I had a long consultation this morning which I thought was worthwhile. It was with Simon, a young lad in his twenties who has been looking after his kid sister Janie. She developed a particularly nasty form of cancer a few years ago, and despite the best efforts of the hospital the cancer has recurred. From what he says I think that the end cannot be far off. Simon has been more than a big brother, in many ways he has also acted as her father because of the lack of appropriate parental figures in the family. He certainly feels very responsible for her. The problem is that he is in denial. The cancer specialist has told the family that he cannot cure Janie, which is his gentle way of saying that she is not going to survive, but Simon still thinks that treatment will help each relapse and that some new cure will be developed in time to save her.
Janie is not my patient so I only know what Simon tells me, but it sounds like a classic situation with the family in denial and colluding to hide the truth from Janie. This morning Simon told me that he cannot think about Janie dying, he tried to imagine her funeral but could not do so. I have been to this particular place and got the tee-shirt, and I recall the moment when I started to entertain the possibility that my son might die. I was driving home from the hospital at the time and it felt rather like grasping a nettle, a painful thought below the surface. I pulled it out and examined it in an almost disinterested fashion. In time I was able to accept the full reality of the situation. So this morning I asked Simon to try simply considering the possibility that he might lose Janie. It was an odd consultation because we were able to talk about things as theoretical abstracts without admitting that they might exist in reality. I somehow managed to suggest that if Janie were dying he might be using up a lot of energy in denying reality to himself and in hiding the truth from her. And I also suggested that if there were to be only a limited amount of time left it would be better if things could be discussed openly. Simon and I have had a good relationship and I hope that today's consultation was helpful. I shall be seeing him again shortly.
Speaking of death, I've been chatting with Martha about our approach to life in general and work in particular. She came up with the genial idea of considering what might be written on our tombstones. She reckons mine will be “he never promised what he couldn't deliver”, while her own aspiration is “she was never any trouble”. I wouldn't dream of challenging her perceptive insights, but I rather like Spike Milligan's suggestion - “I told you I was ill!” The British Medical Journal will publish the obituary of any doctor associated with the UK, and they are particularly keen to receive obituaries written by the doctor himself (before their death, rather than through a ouija board). I should certainly like to write my own but haven't got around to it yet. If I drop off my perch unexpectedly perhaps Martha will oblige?