Fighting A Brain Tumor : Act 1 - Informing The Patient
With Mark R. McLaughlin, MD, FACS, FAANS
Ned is a friend. He asked me how a neurosurgeon goes about delivering difficult news. In particular, the question was "How do you tell someone they have a brain tumor? How do you tell them they have brain cancer?"
Here is how I answered him...
I have to direct this moment both on and off the stage. Off stage, I am slightly detached, arranging my schedule to allow the time to be with the patient and family. I must prepare carefully. On stage, I am close enough to the actors to feel their intensity and pain. My presence as director is calm yet commanding. Even though I know the script too well, I cannot help holding back tears as I watch the characters move through each line.
Sometimes the pathology is favorable or completely benign. That’s when the whole day is brighter for all. That performance is easy, almost effortless. To tell someone she is cured or her tumor is gone, or she will actually live longer than her disease, those are the beautiful days. Unfortunately, the days of favorable pathology news are as uncommon as they are bright.
“The news is bad,” I usually start on those not-so-beautiful days. “As much as I’d like to tell you otherwise, I’m afraid your pathology report tells us your tumor is malignant.”
That patient usually knows the words to come long before I sound the first syllable. Almost always, people with cancer in their lives more than look me in the eyes. The connection is much more intense than simply making eye contact. There exists clarity and a depth of sharing, unique and tragic. Cancer gives people the ability to see through my eyes into my soul: to see fundamental truth, to know if I really care.
“There is cancer,” I go on, “and we’re in for the fight of your life.”
I draw in a deep breath. “I’m with you. We’re in this together. I will help you and guide you, but we’re going to need to trust some other people and their expertise. I am only one part of your chance to beat this.”
Yes, there are long-term survivors and I have been witness to a handful of miracles in my career. Although I approach each patient with an action plan conceived and enveloped in hope, the odds are heavily against surviving a malignant brain cancer.
Options are discussed and the plan for treatment created. Sometimes surgery, sometimes radiation or chemotherapy, sometimes further surgery; there are many combinations and attacks. We recommend an action plan that blends many factors – experience and knowledge, art and science.
“Here’s my cell phone number.” I pass it to the patient and family. “Call me anytime. Call me if you have questions or if you need to talk. I am here for you anytime you need me.”
I turn to Ned, “So that is how I answer the question. And if I do it right, the patient and family know they have met with a professional. They walk out knowing we will fight like hell, that if there is any chance of surviving this, we’re going to beat it. Most importantly, when they leave my office, they know they are not alone.”