The Nervous Patient
A cancer specialist requires a certain amount of calm and equanimity, what I call the proverbial reassuring manner, in order to provide effective care. The reason why is blatantly obvious. Our patients battle horrific diseases that often leave them weak and depressed. Many times they are faced with no hope for cure. Is it no surprise, then, that some of them become nervous? And if you, the patient, are aflame with anxiety, would you enjoy listening to a loudmouth, restless, high-strung oncologist who likes to quote discouraging statistics, and is adept at inappropriate smiling?
Of course not. This is why we cancer docs must teach ourselves to counsel with tranquility. It is not easy to learn at first - a young oncologist is lucky if he or she trains under a professor who has mastered the art of giving out bad news in a way as to not cause a family riot. With time and experience, though, most of the great oncologists develop the poise needed to deal with high-stress encounters with desperately ill people.
Still, though, there are some patients who are so tormented with worry that their emotions make the doctor a nervous wreck. I met one such nice gentleman this week.
My new patient, just diagnosed with metastatic lung cancer, was attempting to deal with the panic that comes when one in perfect health last week is now sitting on the edge of a hospital bed, listening to descriptions of his various organs bulging with tumors, all documented clearly by a CT scan. My patient's anxiety was not only apparent, it somersaulted all over the room. He peppered me with questions, starting out with "Are you sure this is cancer and not an infection?" Classic Kubler-Ross stuff, I thought to myself. As I discussed what I knew about his situation with him, sitting calmly beside him in a chair, I used my most reassuring if not downright serene manner. I explained the facts of his case, came up with a plan to help him, outlined the logistics of the next several day's worth of tests, and did my best to raise the flag of encouragement over his bedpost.
Except, it didn't work worth a hoot.
The more I tried to allay his fears, the more nervous he became. He sat rigidly in his chair, repeating questions that I had answered earlier. Clearly, I thought to myself, he is overwhelmed, and it is time to call it a day. Let the passing of a night hopefully bring solace to him, and pick up our conversation tomorrow.
Great idea, except now I began to feel anxious.
I felt that because I left him as nervous as when I entered the room that I had failed, maybe not in my primary mission, which was to dispense essential information about the cancer, but in my inability to inspire confidence or at least a modicum of hope. The more I flapped my gums, the more my words just sounded annoying.
With this in mind, I unleashed the secret weapon of the medical oncologist, the mysterious strategy we cancer docs keep hidden from public view, to be used only in the event of a dire emergency, such as this one:
I scheduled an office visit for the patient and his whole family.
If there's one thing I have learned about caring for the nervous patient it is that the best way to relieve distress is to form a bond of friendship with him or her. To form such a bond, continue to counsel the patient - it is as simple as that! By sending the indispensable message "I care", the doctor creates trust, trust that the patient knows his doctor will act in his best interest - will become his advocate, in good times and in bad. My feeling is, the more time spent supporting the patient, the more confidence the patient will have in your support. Thus is revealed one oncologist's answer to the problem of the agitated patient: keep talking - and keep listening.