WHEN DOCTORS LIE

This morning, I woke up to read the Paul Kalanithi story. He was a top neurosurgeon at Stanford who succumbed to metastatic lung cancer at the age of 37 earlier this month. He had written numerous essays, “How Long Have I Got Left?” for The New York Times and “Before I Go” for Stanford Medicine, reflected his insights on grappling with mortality, his changing perception of time and the meaning he continued to experience despite his illness. He closed his Stanford Medicine essay with words for his infant daughter: “When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.”

 His story makes me reflect on how doctors, me included, deny patients the truth on the magnitude of their illness and the chance to prepare and face their last days appropriately. I remember the case of X who we had operated on and found that her cancer had spread everywhere in the abdomen and everything was matted together so we couldn't resect the tumor. When she came in to pick her biopsy results I told her the truth but not the whole truth. I did tell her that she had cancer but the look she gave me was so depressing and stressful that I decided to give her 'hope' and lie that we had removed the tumor and that all she would need was intervention in a cancer unit and the disease would go into remission if adequately handled. I figured out that if I broke the news as they are, depression would kill her faster than the illness. I basically left the task of disclosure to the oncologist.

 By reading the Kalanithi story, I realize that most of us deny our patients the chance to prepare for their last days. Some relatives even sneak in ahead of their patients and beg me to hide the truth and not to disclose to their patients that they have an end-stage illness. Others practically wink at me when they realize that I'm almost disclosing the disease to their sick relatives. We doctors lie in so many ways. I remember the case of 'Z' who was battling an unresectable brain tumor that was fast growing. Instead of the doctors in Kenyatta telling him the truth, they told him to go home and wait for their call on when to go for surgery. The family remained hopeful and kept on spending so much money taking him from hospital to hospital to make him 'stable for surgery' because they thought Kenyatta would call in anytime. Three months into the illness and they did not call making the patient hopeful only for him to succumb to the illness. I believe that had the truth been told, adequate preparation and coming to terms with the illness would have been made. Sometimes we even write palliative care referrals for the last-stage patients and lie to them that palliation is highly intensive treatment for metastatic cancer while in essence palliation is basically making the patient comfortable in the last days.

 Kalanithi talked about the importance of proper communication and disclosure of the whole truth in a gentle manner. His ‘dual citizenship’ as a doctor and as a seriously ill patient had taught him that respectful communication is the bedrock of all medicine. I now know and appreciate the importance of proper disclosure. It might stress the patient but with time they do come into terms with it and prepare for their illness and impending mortality adequately and with bravery.Had Paul Kalanithi not known the truth about his illness, he would have probably not planned for the conception and birth of his daughter into his illness.

You would be surprised at how strong some patients are.

The truth hurts but it is better than giving colorful lies