Beyond Appearances

by Ashleigh Van Tonder

Beyond Appearances

One of my work placements was spending half days in different departments of my local hospital. One afternoon, I sat in on consultations with a general surgeon. He saw a wide range of patients, with no two having the same condition. Out of all the patients I saw that afternoon, one sticks out in my mind more than any other. It was an elderly gentleman, in his 80s, who had cancer of the oesophagus. The surgeon however, had to explain to him that his cancer was inoperable. The old gentleman took this news very well, looking a bit worried, but he appeared to accept it immediately. Of course, he started to ask what his options were. I was somewhat shocked when the surgeon explained that he was too old and his cancer was unsuitable for treatment by both radiotherapy and chemotherapy. I remember standing there, trying desperately hard to think of what other treatment I had ever heard of for cancer. Nothing came to mind. These fears were soon confirmed as the surgeon looked down at his notes and started to jot something down, whilst adding something about getting him in touch with MacMillian care. I couldn't believe what I had just heard, the surgeon indirectly had just told this man that there was nothing to be done for him, that he was dying. I was shocked that he hadn't just come out and said it, but instead, he had broken it in a very roundabout way. Not once in the consultation did he mention death. I looked at the patient, trying hard not to stare or seem rude, trying to see if he understood what he had just been told. He looked confused and shocked. I don't think he fully comprehend that he had just been told that his cancer was terminal. The doctor ended the consultation not long afterwards, by calling in a palliative care nurse. I followed the surgeon to the next room, whilst he prepared for his next patient. I was horrified and somewhat angry about how calm he was acting, and how seemingly impersonal he attitude had been. Then I realised what he was doing, he was composing himself. He turned to me and said "Never get to close to your patients, remember to keep your distance. It's really hard losing patients, you have to stop yourself getting attached."



I think I decided to write about this patient, as I think it is an important lesson that I will need to carry with me throughout my career. It was a thought provoking experience, to see how the bad news was broken, and how the doctor had to admit defeat and step away from the care of the patient. It made me feel a quite upset and a little angry at the time, but with hindsight, I feel more accepting now of the way the surgeon conducted himself.

Ashleigh Von Tonder                              Whole Person Care