Is false hope better than no hope?
You have end-stage cancer, the chance of any sort of meaningful recovery is pretty close to zero, if not actually zero. Do you want the doctor deluding you into believing there's hope, and offering a stream of experimental treatments that there's no rational reason to believe will work? Or do you want her to help you accept that this disease is going to kill you, and most likely really, really soon?
I mean, obviously there's no good answer. Of course if there's any chance of success, most patients are going to want even the most long-shot treatments. And if there's any reason for optimism, the doctor certainly shouldn't be discounting it.
But I think what's been getting to me these past few weeks-- as I've been on a service with probably the sickest patients I've seen since I started residency-- is that the amount of hope presented is so disproportionate to the reality. "We'll try this, and hopefully it'll work," is not a lie, but when you've tried three similar treatments, and the patient has the genetic markers that indicate this one won't work either, and even success at this point is extending life by a few weeks-- it's hard to watch the patients get so excited about the possibility, to watch them use that hope to plan the future, to hear them talk about a future that is so unlikely to exist...
No one's trying to do a bad thing-- you worry, to some extent, that at some point treatment takes away from quality of life, and the costs and benefits of doing it-- but in a lot of cases, that isn't even an issue-- the disease causes pain, the disease causes enough problems that even failed treatments aren't necessarily making things worse. If you can barely get out of bed anyway, then, sure, why not try the experimental treatment with a 0.1% chance of helping, if it's not going to make you feel any worse while it's happening?
And the doctors are trying to make miracles happen, absolutely-- they genuinely hope the treatments will help, they genuinely want things to work-- it's just that there's a disconnect between the reality and what's communicated to the patient.
And so when the end does come, there's a level of surprise that it's so hard to see. "How did this happen?" She's been extremely, extremely ill for weeks now, the disease was running its course, this is what we knew would happen-- "But we thought the latest treatment--" The treatment didn't work. We didn't think it would work. We hoped we'd be wrong, but this was the most likely outcome. "But how did she go downhill so quickly--" She's been going downhill for months, this wasn't quick, this wasn't surprising-- Except it's surprising when you're prepared for success, when you're holding on to so much hope that the hope exceeds the reality.
I don't have an answer. I don't think we should make patients and their families sadder than they need to be. I think we should let them hope, and keep trying treatments that might work, even if they probably won't-- as long as the patient wants them. But I also think there's a line-- a line where the hope becomes false, and the interaction is a lie. And I don't know if I could spend a career lying to patients and creating hope that I don't really believe in. It's too hard for the patient, and for the doctor.
I mean, it's hard in any case. People dying-- it's hard. Period. I don't know. I haven't yet seen a miracle cure happen, so I guess I have a hard time understanding how the doctors can make a career of this. I feel like I'd have to see some long-shot treatment work, at least once, to believe it can, and to believe there's good to be done here. Otherwise it just all seems so futile, and like practicing this kind of medicine is pointless. They're dying, soon. We're not really helping. It's hard.