Bedside Manner - How NOT to visit a cancer patient
(by Dr. Albert Lim - published in The Star, May 2007)
WHAT if I told you that cancer patients feel worse off after your visit? And what if I told you that your visit might affect their chances of recovery?
You would probably react immediately with righteous indignation. It goes against all that you've been brought up to do and think. Surely it is the "normal" thing to visit sick people, and especially very, very sick people. Not to visit goes against the cultural grain.
It is accepted practice that we visit our friends (and even acquaintances) when they are ill. It is almost an instinct. In terms of evolutionary biology, it is a programme shaped by our environment, culture and religion. It is nature via nurture.
What if I told you that your visit does more harm than good in most instances? I come to this conclusion after my 30 years of talking to and treating cancer patients.
Would you at least think about it? Would you perhaps, if you see some truth in what I am about to say, consider visiting them less often and for shorter periods?
Picture this scene. The cancer patient is cachectic, pale, jaundiced, and gasps for breath. He drifts in and out of consciousness. He soils his clothes with saliva, urine and worse. He fights to keep awake for the 20 "nice" people in the room who have taken the trouble and time to make the visit.
Someone tells him in an unconvincing tone: "Have faith and you will get well." The patient says, "Sure I will. My fighting spirit is strong," but he thinks to himself, "I have terminal cancer and I feel worse with each passing day. At most I have another three months. I really cannot take any more of these inanities."
This scene is played out countless times all over the world every minute. Malaysia might even be right up there at the top of the league.
Picture another scene. The nurse manager hangs a sign "STRICTLY NO VISITORS" on the door of the patient's room. I enter the room and see half a dozen well-wishers. "NO VISITORS" usually means about 12.
Cancer is sometimes about blood and guts and gore, but it is certainly not a spectator sport.
Let us honestly examine our true motives when we visit patients. Firstly, it may be to earn brownie points. This is a less painful and messy way to reach the celestial realms compared to other actions.
Secondly, we do not want to be the odd person out in our circle who did not want to make that visit. Heaven forbid! What will our friends and relatives think? Are we that uncaring and unkind?
Thirdly, it is the thing to do. Why, it comes so naturally there is really no need to think about it. An ill patient provokes a knee jerk visit response. One follows the other. Slash and burn in Sumatra, haze in Malaysia.
Fourthly, tai-tais can fill up their early afternoons with visits to cancer patients and talk about the visits during high tea. What a splendid confluence of interesting activities.
I could go on.
What then is the harm?
I already intimated earlier that the wrong words could hurt, depress and upset the patient. Moreover, the patient is fatigued and really needs his rest. Visitors increase the chances of passing on germs to the patient, who is already immunocompromised.
Moreover, he does not want you to see him at his worst.
There are two more nefarious reasons for these visits. Some will try to peddle their gypsy cure for cancer (read: alternative medicine). This will only confuse the patient and hinder the oncologist in his work.
The poor blighter is vulnerable and open to anything ("Life is unbearable because death follows life" - Ted Hughes). Some will try to effect a religious conversion in the patient.
Where does all this leave us?
You may wish to mull Albert Lim's eight golden rules for visiting a cancer patient.
1. Always, always, always ask for consent from the patient or the spouse (or his nearest and dearest) before the visit and do take the hint when you hear the hesitant "aahs" and "oohms".
2. Keep your visit short. Fifteen minutes is a good rule of thumb, unless of course the patient clasps your hands in his and says 'don't leave me', which happens more often in movies than in the hospital.
3. You really don't have to bring flowers, Brand's essence of chicken or the latest article on alternative medicine (ozone therapy or is it the cytotron?) Books and magazines are suitable. CDs and DVDs for those who eschew reading.
4. Please don't say "Have faith" (I'm afraid mine is not that strong) or "you will be all right" (you know I won't be) or any variation on the same theme. These vapid clichés will only irritate, depress and unnerve the patient. Such comments may even insult his intelligence.
5. Do something positive. Give him some money. Put his kids through college. Write a letter to a government department for the patient. Take his kids out for a meal and a movie. Better yet, change his undies and give him a bed bath.
6. Do not proffer alternative medicine.
7. Do not proselytise.
8. Before departing, say "Please let me know if you want me to come again. More importantly, please let me know what concrete thing I can do to ease your suffering" (See no. 5 above).
Visiting a cancer patient is not that difficult after all. All it needs is a moment's thought and an hour's reflection on life, suffering and death