Posted by: sayamika, the killer bunny | 2009 February 12

Why do they use nails in coffins?

I saw a case not too long ago that upset me terribly. The patient was a young lady, in her late 30’s, with biopsy-confirmed espohageal cancer.

Here’s the catch: the biopsy was of a lymph node in her neck. Which made her stage IV at diagnosis. Her cancer was too far advanced to be treated by surgery.

She kept asking the oncologist, directly, What are my chances? Am I going to die of this? Is this going to kill me?

The oncologist hemmed and coughed and looked at his watch and evaded her question.

Now, I’m a family medicine resident and certainly no expert in oncology. But I know a few things. Esophageal cancer is a miserable illness, usually found late, as this lady’s was, and notoriously resistant to most chemotherapy. Surgical resection has a cure rate, but chemotherapeutic gains are generally measured in months and quality-of-life

Breaking bad news is not easy. It’s difficult to find the balance that conveys the truth without taking away hope.

I don’t know how this best would be handled. Should such questions be saved for a later date, after the diagnosis itself -cancer with a capital C-has been digested? Would she lose hope knowing immediately the full extent of what she was facing? Or did she deserve to know the whole picture as it stood on that day?



  1. Hi, James Mangosteen Dean here. I just thought you’d like to know that I’ve replied to your comment at my blog.

    Toodle Pip!

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