Escapism

a quarter of my patients have cancer of some kind.

i've spent the last few days taking them into quiet rooms, sitting them down, asking the same question over and over.

"what have you been told so far?"

they go on about how they came in with a chest infection/fluid on their lungs/etc and then i have to launch into the splendid bullshit.

"that's right. now that scan we did yesterday. well it's shown a lesion/mass/abnormality/cyst/shadow/irregular feature and we need to do a few more tests and speak to a few specialists before we can tell you exactly what it is and act accordingly."

what i want to say is that it looks, smells and tastes like cancer. you have cancer. and the pains we'll put you through to get the sample of tissue to prove this isn't going to change the fact that you have cancer.

of course we're not supposed to say that. in fact i got a telling off as a freshly qualified boy doctor for saying to a patient that although we weren't sure yet what we were concerned about was the possibility that his mass (in his pancreas) may be cancerous.

bad Dr D&C. go and kneel before the GMC with your trousers down.

don't you realise, i was told, that if you even MENTION the "C-word" then it will do more damage than the diagnosis itself.

quoi?

the word will do more damage than the cancer? somehow the word will metastasise and infiltrate all his organs? the word will cause him unbelievable pain and nausea and diabetes in a cruel twist?

no, i was told, we must wait for a tissue diagnosis.

of course said tissue sample took four weeks to get because the procedures (cameras down his to his duodenum and the probing around with a brush in various sphincter) ran into problems each time. anyway, we did finally get the biopsy, we told him he had cancer, he said he had expected that it was going to be cancer and then he died the next day.

but of course it was not the adenocarcinoma that killed him, it was the word.

anyway i must now bite my tongue. i shall wait the time it takes to get Mr K's pleural fluid back from cytology, i shall sit in patience as the lab slices through Mrs G's gastric biopsy and i shall make sure everything is ok after they've had a wash around Mr P's lungs with the bronchoscope. and then, one week on, EVEN THOUGH WE ALL KNOW NOW THESE PEOPLE HAVE CANCER, we shall tell them that they have cancer. in the meantime i shall lie every day to them, through the veil of " we need to do further tests" and "the lab is still processing the sample you poor cancer riddled bastard" before calling in the palliative care team who can start the syringe full of morphine and hasten their discharge to Rose Cottage.

excuse me, i have to go and put on my best used car dealer outfit in preparation for a day full of mendacity.

[i am listening to Primal Scream's new single. i saw this on the web today and it made me very geekily excited]