“What Else?”

Rishaan was pacing the room as we asked if we could visit. Upon entering, we could see his muscles tense with worry and his eyes were weary with fatigue. “I know mistakes happen, but this is unacceptable. I want an explanation,” he said.  

His comment was mostly rhetorical. He knew that we, the palliative care team, were there to offer an extra layer of support. Acknowledging our arrival, he went on to describe the events of the past 12 hours. “The daytime oncology team yesterday said we would be starting chemotherapy, but the overnight fellow said we needed to wait.” He sighed with the weight of cumulative concerns that inevitably accompany a prolonged hospitalization. 

“What else?” my attending asked, after meeting his gaze and allowing a brief pause.  

Rishaan turned and looked at his daughter, Diya, in the nearby hospital crib. She was a three-month-old baby who had been admitted to the ICU since birth due to refractory infant leukemia. In addition to the persistent disease, she suffered from a growing list of medical complications. Due to start her fourth attempt of induction chemotherapy, the delay in medication delivery added to her father’s anxiety. “I feel guilty for falling asleep for a few hours last night. I could have made sure that the chemotherapy started on time. Why didn’t anyone in the ICU wake me up?” he asked, his anger rising.  

“What else?” my attending repeated, leaning forward, following a short silence.  

Rishaan shuffled closer to the bedside, resting his hand near Diya’s feet. “I want to hear from the oncology team. When can we start the new treatment? Will this delay affect her chance at remission? We already know her disease is refractory and we’re hoping this new chemotherapy will finally work. Who was responsible for the change overnight? I want someone to be held accountable for this.” 

“What else?” she reiterated, softly, somehow maintaining sincerity to the now-thrice-spoken phrase.   

Rishaan took a deep breath, absorbed in thought. “My wife was here during the day yesterday. We alternate spending days and nights at the bedside. We do our best to tell each other what the plan is for Diya, like starting chemotherapy last night. But the doctors and nurses often seem to have a different understanding. It’s usually small things, but I wish the communication was better.” 

“What else?”   

The father reflected further back on the interwoven short- and long-term stresses of being hospitalized for months: difficulties with IV lines, prognosis fears, nutritional concerns, and worries about their other children. As he finished speaking, the oncology team arrived, and he repeated his concerns. Our team remained at Diya’s bedside, holding the space and listening, feeling as if we had pressed a video replay button. However, we couldn’t help but notice his muscles relax, eyes soften, and calmer voice. 

Silently, I marveled at the healing power of my attending’s two-word communication tool, seemingly simple but profoundly effective when delivered with insight and care. In this impossibly difficult space, at the bedside of a seriously ill child, she tried to identify and address the unmet needs and fears that were residing underneath his temporary anger, and to genuinely validate him as a loving father.  

As the conversation continued, the oncologists apologized thoughtfully and answered his questions patiently. They offered a formal safety event report, a patient advocacy referral, and extra communication from the primary oncologist, which were all gratefully accepted. But, just as my attending had immediately intuited, the oncologists recognized that perhaps more than anything, our patient’s father simply needed to feel heard.  

Which evokes the question: How often do we truly listen well? Research has shown that clinicians interrupt their patients early and often (every 10-20 seconds, on average). We barge to the bedside, ready to rattle off our routine questions and pronounce our premeditated plan. Do we pause between comments? Does our body language communicate openness? Do we elicit our patients’ concerns and adapt the conversations to address them? Or does our list of topics supersede theirs? Again: how often do we listen without an agenda?  

Because what else could be more important?