Too much, Too fast
By Sheryl McAlister, a writer based in SC.
It was a Tuesday morning in March, 2013. The sun was out but the weather was of little concern to those of us gathered on the 6th floor of the local hospital in Columbia, SC. The doctor was to arrive around noon. One conversation and 10 minutes later, the whole world would change for us.
The doctor – a reputable, local gastroenterologist – was surprised by the mob of people in the room which spilled out into the hallway. He was a quiet man and seemed unbothered by our presence. I think the number of us simply took him by surprise. We knew what was coming. He knew we knew.
The silence was excruciating.
He asked my Dad to join him on the sofa in the well-appointed hospital room. He sat close and put his left hand on Dad’s right shoulder. He looked him in the eyes and without emotion or hesitation said: “You have Stage IV metastatic pancreatic cancer. It has spread to your liver.”
The doctor stopped talking and let the words sink in. I almost threw up.
Dad drew a quick breath and said: “Okay, then, let’s figure out a plan to fix it.”
Dad heard him. A smart man, Dad certainly understood what the doctor said. I guess the brain can only process what the brain wants to process. Besides, he had come to the hospital the previous week with a heart attack, and was undergoing tests to prepare him for heart surgery – not this.
The doctor said again – without emotion or hesitation – his eyes only on Dad’s eyes: “Mr. McAlister, the cancer has spread to your liver. There is nothing we can do.”
That time Dad heard him.
The doctor stayed a few minutes longer to talk about things that could be done to make Dad comfortable. He answered all of Dad’s questions. He looked sympathetically and appropriately at Dad and my Mom, who was standing just behind Dad. He squeezed Dad’s shoulder, and he walked out the door.
I was taking notes. It’s what I do. It certainly wasn’t like I would ever forget that day or that moment when some random doctor tells you that your Dad’s life is almost over. I also thought a lot then and now about how such news is delivered and why that mattered so much.
I wondered if the doctor, about middle aged I guess, had done this before. Had he practiced what he would say and how he would say it if and when he was faced with someone in this situation? Was Communication Skills 101 part of the medical school curriculum? I didn’t know and before that day didn’t care. But that day I cared. Because the stakes were high; the news was devastating, and his compassion and candor made a difference.
Three days earlier, a younger colleague in the same practice visited Dad in the hospital. Results of many tests were flooding in daily as we were preparing for Dad to have open heart surgery. With every passing day, test results showed a variety of issues that didn’t add up to anything but trouble. We all sensed it. I don’t think Dad was focused on it or he pretended not to. He was ready to get up out of bed and watch little league baseball.
But the young doctor who came into Dad’s room that Saturday knew. It was premature for him to inform us, and it wasn’t his news to share. But he knew. My sisters and I could see it in his eyes when he glanced quickly from one of us to the other. He didn’t say a word, but he confirmed all we feared the most. We feasted on hope for a couple more days before the worst was officially confirmed.
Before we took Dad home, there were other tests to be run, and doctors paraded in and out – most offering nothing useful. It was a nonsensical process for someone in his situation. I sat down with a senior hospice representative, who told me with both tremendous compassion and without hyperbole: “Get your Dad out of here and go home,” she said. “If you don’t, everything these doctors are telling your mother will make her second guess herself long after your Dad is gone.”
Now three years later, my Mom will say periodically when talking about the doctors: “I wish they would have just told us.” They did. In fact, one doctor told her specifically, frankly and without a hint of compassion that Dad was dying. (Presumably he missed the communication skills class.) Mom promptly threw him out the room and told him never to come back.
The last doctor to see Dad had a particularly unique perspective with which to have the most crucial of conversations. The doctor looked at Dad, then Mom, then my sister and me and shared with us he had lost both his parents to cancer. He told Dad: “Go home. Go home with hospice. And do it tomorrow.”
The floor nurses helped us shift hospice into action that night. Under their watchful eye, we left the next day and took Dad home by ambulance to make the ride a little easier for him. Their soulful eyes and long faces said all we needed to know. But it was a welcome show of support. We were in unfamiliar territory, and they knew it.
We got Dad settled at home with his grandchildren around him, and he instantly felt better. He couldn’t wait to watch a tape of his grandson’s recent baseball game, which someone had thoughtfully recorded for him. He was never alone long enough for much else. There was a steady stream of friends and family in and out of the house. For a man in his situation, he certainly found a great deal to smile about.
I appreciated those doctors and hospice reps who told us the truth and told us with compassion. I appreciated those who didn’t waste our time with false hope. I sometimes play every single minute over and over in my mind. You do that, wondering if you should have done this or said that. It was too much, too fast. In the end, we all did the best we could with the information we had.
Father’s Day brings it all crashing back to the front of your mind. The feelings ambush you. You avoid the card aisles and don’t look at advertisements for the “cool gift ideas for Dad.” As if those are the reasons you feel the way you do. Nobody ever tells you it doesn’t get better – the grief. You just move it around a bit until it’s managed. You put it away until it finds you again.
“I hope you’re doing okay up there, Granddaddy,” my niece or nephew will frequently offer when saying grace. “We miss you.”
We sure do.
Copyright © 2016 Sheryl McAlister.