Think Before You Speak: Lessons for a Motor-mouth on the Pediatric Cancer Ward

I’m a fast talker, the majority of the time unabashedly so.  In any given conversation my mouth is going a mile a minute, with tangents, emphatic inflection changes, and wild gesticulations all part of the equation.  So you can imagine my discomfort upon entering the realm of pediatric oncology earlier this week, where everything you say holds a gravity so great even Sir Isaac Newton would be impressed.

The fact of the matter is that this field deals with very ill children whose illnesses may be life-threatening, but are always life-changing.  And one of the challenges – beyond the medical behemoth of fighting the cancer itself – is communicating the specifics of the situation with the parents, such that they have an honest, realistic assessment of what is going on with their child.  In other words, this is not the time for word vomit.

One of my patients was a tow-headed toddler undergoing her second round of multi-agent chemotherapy (6 toxic medications in total) for a non-resectable, incredibly rare sarcoma.  With only a handful of cases reported in the literature, and virtually no data with regards to treatment protocols, the attending physician sought out opinions from national experts in the field, only to find that the prognosis was most likely around a 1 in 6 chance of survival.

Little did she know that the mother of the child had contacted the same experts herself and had received the same troubling news, setting the stage for a potentially messy situation.  Luckily, this attending has an incredible way with words, and a knack for articulation that ensures that the words leaving her lips are exactly what she means to say in that moment, no more, no less.  And so she reported what she knew to the mother, succinctly yet compassionately, and in the process gained her trust.  Above all else, she seemed to be relieved that she wasn’t being placated with sugar-coated prognoses; the fact that the mother knew beforehand, and received the same news from both doctors meant that she was fully integrated into the decision-making process regarding her daughter’s care.

And so, content in that level of trust, she went on to ask a more subjective question: was the attending optimistic that her daughter would be the 1 out of 6 that beats the odds?

Of course, placed in this position, anyone would want to say yes and be able to reassure the parent that things would be okay.  Yet, in cases like this, where things actually may very well not turn out well, you can’t act on that impulse.  So in that moment the doctor did something so simple, yet so profoundly important: she paused.  It was clear that she was in deep thought during those several seconds, finding exactly the right words, fully aware of the subtle importance of syntax and semantics, because when she spoke, what came out of her mouth was the absolute perfect response for the situation.

“By my nature, I am an optimist, and I truly believe that we have found the absolute best treatment that we know of, given the specifics of your daughter’s case.  I also want you to know that she is in incredibly good hands at this institution, and that we will do everything within our abilities to aid in her treatment.  But with regards to the statistics, I cannot say one way or the other how I think it will turn out; as you know, this is a rare cancer with unpredictable course, but we will continue to do our best on her behalf and yours.”

The incredible level of respect, compassion, and empathy implicit in that response is all anyone could ask for in such a trying situation.  What the attending did was provide much needed healing during a time of suffering and uncertainty, and offered a healing of the spirit when healing of the body was uncertain.  And all because she paused and thought before she spoke.

Picutre of author

About Justin Fiala, MD Candidate

Justin is currently in his third year of medical school at UIC's College of Medicine, and is hoping to pursue a career in internal medicine. He has a strong interest in addressing the health needs urban communities and is part of the College of Medicine's Urban Medicine program. Aside from academics, Justin enjoys cooking, listening to public radio, and perusing the New York Times website. He is also a trained pianist and self-professed lover of all kinds of music.

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One Response to Think Before You Speak: Lessons for a Motor-mouth on the Pediatric Cancer Ward

  1. fang28 says:

    Wow that was beautiful. Cancer is a very hard topic for anyone to explain and talk about with and she handled it with great confidence. I know this is a late response but I didn't have a chance last semester to read your posts. You are a wonderful writer and your experiences are very valuable to me. Thanks for making me even more interested in pursuing a career in medicine! (: