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.