There is a finale to my last post. When I ran into John’s liver surgeon after surfing last week, I mentioned to him,
“There were some things that you said to us that were really disturbing to us at the time.”
He was nodding his head. He knew exactly what I was referring to, his now infamous line about chemo:
“You don’t have to do all 12 treatments. You have the option of stopping at any time.”
I went on to say that we had such total confidence in him, that we were shocked that he would say such a thing. Our shock came from coming face to face with the discrepancy between our surgeon’s earnest advice and the impression our oncologist had left us with, that chemo was like taking antibiotics: bad things could happen if the patient did not finish the prescribed number of pills. He continued to nod his head sadly. He knew this because John had written him an anguished e-mail, to which he never responded.
“There was so much that wasn’t clear to us during that time,” I said. “But later on, John and I were able to look back and understand that you were talking to us in code.”
His eyes met mine and he nodded again in affirmation.
“There were just some things that you couldn’t say to us directly,”
I suggested. “Yes,” his eyes said. He seemed quietly pleased that we had finally understood his motivation. How truly extraordinary, that circumstances would conspire so that we were able to have this conversation that was so healing for us both. I am sure that it meant a lot to him to know that at the end of John’s life, his enormous respect for his surgeon was untarnished.
What we came to understand was, that in the context of our particular situation, John’s surgeon was constrained to speak in code– to avoid the appearance of contradicting his colleagues, and to sidestep the murkiness and uncertainty of the whole chemo terrain. What we finally understood was that he was doing his utmost to empower John in the choices that lay ahead, and very probably to endorse the decision that he must have known was inevitable at some point, to stop chemo altogether.
Although his motivation was a kind attempt to clarify, his trained instinct to present medicine and his medical compatriots in the best possible light created a conflict which ultimately caused greater suffering for his patient.