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A Piece of My Mind
April 6, 2011

Melancholy

JAMA. 2011;305(13):1277-1278. doi:10.1001/jama.2011.364

It is late fall in New England. Flocks of geese race southward. Fallen leaves eddy at the roadside. The sun's oblique rays are barely warm. I am driving to my office from the home of Mary Emanuel, a 74-year-old woman who has stomach cancer. Upon being diagnosed one year ago, Mary dutifully agreed to surgery, chemotherapy, and radiation. She now, however, has bulky abdominal metastases, is losing weight, and feels weak and ill. I visited Mary to tell her she was dying.

Such conversations ought to be had in person. Recently admitted to the hospital with a small-bowel obstruction, Mary was so cheerful with the staff, remaining warm and pleasant despite her pain, that none of her physicians would disclose to her the true extent of her disease. No one, I was later told, wanted to “rob her of hope.”

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