How One Doctor Delivers Bad News to End-Stage Cancer Patients

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He's also a heck of a storyteller. We did a longer version of the whole story of brain surgery and you can go to our American stories dot com and search for Dr. Theodore Schwartz. Here now is Dr. Schwartz talking about how he breaks bad news to patients.

The initial office visit, in fact, can be surreal. At this early stage, the patient is often minimally symptomatic. They're obviously aware that something is growing in their brain.

They sought out medical care, after all, and they know it needs to be removed. Maybe they've done a little research or they've had a family member with a brain tumor, which may or may not have been similar. They're also often scared and unsure of what lies ahead or what it all means. Commonly, they're frequently somewhat oblivious to the gravity of the situation.

This is all new to them, but as I listen to their questions, I see things they are not yet capable of seeing, let alone processing. I see the mother of three young children who will not make it to their high school graduation. I see the father and sole provider for a family of teenagers with college payments looming who will not be walking his daughter down the aisle. I see the hedge fund manager who is sitting on top of the world, planning his retirement and next lavish vacation, who will soon be closing his fund. He's about to lose not only his long anticipated opportunity to spend his money, but his ability to bathe and feed himself. And yes, thinking of others' deaths can be debilitating.

It's even the most hardened of us surgeons. Giving bad news, seeing families crumple from the oncoming train bearing down on them. As I stare into the void, imagining their future, I want to stand up and scream at the top of my lungs or collapse on the ground in a flood of tears.

I do none of this, of course. My job at this moment is to fight this battle with every fiber in my body and shepherd these victims of nature's callous and indifferent design. I believe in revealing the truth of my patient's prognosis at a slow and deliberate pace, but I also never, ever take away their most powerful weapon, hope. We're not talking about false hope, as in we're going to beat this thing, but rather true hope, a concept introduced by Jerome Groopman in his book, The Anatomy of Hope, How People Prevail in the Face of Illness. True hope sounds more like this. They're a small group of long-term survivors and I'm going to do everything in my power to give you the best chance of being one of them.

Or even your remaining days with your family can be beautiful, maybe even more beautiful than all the days that have come before. So how does a doctor walk this tightrope between truth and hope? I usually start the conversation with a clear presentation of the facts. I may say that the preliminary diagnosis showed what we feared, that the tumor is in fact malignant.

I prefer to use the words we and us. I also emphasize whatever positives I can. The good news is that the surgery went extremely well and we got out as much tumor as could safely be removed. Although it's a tough tumor to beat, the surgery puts us in the best place going forward to attack the microscopic disease invariably left behind. I then tell them that they will likely need radiation and chemotherapy, the standard of care in treating glioblastomas, and that we will find them the most experienced neuro-oncologists to help coordinate the next stage of this process. While our neuro-oncologists at Cornell are some of the best in the world, patients often want second opinions, so I let them know we will help them get their records together to send wherever they'd like. Patients often express a fear of telling you they want a second opinion, as if they're cheating on their spouse or insulting a relative. You never want anyone looking back as the end approaches, feeling that they didn't do everything in their power to find the right treatment, didn't explore all the options, or left a stone unturned. It's unimaginable what it must be like to share that kind of news, the kind of job some people have. What Dr. Schwartz said bears repeating. As I stare into the void imagining their future, I want to stand up and scream at the top of my lungs, or collapse on the ground in a flood of tears.

I do none of this, of course. My job is to fight this battle with every fiber in my body and shepherd these victims through nature's callous and indifferent design. What words? And then that hope, and how to give patients hope, and what a talent that is. And then Dr. Schwartz, well, he started to talk about how he breaks the bad news to patients. Here's Dr. Schwartz. I've witnessed only a handful of medical miracles in my career, tumors that miraculously shrank without any treatment, long-term survivors of fatal diseases.

What's the explanation? We just don't know, but these cases do provide some room for hope. The patients I've treated who are still alive 5, 10, or even 15 years after a GBM diagnosis are a rare reminder that my degree and years of experience go only so far. What makes these long-term survivors so special? What do they do to beat the odds? Another frequent question my malignant tumor patients ask is, why me?

Was it anything I did? It's human nature to attempt to find cause for suffering, to create order out of chaos, to shake our fist at the randomness of fate. Often my patients will place blame on environmental exposures such as smoking, power lines, or toxic chemicals released by a local factory. They also worry that their brain tumor might have been inherited or will be passed to future generations.

Both fears are somewhat legitimate. Most brain cancers are triggered by some random and little understood series of events that either alters their DNA within the nucleus of brain cells or misaligns the careful balance of proteins that promote and suppress cell growth. I therefore try to emphasize to my patients that they did nothing to bring this upon themselves.

There is no one to blame or resent, and there's no reason to feel guilty that their children might be at a higher risk of the same fate. As scientifically unsatisfying as the answer may be, the cause for most brain tumors is just plain old bad luck. And you've been listening to Dr. Theodore Schwartz. He's the author of Gray Matters, a biography of brain surgery. He's a neurological surgeon at Weill Cornell Medicine in New York City, one of the busiest and highest ranked neurosurgery centers in the world.

Schwartz has removed nearly 10,000 brain tumors. And that question, that recurring question he gets from patients is, why me? Was it anything I did? He described how it was human nature to attempt to find causes for suffering and to create order out of chaos. But in the end, but in the end, he always just settled them in with the idea that there was no one to blame, no one to resent.

It was just a case of plain old bad luck. The story of our brain surgeon breaks the bad news to his patients here on Our American Stories. Here at Our American Stories, we bring you inspiring stories of history, sports, business, faith, and love stories from a great and beautiful country that need to be told.

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