Editor.