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What do you mean he has cancer?!

“What do you mean he has cancer?” said Mrs. Client, frowning, as I handed her adorable ball of fluff back to her. Fluff-ball had been staying with us at the clinic for a month. For radiation therapy. Which treats cancer.

“Err….ahhh…ummm…” I start stammering. This is the first time I have met Fluff-ball’s Mum, as another (very capable) clinician did the initial consult and treatment plan. He had her sign the consent form for radiation therapy and boarding. Pay the sizeable deposit. Talked to her about prognosis, on-going rechecks, side effects, etc.

For the last month a resident or student had been calling Fluff-ball’s family every day to let them know how he had recovered from the anaesthesia, what the radiation side effects were like, how he ran around the room during rounds and how we loved him.

“I just thought he just had a lump, a mass!” Mrs. Client’s voice started climbing an octave or two “and this, this, x-ray treatment would fix him!”

I’d like to say I handled this situation with aplomb and class, but to be honest the whole next section of my memory is a tachycardic blur – I (belatedly) took her from the waiting room into a private area, and started hoping that Cornell, in upstate New York, would suddenly suffer from a very powerful, but focal, earthquake which would swallow me whole and leave everyone else OK.

You have probably been in a situation like this – when someone hasn’t really heard what you’re saying. This is common when stakes are high, emotions are heightened and the frontal cortex isn’t quite in full swing.

Cancer is such a scary prospect to be faced with, and this client had taken ‘mass’ ‘lump’ and ‘tumour’ to not mean cancer. What I learned that day was to ensure I used the word cancer during the initial consults, which, despite being an oncologist, is harder than one might think. We tend to actually name the tumour type, eg sarcoma, carcinoma, and not necessarily say Cancer. I usually start off my initial consults with “So, Fluff-ball has been diagnosed with cancer X…(pause)…what questions have you got for me today?”

Sometimes clients will also start repeating the same question if they haven’t been able to take in everything that you’re saying – and this isn’t a reflection on you not telling them, or them not listening, they just cannot absorb it in that moment. Recognise that for them, the stakes are high, and be prepared to repeat yourself, answer in a different way, and provide written material – even a white board in the consult room is useful.

Luckily for me Fluff-ball’s cancer was one that was ‘fixed’ by the radiation therapy (grade one soft tissue sarcoma, incomplete resection for those interested) and so the conversation was less fraught than it may have been. Now it’s a funny-traumatic memory and a learning opportunity during my residency at Cornell University that has me saying ‘Cancer, Cancer, Cancer’ to remind myself to get back to the basics at the beginning of the consultation.

May your conversations be easy this week!

Sandra XOXO

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