Speaking the Unspoken

Craig R. Hildreth, MD

Dear Patient-Although the circumstances were stressful, it was indeed a pleasure meeting you and your family today. In order to prepare you for your first treatment we covered a lot of ground, and I know it can be overwhelming to remember all of the details. I promise you we will regularly review everything I said.

Today we talked about the essential points: how you came to be sitting in our office, what our plan is to help you, what the logistics of intravenous treatment are and what are the side effects, possible outcomes, and warnings inherent in any drug used to fight cancer. By the end of the visit one would think that every last word on the subject had been spoken. This, however, is not the case.

There are words I wanted to say to you today but didn’t, for fear of distracting you from the immediate plan and also, I must admit, out of a certain degree of evasiveness. I know that there are words you wanted to say to me, but just couldn’t voice. I recognize that what you and I left unspoken is just as meaningful as the technical information you received, so with your permission may we speak them now?

I knew you were dreading this visit like no other. Although you tried to hide it, I could see you were worried. I could sense your thoughts flying around: ‘Am I going to be alive next year? How do I tell my children about this? Will I be able to care for myself? Am I going to be in severe pain? Can I afford to take this treatment? Will my friends avoid me once they find out I have cancer? Am I going to become helpless? How will my family take care of me if I become disabled?’

You wanted reassurance that that your fears are unfounded, that everything will be all right soon, that your cancer team will rid you of your disease. You did not ask, however, and I did not volunteer to give you these answers.

The truth is that no one can predict your future. No matter how much I wish it, I cannot guarantee that this treatment will be effective. All cancer patients are confronted with this uneasy thought.

What I can say with confidence though is this: you will get the best possible regimen available for your cancer. We will first and foremost be your advocate, doing what we can to alleviate your symptoms and allay your fears. We will listen to you. We celebrate your uniqueness and respect you, your family and your friends. You are the only reason we come to work each day, and it is a privilege to serve you. We will always speak the truth to you. We will never waste your time with cancer treatments that have little chance of helping. Even if your cancer can no longer be treated we will still care about you and think of you.

Do you see why I left this unsaid? It comes off as smarmy and condescending. Yet given the possible trouble that lies ahead, I must share this. Cancer has no qualms and no remorse as it tries to ravage our patients. We owe it to ourselves to confess our fears and affirm our commitments, so that our relationship will become strong enough to weather any storm. In our partnership to restore your health, let our words always be spoken.