True story:

A middle-aged woman presents to the Emergency Department with bleeding. Turns out that she has cancer and she has not much long left to live.

She does not want the doctors to tell her family.

The cancer continues to spread. She is increasingly impaired by the pain, but goes on with life as usual. She does not take days off work so comes to hospital for treatment straight after her shifts end. She refuses community nurse home visits, refuses social worker care….she does not want anything out of the ordinary to happen to prevent her family from finding out.

She presents to the Emergency Department again with a huge, fungating mass. She is rushed up to the wards. Her distressed husband gets aggressive with the nurses and demands an explanation. The social worker begs her to please tell her husband the truth.

Social worker: Please tell your husband.
Woman: I can’t tell him. He’ll get upset.
Social worker: He is already upset.
Woman: You tell him. I can’t.

The social worker then gets a witness to that process of giving consent, goes to the husband in another room and tells him the diagnosis. He breaks down and says that he knew it, all along.

How did this woman hide a huge, fungating mass for so long?

The gynae-oncologist’s response: “The entire family – husband, wife and children were colluding in denial. They knew something was wrong but nobody spoke about it. There was another woman who presented with advanced breast cancer that had eaten through her chest wall. And her husband didn’t notice. People deny there’s a problem.”

This patient died soon after her husband and children found out. At least they had that time to say goodbye.

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Thanks to a thoughtful reader’s astute response, I thought I’d elaborate a little more on this issue. By no means am I trivalising this very real and very sad story. Just remember that often, when I blog about these things, I’m exhausted myself, and sometimes find it tricky to do these entries justice. Also, if at any point you feel that I’m revealing too much identifying information about the patient, let me know. I’ll either delete the entry altogether, or adjust it it accordingly. A lot of these case studies have been taught to us as part of our medical degree, to teach us something. This is how medicine, as both a science and an art, is taught. Through case studies, through observing other patients, through dealing with other doctors.

The point of me sharing this story is this – the human race has a huge capacity for denial. We can tell ourselves that everything is okay to keep us functional. So if you have a loved one who has a health condition…don’t let it slide. Address it. Try to foster an environment of openness in your family as a whole, so if tragedies like cancer occur, you’re better able to deal with them, out in the open. It’s scary, but what’s scarier is your loved one dying a premature death, simply because everyone was too afraid to tackle it head on.

There’s a big difference between allowing a family to grieve, and shoving cold, hard ‘reality’ in their face. I say this with utmost respect to this amazing blogger, who lost a loved one to cancer. Nobody can really predict when anybody will die, let alone a cancer patient…but yes, it’s safe to say that their time is running out faster than you or I, due to their illness. But let’s not break their spirits by harping on about how hoping for the best is bad. Like Prof Chris O’Brien said – “There is no such thing as false hope.”

Ladies, do your pap smears! Gentlemen, visit your doctors regularly so you can get checked out before anything goes wrong. Stop smoking, cut down on your alcohol intake, make exercise and relaxation integral parts of your routine. Find out if you have any family history of disease, whether it be physical or psychological. It’s all about good self-care.