Wednesday, August 04, 2004


"What are the chances for survival?"

This is the question that every patient asks. Everybody wants to know how much longer they have. Neither the patients nor their families understand that every case is different, that every patient behaves differently, that a thousand variables exist, and that nothing is for certain. Simply put: I don't know. But I can't say that. They don't want to hear that. They're looking for something definitive. Something positive. They're waiting for me to say that their family member is the one in a million that will survive, or that they will overcome their multisystem organ failure, or that they will destroy their metastatic cancer and walk out of the hospital, smiling and waving.

But that's never the answer I give. I think back through all of the literature I've read, my past experiences, and the teachings I've memorized, and I give them my best estimated number, which is never enough. Nobody wants to hear my honest answers. My answers are met with pain, disbelief, sorrow, guilt, even hatred.

Sometimes families will cry. Sometimes they'll thank me quietly and hold onto each other for support. Sometimes they'll lash out, unsure of where to place their grief and anger. I've been accused of being an inadequate doctor, being incompetent, being biased and not offering them the best of care. I've also been hugged, my shoulder used for support, my white coat used to catch their tears.

The forced realization of their family member's mortality evokes a multitude of responses. Whatever their reaction, I stand by them until they dismiss me.

Today I told Mr. B that his wife had a 50% chance of surviving the surgical procedure she desperately needed. Even if she survived, her debilitated state from her metastatic cancer substantially decreased any chance of recovering from the operation. I told Mr. B that without an operation, she would become overwhelmed with sepsis and die. No matter what we could do, his wife had no chance for survival.

I saw the life leave his face as he offered me a handshake, accepting the inevitability presented before him. His eyes reminded me of how I felt, 5 years ago, when a doctor gave my mother a similar prognosis.

I shook his hand with a saddened heart, wishing him courage and strength. The two of us stood alone in that crowded ICU hall today, each desperately seeking for some kind of resolution.