Mea culpa 

By Eric Last, DO, Zucker School of Medicine & Department of Writing Studies, Hofstra University 

I walked across the threshold of the sixth exam room door I’d opened that morning. I immediately noticed not the patient, but a scowling visage, expressing unapologetic anger. 

My schedule for the day (or as I’ve called it my “aspirational list”) was corrupted even before the first patient entered the building. My already short-staffed team was further whittled down by illness. Those that were on their way to work were delayed by the perennial affliction of traffic on Long Island. And the spirits that possess the technology that runs our practice had conspired against us, delaying the importation of the previous day’s lab reports, and throwing me off the EMR before I could push “save” for a very detailed note. 

The real delay, though, was presaged by the results I saw on my computer screen just before entering the third exam room of the day. “Metastatic carcinoma, consistent with patient’s previously diagnosed primary malignancy” read the pathology report from the biopsy the patient had undergone three days prior. Just short of five years before, she’d undergone difficult and life altering surgery for cancer. Her post-op course was marked by complications that she’d overcome. Because the surgery was successful, with the pathology report celebrating “wide, negative margins” and “19 lymph nodes with no evidence of metastases,” she required neither chemotherapy nor radiation. She’d gone about her life for the succeeding 4.9 years, complying faithfully with her surveillance schedule, all revealing “no evidence of recurrent disease.”  Then she developed symptoms thought to be unrelated to the original cancer and the complications. And so, the imaging that revealed a mass consistent with possible metastatic disease came as a surprise to all. As did the devastating results of the biopsy. 

The faces behind the third door weren’t displaying anger. Rather, their expressions quickly transformed from fear to hope, to despair, then back to hope as our discussion ranged from the giving of bad news to assurance that there were reasonable treatment options. The final expression was gratitude—the patient and her partner were grateful not for the news, but that they’d heard it from a person they’d known for years. They were relieved that they wouldn’t need to endure a tortured weekend of waiting to see the oncologist before hearing the test result. 

By the time I entered the sixth room, my reserves were ebbing. When the indignant facial expression coalesced to a verbal expression of anger: “You kept me waiting so long I thought you forgot about me,” my meditation practice failed me. I started to react with “I’d never forget anyone, but we’re having a really difficult day.” 

And hence my mea culpa. I realized—and acknowledged—that I wasn’t having a bad day. I may have been annoyed, bothered, and frazzled. But the truly bad day was had by the patient with cancer, and by her partner. My staff and I would return home that night pretty much as we’d left that morning. Our patient would not. 

It’s incumbent on us to remember that those truly experiencing a “bad day” are the people whose lives will change forever when we cross the threshold into their exam room and tell them things they never wanted to hear.  

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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.