Going beyond the question list

Dave’s wife* pulled out a list of questions from her purse. Sitting across from her, I could read her first question upside down, in a shaky cursive script across the top of the page. Her question: “How much longer?” She knew that her husband’s situation sucked. Typically, however, she was more polite. Dave was in the hospital with a bowel obstruction due to carcinomatosis; we were sitting down for a serious conversation, and the real topic was dying.

I didn’t let on that I knew her first question. But when I asked her to read me the whole list, she didn’t include “how much longer?” I got Dave to talk about what was important now (time with grandkids was at the top of his list). We talked through her other questions, about carcinomatosis (bad), more chemo (no), IV nutrition (not helpful). She was trying not to cry.

We had covered a lot, I thought, and from the way she was staring down at her notebook, I judged that she probably had heard as much as she could manage. She seemed determined to get through this without crying, and I didn’t want to push her over the edge—she’d be so embarrassed, it would interfere with our next conversation.

But then she put her notebook aside, looked right at me, and said “Okay, how much time do we have?” Her husband nodded. I said that the time frame was weeks, with a worst-case scenario being two to three weeks, and a best case scenario being 10 to 12 weeks. She looked down again at her notebook, her hands shaking. “Ten weeks from now is winter,” she said, shaking her head. “That’s a terrible time to die.”

This kind of moment happens in cancer care all the time. The communication researchers call it an “emotion cue.” But what’s misleading about that label is that the cue is often masked with a statement (e.g., winter is a terrible time to die). And often we clinicians feel cued to correct the facts, to say something like, “There’s no good time to die.” When you hear an emotion and feel compelled to respond with a fact, hit your pause button.

I waited until she had finished shaking her head. She slumped over in her chair. Then I said: “That wasn’t what you were hoping to hear, I know. This is a very tough situation.” Her face crumpled. “No,” she said. She was holding her breath so she didn’t cry.

When I saw her shoulders relax a little, I said, “What you just heard is a very hard thing to hear.” She sighed, and said. “Well, yes, but that’s how it is.” In another few moments, I knew, she would be ready to make some real plans. Dave’s daughter described it later: “She needed to process, but Dad was dry-eyed. He was expecting this.”

[Originally posted as a guest commentary for ASCO connection*A few details altered for confidentiality. I'll be sharing more skills at the ASCO Palliative Care Symposium later this month.]


9 comments:

  1. yes its very simple to get rid of belly fat by follwing these tips

    ReplyDelete
  2. Posted here something which is really informative to know. Thanks for posting such a informative blog with us.
    I want to share something with all kidney cleanse diet or homemade detox cleanse aim is to get back to your fitness and always feel fresh to start any work in your corner.During Cleanse process you should feel better and get some fresh energy to do any work but not enough to get into gym & do some workout it behaves according to your routine.

    ReplyDelete
  3. Interesting words regarding "Going beyond the question list". Thanks for sharing with us !

    pankaj

    ReplyDelete
  4. Seek the help of resort videography service Minneapolis or all kinds of suitable marketing and professional videos that can make your business popular one for the purpose. There are some amazing new themes as well as solutions provided with commercial video advertising team who are always striving forward to come up with some amazing new results as well as ideas.

    ReplyDelete
  5. http://www.netbook1.com/blogs/post/67600
    http://www.gadangme.net/blogs/post/31914
    http://test.holmeslovesme.com/groups/1592
    http://live-great.nl/oxwall/groups/747
    http://www.ocperio.org/group3/blogs/post/14359
    http://www.internationers.com/blogs/post/133608
    http://www.collaborativemotherhood.com/blogs/post/19392
    http://consultantchat.net/blogs/post/566
    http://postboard.net/groups/1424
    http://rumodels.com/models/event/1213
    http://tequisquiapan.tv/groups/155
    http://diduknow.allrh.com/blogs/post/31490
    http://myturnondemand.com/oxwall/blogs/post/188204
    http://study.benchmark-insight.com/blogs/post/23062
    http://man.onlygayjoy.it/community/blogs/post/454
    http://youbeach.it/blogs/post/20638
    http://freedomsocial.altervista.org/blogs/post/4252
    http://jired1.com/boomers/groups/1448
    http://icrave2.com/blogs/post/19710
    http://www.streetcarsrater.com/groups/13215

    ReplyDelete
  6. Thank you for sharing the interesting information. As I hoped, these info will be useful to many people.
    hoa lan ho diep | civil engineering outsourcing | Outsource Structural Drafting Services

    ReplyDelete