Posted on 22 November 2012 by Aoife Abbey
‘I’ll be OK, won’t I? This won’t shorten my life?’
I went in to see her after I knew she had received a visit from the oncology team to break the news. She was a young woman with a glioblastoma.
To tell or not to tell?
I had found out the histology the day before. I was not aware my behaviour had changed in any way. She asked if I was OK, and said I seemed different. I feigned tiredness and changed the conversation; she had asked me the question I did not want to be asked.
My head said the five-year survival rate for glioblastomas was 6 per cent. Did she really want the truth? It was hard to decide in that second. What would I want?
I think I would want to know the truth, but would it be right for me to dash her optimism? Was I sure enough that she was one of the 94 per cent to remove from her that hope?
She repeated her question, adding: ‘If I’m wrong, I’d rather know now while it’s just me here.’
I explained to her I was not an oncologist but I knew she had a high-grade tumour and there were positive factors; she was young, fit and had a clear plan for treatment.
I said if she was an older woman with multiple co-morbidities, I might give an optimistic prognosis of one year but with her it was not clear cut.
I did not know if the tumour margins were all removed, I could not tell if it would grow back, and I did not know how she would respond to the treatment regimen. ‘But yes, there is a very real chance that this will shorten your life,’ I said.
She seemed content with this explanation. I sat with her for a while longer and we spoke about how upset she felt that she had brought this worry on her family.
I sympathised and told her that she could not stop her family from loving her and it was their prerogative to do so. I said that I hoped she would in time be able to free herself from the burden of feeling responsible for their pain.
Had I answered her questions truthfully? I had not lied. There was a real chance this would shorten her life. I wondered if I was wrong to alter the perception that she had been given by the oncology team.
Perhaps she did not ask them this question directly. She had chosen to ask me, and I think I would maintain it would have been wrong of me to lie.
Oscar Wilde said ‘the truth is rarely pure and never simple’.
Aoife Abbey is a foundation doctor 2 in neurosurgery in the West Midlands
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