Everyday, every day

I love language, which I suppose is as good a reason as any for being a writer. I’m also terribly critical—I hate misuse of language, especially my own. I’m not talking about silly grammatical rules that real speech renders moot. I’m talking about the misuse of words that actually changes meaning.

Every day I give bad news. I hate it. For me, it’s an everyday thing—not routine, exactly, and not rote, but profoundly normal. For patients, it’s the furthest thing from normal. Bad news doesn’t come every day. No matter how everyday it is to me, my words can deliver the worst news of a person’s life.

Part of delivering bad news is helping guide people’s reactions. I can’t stop someone from being sad or angry, but I have to help them stay on course. If they find the news so devastating that they can’t function, the battle is lost. Thankfully, I have examples of survival to share with my patients.

Several years ago, I diagnosed an acquaintance with metastatic lung cancer. It really was a horrid diagnosis, and most people with her diagnosis die—quickly. She didn’t (but she’s gone now, a story for another time, perhaps).

One day, after her life had change completely, I ran into her in the hospital on her way to chemo. We sat in the lobby and chatted.

She had a young child, a terrific husband, a brilliant career. She wasn’t really talking about that. As we caught up, a patient walked up to us.

“Dr. Pal? You probably don’t remember me. You found my pancreas cancer a couple years ago.”

I remembered him, alright, I just never expected to see him again. I stood up to shake his hand.

“It’s great to see you! How are you?”

“Well, the cancer’s still around, but I’m on some chemo and I feel fine.”

It’s hard to call anything about cancer “small talk”, but, well, we finished our small talk, shook hands, and said goodbye.

I told my friend his story—how I had diagnosed him with a dreadful cancer, fully expecting him to die, and here he is, clearly not dead.

I like to think that this helped her. We never really talked about it.


The blogosphere is a small world, the medical blogosphere even smaller. Last year, one of our number gave us some terrible news—her son was diagnosed with cancer. Despite this, or perhaps because of it, she continued to write, and the writing is damned good. The news is also pretty good. For anyone who wants a day-to-day (but not “everyday”) look at dealing with a parent’s worst nightmare, her writing is a good place to start (but you have to bring some kleenex).

I can’t tell a patient how to react to a diagnosis, but I can give them examples. The worst possible reaction is panic, as it prevents considered action. My role models are people like my friend with the lung cancer, and Dr. Smak. By their example, they show the rest of us how we might survive in similar circumstances, should we be unfortunate enough to face them.


  1. It’s nice to know that some doctors and medical personnel are sensitive in the way you described. Going to a hospital or health facility for test results, etc can be very stressful and an addition to the stress is often that one can feel very insignificant, a statistic as one walks by the cancer wards and so on.
    Your expression of uncomfortableness with cancer being a topic of small talk is very interesting. Small talk is not a concept which does not exist in all cultures but which is very prominent in North America. I tend to often see small talk as manufactured and insincere; simply a way to fill silence. The conversation you had with your former patient was sincere and short, and from what I gathered, not manufactured (phony). This is more congruent with other cultures’ lack of small talk. In Germany for instance, small talk is useless. If a person talks, it is to communicate something, usually not superficial, but important.
    I feel that your “guilt” in speaking about cancer in a short conversation is simply based on your North American (I don’t have your full bio though) culture. It is perfectly normal and guilt-free to speak of heavy topics in short conversations in other countries. Just think of European films. As I said earlier though, it is very comforting to learn of such sensitivity in the medical profession.

  2. I agree that it’s comforting to learn that health care providers are sensitive and that it’s actually a really difficult part of their jobs to delivery bad news.

    When a close family member of mine was diagnosed with lung cancer a few years ago, the doctor delivered the news with a really uncaring “you did it to yourself, now you better get your affairs in order before you die in a couple months” attitude.

    It was just a really insensitive and un-compassionate way to deliver such shocking and life-changing news. We all know that smoking is bad, but that doesn’t mean health care providers should treat human beings as though they somehow “deserve” to suffer.

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