He opens the door
and walks in,
his face and white coat
stiff with starch,
holds my hand, and
I am afraid
you have cancer…”
From: “Diagnosis,” by Majid Mohiuddin, in The Cancer Poetry Project, Vol. 1, 2001)
“Write about the moment when the doctor said, “Cancer.” It’s usually one of the first prompts I offer in each new series of my “Writing through Cancer” workshops. That moment of confirmation, the seconds in which a physician delivers the words that will change your life in an instant, is an experience shared by each person in the group, and, as it is described and written about, one that evokes strong emotions.
Writing that is most healing has some particular characteristics, as psychologist James Pennebaker and his colleagues have noted, among them, writing that is concrete, vivid, and gives detailed descriptions of trauma, distress and emotion. When I ask survivors to return to that first moment they heard the word, “cancer,” no one responds in generalities. The writing is detailed, descriptive and when shared aloud, often accompanied by tears.
While the words, “you have cancer,” may be new and terrifying to those of us who first hear them from our doctor, yet for the physicians, they are words they have had to repeat many times to many patients. What might your doctor have felt in the moments before he or she delivered a cancer diagnosis to you? David Huffman, MD, describes those feelings in his poem, “The Door:”
The door seems impenetrable.
Today is arduous.
I have seen patients with cancers of pancreas,
Gastric, cervix, colon—all unresectable…
Why is it so difficult to enter this room?
(In: The Cancer Poetry Project, Vol. 1, 2001)
This past Saturday, I spent the day leading a bi-annual creative writing workshop for faculty, alumni and students of the Stanford University Medical School, something I’ve been doing since 2005. During the morning half, I offered an exercise that required the attendees to write about the same moment, but from two different points of view: one, as the person delivering bad news to a patient or loved one, and two, as the person receiving the news. I’d been inspired by a touching and eloquent essay written by Jennifer Frank, MD, published in the Journal of the American Medical Association. Entitled “The Before,” Frank offers her readers a rare—and poignant–glimpse into the doctor’s mind as she prepares to call a patient to tell her she has cancer.
This is the before. A moment suspended like a bubble floating on a warm summer breeze gently but inevitably toward the ground. I feel the pop coming, an implosion of the very center of your life. Anticipating what this moment would hold, I nevertheless hoped for something different. To be able to eagerly dial your number and shout out the good news to you in a breathless rush. “It’s not what we thought. It’s not cancer.”
Instead I take a deep breath, pressing each number slowly, cautiously, drawing out the moment before the burst. The burst of your plans and your dreams and your future. I stall for time, asking if this is a good time, are you alone, do you have a pen and paper? …
I want to be straightforward but not blunt. I want to be compassionate but remain professional. I slow myself down, remind myself that the words I’m about to say are ones that I’ve said before, many times, but that the words I’m about to say are also ones you’ve never heard before… (In: “A Piece of My Mind,” JAMA, March 7, 2012, v.307. no.9).
When we are the patients, the ones receiving bad news, it’s unlikely we comprehend what the person delivering the diagnosis is feeling. We may never really know, because what’s most important is that we have a medical professional with practiced and steadfast hand who can guide us through the upheaval, help us find our way through the myriad of treatments, and inspire trust. “All I can offer is my hand,” Frank concludes, “…to hold you up, prevent you from going under until the sea calms and the path clears.”
During the workshop, I instructed the group to write about the moments before they had to give a patient or a loved one difficult news, whether a cancer diagnosis or a death. “What did you feel? What was going through your mind” After twenty minutes, I asked them to write again, only this time, to put themselves in the shoes of the other—the one receiving the bad news. When the time came to read aloud, the feelings expressed in each person’s narrative were no less powerful than those of their patients. They expressed fear, heartache, compassion and caring, and the weight of responsibility for another’s life and well-being. It was an honest and touching glimpse of what’s behind the mask; a reminder of what it is to be human, to care and to feel, whether patient or physician. As Huffman expresses in “The Door,”
…I can only be forthright and compassionate.
Why is it so difficult to enter this room?
Maybe someday I will be in that bed.
I hope that if that time comes
My doctor will be as truthful and considerate.
But if she hesitates at the door…
I will understand.
Recall, if you can, the moment you heard the words, “you have cancer.” Describe it in as much detail as you can, for example, what you were feeling, where you were sitting or standing, your doctor’s voice, eyes, or face. Once you’ve described that moment, turn to a fresh page, and write about that moment once more, only this time, write from your doctor’s perspective. Become the one who must deliver the news, the diagnosis, to you. What the doctor might have seen as she or he looked at you or heard when you came to the telephone? What might she or he have felt? Write in as much detail as you can. When you finish, compare both. Did anything change in the way you think about that moment? Did you stumble upon any new insights or understanding? What was it like to write from the doctor’s point of view?