The Magic Words: On Beating Cancer and More

I’ve been a practicing physician for 20 years. In this series, I share some of the best practices and helpful phrases I’ve learned for talking about bad news and end-of-life issues with patients. This time, I’m reflecting on death and dying, and the lessons patients and families have taught me.

Some bonus reflections, after seeing and managing too many deaths:

Always thank them

I didn’t figure this out immediately. It took me a while. Definitely, no one taught me this secret. For over a decade, I saw doctors treat dedicated family members as some kind of taken-for-granted and inexhaustible resource. They’d just interrogate them for information on hospital admission, and assign them tasks prior to discharge. Never a kind word, it seemed.

This is a shame.

We recognize the sacrificial work of parenting all the time, and we should. It’s crucial, society building, difficult work to raise a kid. It’s also awesome watching them develop and learn. Giving up your own life to take care of chronically ill, failing loved ones, on the other hand, is at least as much work, usually much more. And the reward isn’t the laughter of children but shared pain, progressive loss, and eventual death.

Doctors, please reward these amazing family members with at least your respect and thanks. Repeat after me: “You have the hardest job in medicine, and it’s unpaid. I appreciate you and all you’ve done.”

It’ll take you a second and cost you nothing. It’ll mean the world to them.

Normalize the normal

It was 2001, I think; I’d been up all night managing a patient whose bile duct cancer had obstructed his bile flow and triggered a serious infection for the seventh time, only days after the last procedure to unclog his duct, and he looked simply moribund—hard to arouse, febrile, bright yellow. I wasn’t as skilled with end-of-life discussions then, but I got his goals of care changed to comfort. The technical goal had been achieved. The following morning, a supervising doctor showed me how to do it with grace.

The patient’s wife broke down as we spoke in the room. “I’m sorry, I’m so sorry,” she kept saying as she cried.

On this service, outside doctors often managed patients who had been admitted to the hospital. They had long-standing relationships. And I could see the benefits immediately.

“No, No, it’s okay,” the doctor said, pulling the wife into a hug. “It’s your job to be upset. What would he think of you if you weren’t?” I knew right away I would use those magic words many times in my career, and that I’d be following this doctor closely to learn more of her skills.

“How long have you known them?” I asked, thinking she was saying goodbye to a long-term patient.

“We just met,” she said. I was blown away. She had such ease with them, such care. It makes such a difference.

Yes, we can win

“She beat cancer.” These are the words of a mentor and colleague, on the occasion of losing his wife to a more than two-decade battle with cancer. How do you win in dying? The logic is pretty simple. We all die. Does that make us all losers? Are we all eventually defeated? Or should the judgment lie in how we live, and what we do?

Some patients with cancer raise kids. They keep working. They try, and try again, when treatments don’t work. They keep their composure. My colleague’s wife battled cancer for years and it failed to sap her spirit, her love of family, and her love of life. I’d never heard anyone put it that way before (“She beat cancer”), but when I read those words and his convincing explanation in her obituary, I was deeply moved. Here was a new way of confronting illness I hadn’t conceived of after all my years as a hospital doctor. And I wanted to try those words out the next time I needed them:

“Cancer wanted you to give up. You didn’t. You fought with everything you could and you kept your humor and your dignity and your values. You beat cancer.”

Those, on the occasion of enrolling a patient in hospice and preparing for their certain death, are definitely some magic words to say.

Thanks for reading. It’s been quite a journey and privilege taking care of amazing people at some of the critical and vulnerable moments of their lives. I hope these posts are helpful for patients facing cancer and other serious diagnoses, and their doctors.