TALKING ABOUT DEATH AND DYING – Why is it we don’t talk about the greatest inevitability in our lives? Why don’t we talk about death and dying? We explore the consequences of this silence in this series, today considering the issue from an oncologist’s point of view.

Patients want their doctor to tell them the truth. Michal Porebiak

This is another important topic undertaken by theconversation.au.edu.

Mrs Jones is a delightful 75-year-old church volunteer diagnosed with cancer. Recently, she required surgery to remove fluid from her chest cavity. Much to her relief, she returned home after a prolonged recovery.

Some months later, the fluid in her chest was drained again but the progression of disease was obvious. Encouraged by her family, she decided to try chemotherapy. Her stated intent was that she wasn’t yet ready to die and would do anything possible to beat her cancer.

She felt buoyed by the first cycle of chemotherapy, but the second landed her in hospital – with all the side effects she had been warned to expect.

She left but spent the next two weeks in bed, weak and washed out. But her original intent remained strong and when it came time for the third cycle, she decided not to reveal just how ill she had been feeling.

She feared, reasonably, that no one would entertain giving her more chemotherapy, if they found out the truth. So she went on to have more treatment, which destroyed her body’s meagre reserve. For three days she was delirious, unable to recognise her own children, looking a sorry shell of her former self.

Resuscitated with antibiotics and fluids, she improved. But scans showed her cancer had progressed. Doctors are notorious for getting the prognosis wrong but in my estimation, she had only a few weeks to live.

Talking about it

As I sat by her bedside the first day she could talk coherently, imagine my surprise when she asked me what chemotherapy I was planning next. My first thought was that she was still delirious.

I thought of firmly stamping out the idea of further chemotherapy in her mind, pointing only to her recent near-death experience. But it seemed odd that an intelligent woman would behave like this.

So instead of answering her question, I asked her, Mrs Jones, what do you expect more chemotherapy to achieve?

To prolong my life, of course, she responded, looking curiously at me.

This is the oncologist’s dilemma – how to tell the truth without extinguishing hope. How to tell Mrs Jones that her lifespan was limited, that further chemotherapy would be futile, or even hasten death, and that her remaining days would be much better spent cherishing life than fighting off unnecessary toxicities.

How do you shine a light on frankly unrealistic expectations without coming across as uncaring?

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