Today in clinic, I delivered some bad news to a patient. I told him and his wife that he had liver cancer. Three weeks ago, he came to clinic after being referred for gallstones. When I examined him then, his liver felt really rubbery and weird, to use technical terms, and when I showed Dr. Pott, he thought it worthy of an MRI. The guy had been a heavy drinker, and also had signs of chronic illness - temporal wasting, weight loss, etc.

Today, the patient came back with the results of the MRI, which confirmed hepatocellular carcinoma. After Dr. Pott and I had a hushed discussion while examining the MRI, Dr. Pott left the room briefly. I was left with the patient and his wife, and I asked them if they had been told the results of the MRI. They hadn’t. To me, it seemed obvious that the patient needed to be told that he had cancer, so I told the patient and his wife, as compassionately as I could, that he had cancer of the liver. They looked at me, stunned and confused. As a medical student, I probably overstepped my role, to tell them this without the attending doctor in the room. However, I felt that the information should be relayed to the patient and assumed Dr. Pott was about to do just that.

Dr. Pott came back in the room, but didn’t know I had told them the news. He asked the patient to leave the room so he could talk to the wife. After the patient left the room, Dr. Pott told the wife that the patient had liver cancer, for which there was no treatment in Belize, and that he had 6-12 months to live. The woman was clearly holding back tears. Dr. Pott, not knowing that I had already broken the news to the patient, asked the wife how much information she would like him to tell the patient. She replied that she would like him to say he had liver cancer, and that’s all. The patient was called back in the room, and Dr. Pott told him he had liver cancer.

In the U.S., the way this scenario played out would have been a violation of the patient’s right to privacy. Dr. Pott may have had a reason for telling the wife and not the patient the full story, e.g. perhaps Dr. Pott knew the patient well enough to know that the patient wouldn’t want to hear he had cancer and would rather have his wife make all medical decisions. I think this is unlikely. In this culture, it is likely that the way Dr. Pott handled the situation is the norm. In retrospect, before I broke the news, I should have asked the patient how much he wanted to know about his illness. Nonetheless, it was a moving experience, and I will never forget it.

Photo: Man fishing in Hopkins, Belize