Listening to the Sounds of Silence

Originally uploaded by Brittany G

Diagnosis day, or D-Day in the words of Vicki Kennedy, is that pivotal moment when a patient learns the extent of his or her illness. This week’s post, written by medical oncologist Robin Schoenthaler, explores the lessons of D-day from a physician’s perspective. What lessons have you learned from D-Day?

"As a young doctor, training to become an oncologist, I quickly learned that many diseases don’t follow a “textbook” presentation – and neither do patients. Being able to recognize and respect a patient’s changing needs has been a crucial part of my practice ever since.

One of my first “teaching patients” was an insurance salesman. He’d begun seizing while meeting with a new client. After a harrowing ambulance trip, a long ER stay, and many scans, it turned out that a suspicious mass was lodged in his lung and an even more ominous mass sat in his brain. Within a few hours of his sales meeting we were telling him we wanted to get a brain biopsy and lung sample.

He stayed in the hospital for four days. During that time he told me over and over that he wanted "all the facts," that he was an insurance guy who was used to numbers, that I should tell him “the whole truth and nothing but the truth.”

Three days after his biopsy, I went to the lab, looked under the microscope, and saw a sickening sight. He had cancer in both the brain and the lung. The brain mass was, as we feared, a metastasis from the lung tumor. In those days, most patients with this diagnosis didn’t live six months.

I spent a hectic morning with other patients. Although I ran into his room a couple of times to check on labs and meds, I didn’t have time to sit down with him until late afternoon. As I stood in his room that morning, checking his IVs and trying to look him in the eye, I felt like I was choking.

Around five o’clock, armed with facts and figures, I returned to his bedside. "We've got the results back. I wonder if we can talk for a few minutes?" We walked together to the side room down the hall.

That ten minute conversation taught me an important first lesson in compassionate care: share the truth the moment you know it. And it was there, in the sanctuary of that starkly lit room in a busy inner city hospital, that I also learned to listen to a patient’s silence.

I watched this man -- to all appearances a classic "information seeker,” an insurance guy who had solicited statistics for days – take in the information, take a breath, and then completely reverse his course. He held up his hand and said, “Just the facts, doc, and just the facts that I ask for.” He then proceeded to ask questions about treatments and transportation, and about side effects and symptoms. He listened to my answers in silence and never asked about numbers, statistics or the likelihood of survival or cure

He only asked about logistics and he stuck with logistics for his remaining six months.

The next day, as he was discharged to his known but uncertain fate, he said, "I will always remember the sound of your shoes as they clicked against the linoleum as we walked into that room." And I will always remember the sounds of his silence."

Dr Robin Schoenthaler, a radiation oncologist practices at the MGH Department of Radiation Oncology at Emerson Hospital in Concord, MA. She also writes about her experiences as an oncologist. Her last essay, about men who hold their wives’ purses in cancer clinics, appeared in the Boston Globe Magazine last fall.