February marks World Cancer Month.
I recently watched the movie The Farewell, a true story about an elderly Chinese woman with stage 4 lung cancer, who was given 3 months to live, and the elaborate schemes her extended family goes through to shield her from her diagnosis and treatment. All this at the great dismay of her Chinese American granddaughter. “What about her goodbyes? She has a right to know! You can’t decide for her!”
As it turns out, I recently had this experience in the US, when the family members of my Arabic patient begged me not to tell her about her diagnosis. “She won’t be able to tolerate it”, they said. “We will carry the burden”, they pleaded, “and will deal with it in our own way”.
No, that’s unethical, I though. What if she needs surgery? chemotherapy? And then, there’s the law…
Shielding patients from their cancer diagnosis is very common in many cultures. How many times have we asked our patients about their parents’ and grandparents’ medical history, only to be told that they don’t know, no one really talked about cancer. My brother, a geriatrician in Lebanon, informed me that before the advent of electronic health records, 2 years ago, some physicians had labels posted on their patients’ charts: ”patient does not know diagnosis”. One of the families’ fears, he said, is that the patient will be given the diagnosis, then left to deal with the onslaught of associated emotions and information on their own. He recounts the case of a patient whose daughter lived far away, yet her family did not want the patient to know, at the cost of dying without seeing her daughter . Through his team’s gentle care and guidance, she was made aware of her diagnosis, and was able to say her goodbyes to all. The entire family thanked him after her death.
It’s not all about medicine. Or rather, medicine isn’t all about medications and surgery.
So here’s to all the health care workers, family, friends, colleagues who reach out and make life easier for patients every day.
Thank you,
Leila Hajjar, MD, MHSA, FACOG
President, NAAMA-MI