I reviewed my patient list for the day, and saw her name as my last appointment.
Osoria is 41, diagnosed three years ago with locally advanced breast cancer. She had a mastectomy, received chemotherapy, radiation and was on hormone blocking pills with no evidence of disease. She was doing well. Her visits became less frequent as time passed. I knew she was at high risk for recurrence, but convinced myself after each visit that she was going to beat the odds. Then she came in with shoulder pain.
As I feared, the biopsy came back positive for cancer. I came into the room and I knew she was examining me. We shook hands. I had to quickly give her the news. "The pain in your shoulder is due to cancer. The breast cancer has recurred in your bones." She started to cry and turned towards her husband. I put my hand on her arm. "What can we do now?" she asked. Unlike previous visits we were not going to talk about how her kids were doing. I felt myself tearing up, but tamped it down quick.
I've learned to give bad news. I am careful with my words, the pauses, the silences. It has gotten easier. I am amazed at how differently people respond to devastating news. I often ask myself how I would respond in their place. Would I rage, wail or run out of the room? Remarkably, my patients never do.
"We cannot get rid of this cancer," I told my patient that day. The news was given, her world changed forever.