Arzhang’s Blog

The not so awkward silence

It’s amazing how much can be said by silence.  In our ever changing (unfortunate) move to assembly line “pack as many patients as you can” medicine often patients are given the opportunity to talk.  Some times it’s what they don’t say that speaks the most, that tells their real story.  

The other day I had a patient with metastatic breast cancer.  I had just got done pronouncing the death of a 39 year old woman with breast cancer metastasis to the brain when I came to visit her, so I knew the prognosis all too well.  It was late.  I didn’t even bother to check my watch.  A shadowy skeleton of a figure was slouched in bed, the stubble on her shaved head catching the hints of light in the room.  She slowly moved her eyes up.  Her lips were curled down, defeated.

“Hi I’m Dr. Fallahi.”

I asked a few standard questions.  She recited her history like she had done countless times before.  She looked up at me, “I don’t want to do this any more, I’ve been going through this since 1989.”  She spoke in that agonizingly soft voice of someone that has gone to hell and back.

“I went through chemo.”

She looked up at me. Silent, as if expecting I knew what it was like. Her eyes told the story.

“I feel so weak.”  She then looked at me as if longing for something.  Here eyes intent, lips somewhat curled as if  it wanted to give some sort of smile of desperation but couldn’t.  There wasn’t much more that needed to be said.  No one was going to cure her cancer.  For that matter things were going to get worse.  She had metastasis to the lung, bone, and and she was starting to turn yellow from her liver metastasis.  I could have tried to lighten the situation with some sort of optimistic anecdote but I knew it wasn’t the time.  I finally broke the silence, “I’m so sorry.”

As I left the room, I looked back at her, paused.  This time she broke the silence with what I would like to think was some attempt at a smile, “Thanks for your help.”