A recent example: I saw Ivan at home one September afternoon. He was dying from far-advanced cancer, and it was clear to me that he had only days to weeks to live. He was in and out of consciousness. He'd emigrated from eastern Europe, the family told me, and he hadn't seen his two brothers in over 30 years. His dying wish was to see them one more time. They were planning to come at Christmas, coming to say good-bye.
Ivan's wife and children were stunned when I reviewed with them my assessment that time was way too short to allow for a visit three months in the future. They recovered, though, and began talking with our hospice social worker. When I came back in a week, Ivan had deteriorated further, and even the most skeptical of the children could see what lay ahead. The social worker was amazing. It literally took phone calls to the U.S. Embassy in the patient's native land, but the brothers got expedited visas and arrived about ten days after I first met him. They had a good visit, I was told, and Ivan roused enough from time to time to recognize them. Two days after the brothers returned to Europe, Ivan was gone.
What would have happened if I'd sugar-coated the prognosis? If I'd done the easy thing and just nodded my head when they told me about the plans for the Christmas visit? (Apparently, that's just what their oncologist had done.) Ivan would have been denied the one thing that mattered most as he lay dying.
The truth was hard to hear, but it gave Ivan's family power.