Dear Diary

by Barry Main

Thursday, 15th July

Dear Diary,

It was busy. And hot, very hot. The middle of July, in a hot, crowded clinic waiting room and I was about to be told I had cancer. Of course, I already knew what the experts were about to tell me. I'd had a week since the biopsy to think about things, to mull over what it would mean, to explore the internet for the answers to questions I was impatient to ask. Nothing I found out cheered me up very much. By and large, the treatment would make me feel worse, much worse, than this little lump on my tongue did.

I stood propped against the wall, hot and annoyed that even those with cancer can't get a seat in a hospital waiting room. I looked around at the others, hot and waiting, wondering what each of their stories might be. Some were very much older than me. Some much younger. This saddened me. My cancer, I knew, was much to do with my years of reliance on Silk Cut and Gordon's Gin for comfort during the lonely times. Now, still lonely, I'd have to give up my two best friends.

Twenty-five minutes past my scheduled appointment and a nurse finally calls me in. I drop my newspaper en route, bend over to pick it up, and on the way back up, make eye contact with another patient. His face is distorted, his neck scarred and he looks painfully thin. Is this what I have in store? I ask myself. He attempts a smile, but his post-operative face doesn't comply. I feel like running back out of the clinic.
The nurse opens the door to the room, and I enter. I'm alarmed to find there are around fifteen people assembled around the periphery of the room. Who are they? What interest do they have in me? I'm ushered towards the far end, to a seat, opposite a smartly dressed gentleman I recognise as the consultant. He offers his hand, I respond, shaking. His hand is firm and steady - good qualities for the man charged with operating on me, I decide. He briefly tells me who the others in the room are. I pay no attention. Get to the point I feel like shouting. First, though, a half-dozen of the gathered strangers have to look in my mouth. I open co-operatively, my tongue still aching from the biopsy, and see six pairs of strange, inquisitive eyes staring in. I catch the glance of one of them, a young doctor, who smiles sympathetically back at me. I feel like telling him not to worry, I know the score.

The consultant finally gets to the point, and tells me what I already knew. Apparently, it is a 'good cancer', and surgery should be relatively straightforward. As he continues to divulge technicalities, I find myself drifting into thoughts of my own - my children, my job, my friends, my cats... who the hell will look after my cats? I pretend to listen to him, nodding where I think I should. His language is efficient but confusing and frightening: resection, tracheotomy, intensive care, reconstruction, lines, catheters, ventilators, radiotherapy. It frightens me most because, apart from my aching tongue, right now I feel absolutely fine - physically. He asks if I have any questions. Of course I do, thousands of them, but feel unable to string a sentence together, daunted slightly by my audience.

The consultation ends with the consultant pencilling me in for a few weeks' time. Why doesn't he write it in ink, what else more important could come up for that date I wonder? I'm taken to another room by a lovely nurse. We spend a long time chatting, honestly and openly in language I can understand. Finally, I feel ready to leave the clinic and walk out into the hot, sunny July day. Any other day, I would be happy in this glorious weather. Today, I wished it was raining and dull, to match my mood. I reach into my bag and take out a Silk Cut, light it and take a long, long drag. I decide this friend will have to stick around a little longer, as I figure out how I'm going to tell my children the news.


Reflection

I wrote this piece following personal experience of situations like this. Before studying medicine, I worked as a dentist in a range of Oral Surgery units , and most recently in a Maxillofacial Unit whose work load was largely head and neck oncology.
I used to participate in the weekly oncology clinic, and often wondered how the patients felt about these clinics, which invariably had around 15 staff in attendance. At these clinics, new patients were told their diagnoses, whilst all these strangers looked on, often with the patient's back to much of the room.

I decided to write this piece as if a diary entry of personal reflection of such a patient. The character is an amalgamation of many of the patients I met during the time, but resembles one more in particular. I had to use what I had observed personally of patients' reactions to being told they had cancer, but also their reactions on entering the room of the clinic, curious about who all the people were. However, having never actually been such a patient, I had to imagine being the patient being told this news in a strange, frightening environment. I also knew that many of the patients were much happier after having talked with the specialist nurse on the clinic.

I hope that my piece is an accurate reflection of how a patient might feel on a day like this. I think in the process of writing, I thought very carefully about the patient experience of such a clinic. As professionals, it can be very easy to become depersonalised in such a situation. I hope that, in the future when I qualify, I can recall this piece of writing and apply my thoughts and feelings to similar situations, and prevent becoming automated and depersonalised when breaking bad news.

Barry Main                                                         Whole Person Care