Sometimes, the truth can be uncomfortable. It can be difficult to hear and often, even more difficult to say. In her Field Notes piece entitled “Doctoring and Disobedience” (Spring 2020 Intima), Dr. Lisa Jacobs recalls her struggle with being told to hide the truth of a prognosis from an elderly patient with metastatic disease. Despite the instruction of her attending physician, and the decision of the patient’s family and ethics team to not speak of death to the patient, Dr. Jacobs feels compelled to let her cognitively-intact patient learn the truth. So strong is her conviction that she takes on considerable risk to her own career for the sake of bringing the truth to her patient.
Dr. Jacobs’ story resonated with me because I too am a proponent of finding a way to tell patients uncomfortable yet necessary truths. Perhaps her patient was from the same “old country” as my grandfather (“A Difficult Conversation,” Spring 2021 Intima) and her sons felt as uncomfortable at discussing the topic of death as my mother. In not speaking of death, perhaps they feel they are sparing their mother the discomfort of facing her own mortality. Or, perhaps simply sparing themselves the discomfort of a difficult reality. All of the discomfort is understandable; it is the hiding of important information from a person who is capable of understanding it that is not.
A mentally-competent person deserves the right to know the reality of his or her prognosis, at any age. Knowing the reality of what is happening allows one to reflect on his or her life, plan and come to accept mortality. Keeping such information from patients denies them the chance to spend their final days on their own terms.
I commend Dr. Jacobs on her heroic effort to bring a necessary truth to her patient. Of course, the patient was not surprised at the news. She too, had simply avoided discussing death with her children. Perhaps sometimes we are all guilty of keeping uncomfortable truths from each other.
Anesthesiologist Kelly Elterman
Kelly Elterman is an anesthesiologist and writer in San Antonio, Texas, who has loved both writing and medicine from a young age.In medical school, she published prose and award-winning poetry in The Legible Script, a national literary journal for medical students and later focused primarily on scientific writing. More recently, Elterman has returned to poetry and prose and her work has appeared in KevinMD.com and the San Antonio Medicine magazine. Learn more on kellyeltermanmd.com. Her Field Notes essay “A Difficult Conversation” appears in the Spring 2021 Intima.