"I could have simply been there with him and said nothing at all."
 | By Alexandra Sifferlin Senior Staff Editor, Opinion |
"I wish there were something we could do, but the cancer is too advanced. You're dying," Daniela Lamas, a critical-care physician and contributing writer for Opinion, once told a patient. "It could be hours now. I don't think you will make it through the night." |
Her patient had aggressive colon cancer, and he was in denial. He had put off many months of treatment and follow-up appointments. He yelled at Lamas and her colleagues who were trying to treat him and insisted that he was fine to go home. In response, she told him the unvarnished truth, and to this day she wonders if it was the right thing to do. |
"Denial was my patient's only defense mechanism," she writes in a guest essay. "And as soon as the words left my mouth, I realized how cruel it was to try to take this defense from him in the final hours of his life." |
Patients in denial are a challenge for doctors, writes Lamas, especially people who are dying in large part because of their own decisions about their health. Doctors are supposed to tell patients the truth, to help them understand their reality and offer opportunities for them to reach out to loved ones and make other arrangements when time is running out. But can delivering painful truths, with so little time left in a patient's life, also be a form of harm? |
When editing Lamas' essay, I thought about doctors in hospitals across the country who can face many types of denial from their patients and their family members. Many are dealing with an incredibly destructive version right now — denial over the danger of Covid-19 and the necessity of vaccines. All permutations of denial are challenging, and the right course of action isn't always the same. |
In this particular case, Lamas argues that her own anger at her patient's denial obscured "the reality of his suffering," and she caused harm as a consequence. |
"I wish that I had done it differently," she writes. "I could have paused and told him that yes, he was going to go home. I could have simply been there with him and said nothing at all. That small kindness might have done more for him than the truth." |
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