Sunday, April 5, 2009

The Power of Truth

Over and over in this work I'm reminded of how hard it is for patients and families to get the one thing they crave -- the plain, unvarnished truth of their situation as they face serious, life-limiting illness. Bad news seems to chase honesty from the hospital room. Just when people need hard information the most, they can't seem to get anyone to give it to them. And not knowing the truth can prevent them from achieving their final wishes.

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.


  1. Truth is the best thing. I think patients and families always know when you are lying but they don't want to say the truth because it feels like they are giving up on the patient. But hearing the truth spoken aloud frees everyone up to stop pretending. When there is little time left, there is no place for pretending---which is different from hope.

    1. I heard on a TED talk (Pamela Meyer) that a lie is only viable if the listener chooses to believe it. Makes sense with your example.