The Moment of Truth

DOI: 10.1200/JCO.2009.22.1960 He placed the cold stethoscope back into his starched white coat. “I’ll be back shortly,” he said as he exited the exam room. Once in the narrow corridor, he slowed. His patient, Richard, not only had developed enlarged neck nodes despite radiation therapy to that area, but now had new ones in his axillary and groin regions. Amid 20 minutes of cheerful conversation, it took seconds to discover that Richard was a terminal patient. Yet, he had left him in the room the way he had done it so many times before: the reassuring smile and the gentle closing of the door. He heard Richard’s muffled voice, “I think Carol wants to speak with you.” He reached the waiting room, took a deep breath, and entered. There was nothing in the room to suggest that it was a physician’s office. The chairs were natural wicker with floral upholstery; several original Calder paintings hung on the walls, and an antique table sat in the middle of the room covered with Gourmet, Arts & Antiques, and Esquire magazines. Only the sliding opaque glass panel shielding the receptionist suggested that an entirely different world existed behind this facade. She was sitting in the corner. He was glad that it was lunch time and the room was empty, given that she tended to be so emotional when they discussed her husband’s condition. She was 10 years younger than her husband and very much an artist: black hair pulled back in a bun and long gold earrings. Her mouth was a striking red against the absence of all other makeup, her blouse was a colorful South American weave, and her skirt full-length denim. He looked for sandals, but she wore simple, flat black shoes. He was not certain if any of her paintings had ever sold, but in the years he had been caring for her husband, she was always between paintings; abstracts, she had told him, though she had never shown him any of her work, not even a photograph. He knew that she detested the Calders in the waiting room. She immediately got up and kissed him on the cheek. “Thanks for coming out to talk with me,” she said, as if it were the first time. She was tall, and her eyes were level with his; green eyes that seemed to penetrate through his professional veneer. “Did he ask you to come out to see me? You know how he likes to have everything told only to him; then he can pass out selected bits of information to everyone else.” “Well, he did say that you might want to see me. He’s dressing now.” “You are going to tell him, aren’t you?” she asked, squeezing his arm. “Tell him what?” he asked, feigning innocence. How could she know what he had only discovered minutes ago? “That he is dying.” He stepped back suddenly, as if the words had struck him physically. He quickly recovered. “He’s been slowly dying for 2 years from his lymphoma— why tell him now? Besides, surely he knows.” “If he knows, why is he doing crazy things? Since he completed his radiation last week, he has arranged for a cruise to the Caribbean next month, and he is out looking to buy a new house—after 25 years, he wants to move.” He was puzzled by her surprise: didn’t she understand that that’s how the dying behave? “That’s not unusual behavior,” he said, trying to be reassuring. “Really? What about the fact that he wants to write several books; one’s a new translation of Thucydides and the other is a historical novel of a Greek boy in an Odysseus-like adventure. He’s already working overtime in his library, and yesterday he asked his agent for an advance on his novel. Tell him, John. Please tell him.” He liked it when she used his first name. He managed to smile. “Look, he got through radiation; he may have another 6 months.” “He’s acting like he has another 10 years.” She released his arm and slumped into her chair. She was crying. He hesitated. Then he sat down beside her and gently put his arm around her, comforting her. He could feel her shaking, and tears ran down her cheeks. He gave her his handkerchief. She took it and wiped her face. The tears continued. “He might as well see me cry. He never has, you know. I’ve been afraid to do it in front of him. And he never says anything about not making it—not JOURNAL OF CLINICAL ONCOLOGY T H E A R T O F O N C O L O G Y: When the Tumor Is Not the Target VOLUME 27 NUMBER 22 AUGUST 1 2009