Would you call that a honest demand?
I wouldn’t.
In ordinary circumstances, a patient would never ask that
from her doctor (yes, let’s assume we talk about a ‘she’
patient).
She trusts him — let’s also assume her doctor is a ‘he one’–
and she knows that he always talked genuinely with her.
And never would hide anything important concerning her
health condition.
Really never?
It CAN happen that the doctor, quite unsure about a possible
bad evolution in his patient’s condition, prefers to keep quiet.
But when the patient’s condition has obviously been worsening,
she guesses very often that her doctor is trying to hide her his
opinion about her situation.
And then, sometimes, she finds the courage to ask him, in fact
to beg him:
“Tell me the truth, doc!”
What does she really mean? Most probably this:
“Stop, please, hiding me what you really think about the
possible evolution of my illness!”
And such a demand is a very serious one when the doctor
is actually concerned with the possible nearby death of his
patient!
What can he tell her without risking to loose or — at least –
seriously damage her trust in his sincerity?
Should he talk her about the statistical probability of her
Survival? I don’t think it would be a wise answer.
The Medical Faculty taught him that an average patient at
this stage of the evolution of this special illness will probably
be dead before so many weeks, months or years.
Probably the “average” patient, yes. But is SHE one of these
average patients the stats tell us about?
Okay, MOST patients will behave according to the stats.
Let’s say 90%.
But the remaining 10 %? What will THEY do?
Let’s assume that 5% will die earlier, maybe much earlier.
But the 5% — at the other extreme of the probability curve –
will live much longer. Maybe not die at all (at least from
this disease.)
One talks then often of a medical miracle. But it’s nothing
more than a totally foreseeable statistical phenomenon: the
exception that “confirms the rule”.
Not SO exceptional either: one on the hundred ‘members’ of the
Stats may expect such a good fortune!
Why not her? This very patient of mine, there in front of me.
I really don’t know for sure how this life endangering illness
will develop in HER case. I can just make suppositions — for
and in myself.
Nothing I can tell her, of course. But I owe her an answer!
A quick college statistical, nevertheless? Maybe. But not
every patient can be satisfied with such an vague answer.
She wants to know HOW SHE will DO in the nearby future.
She doesn’t care about ONE’S ILLNESS where the scientists
always talk about.
I could talk her – I did that several times during my career as a
family doctor — about the really life endangering present stage
of her illness. That she possibly could die, not so far away.
BUT that her WILL to fight for her life, even in this dangerous
moment, can make that SHE won’t die, that she will make true
the next medical miracle in my career!
And that I am eager to help her realize that miracle.
That remembers me of a patient of mine, a sixty six old man by
whom a quickly developing colon cancer had been diagnosed.
When he asked me how long the Faculty gave him to survive
his operation, I honestly answered him: “Probably half a year”
and encouraged him to fight with all his power.
He fought successful one and a half year, with the help of some
expensive but very efficient holistic drugs. A month before he
collapsed, he spent a beautiful summer holiday with his family
in the Austrian Alps. He was even able to make some climbing.
When he realized that all at once his strength was fleeing away,
he asked me once more how long I thought he might stay in life.
My answer was; “A couple of days if you stop feed yourself.”
He chose to stop even drinking, but asked for opiates to lessen
the pain and died very serenely a week later, short after a nice
farewell ceremony from his family which he asked the parish
priest to organize around his bed.
This is of course the way many of us would prefer to die. Not
everybody however wants to stay as conscious till the utter end.
Not every patient can stand the naked scientific “truth” about
her nearby death. Many less courageous people will receive
from their doctor a different version of the truth they maintain
to claim.
The duty of the ‘accompanying’ doctor is to evaluate and to
reveal to each patient the amount of “truth” she is able to cope
with. Not more but certainly not less.
Each patient is a unique person who deserves an appropriate
and even unique answer to her solemn request. Only a sound
knowledge of her psychological – and spiritual – needs can
inspire the right words to her ‘end of journey’ counsellor.
If you let me give you a good advice, dear reader of this mail,
Don’t wait till the fore last minute. Choose in time the doctor
whom you will be able to ask — in full trust that he won’t lie
or hurt you –
-Tell me the truth, doc!
=============================================
I hope you won’t mind if I make now a few ‘philosophical’ or
linguistic’ reflections.
You know, I taught medical psychology for 20 years to a lot of
medicine students. In fact since the very beginning of the
Antwerp Medical Faculty.
And all those years I tried to make my teaching language
each time clearer and more adequate to the topics I discussed
with my 21 years old students.
They were not more than 30 in the heroic beginning of the
University : almost boys. But in my last years, they were
Already more than 100 — almost girls. Times do change.
I am sure you’ll forgive me to have revealed something about
my own person before you take the challenge to follow me in
my more “philosophical” reflections.
If you are NOT so interested in such a “heavy” topics,
please * J U M P * straight to the END of next section:
==============================================
BUT.if you ARE, Fellow Heavy Thinkers, here we go!
==============================================
4. The Editor’s view about Truth!
=============================================
What for a “truth” is the patient here above asking for?
What would SHE call The Truth in this case?
A plausible description of the development of her bad health
condition. An explanation she can believe and put up with.
But a “truth” her doctor also really can believe. And actually
does believe. In fact she asks for a “truth” they both believe
in and want to work with.
Is The Truth then nothing else than a suitable, from both
partners agreed tale? A story we now believe because
we trust each other TODAY ? Maybe we won’t believe
“that truth” tomorrow any more. But another truth:
Our tomorrow’s truth.
Truth – our truth – is like a living being: it has to be born,
To live a certain amount of time, to die and fully disappear.
Just as our Feelings do. Their existence is limited to the
duration of our actual relationship to a person or an object.
Do I assume then that there is no other Truth than such one?
Yes, I do. Truth is for me “social stuff”. A kind of secret
between a “You” and a “Me”.
And a secret “we” BOTH believe in.
For the present moment.
And this “You” has not to be a person of flesh and blood.
It can be God, the Bible, or even the Science, the Fate.
As long as I confirm “Your” existence for me by talking
to “You”, by BELIEVING in “You”.
Truth is thus a question of belief, of trust.
When the trust is over, the belief vanished? “Farewell Truth!”
Scientific Truth becomes “a remnant of a primitive stage of
Mankind”. Do you remember the “childish” conception of
the old Ptolemy: the Earth as the centre of the Universe?
Even Religion is often degraded nowadays to the status of a
nice fairy tale “we” once believed when “we” were just kids.
And consider how difficult it is for us to remember vividly
that we have really been in love with a person we now fear
or despise so much.
But we really have been, you know! And it was true love.
THEN.
Let me try to give an exacter definition of the word truth,
as we commonly use and understand it:
Truth is what both (or more) partners agree to be true
at the very moment of their trustful conversation.
They both (or all) believe that truth. But They are
the only ones to can bear witness to it.
Nobody else can.
Truth has nothing to do, consequently, with a Permanent
Universal Reality that would exist on its own, either we
believe it or not.
Truth has thus nothing to do with Objectivity. With Facts.
And only facts seem to obey to the laws of the contemporary
Science. They can (mostly) be checked by an independent
observer. One can measure them, mathematically analyse,
repeat and predict them.
Do you need to believe something or someone to be sure about
a fact? NO ! You just have to check it by yourself.
Facts can’t be true or false. They just ARE there, outside
of us, ‘waiting’ till the Science begins to explain them. In
other words, till we perceive them and give them a name,
a significance.
And that name IS NOT the fact itself , but the OPINION one
has about this fact (e.g. “the Earth is flat”) depending a lot
of the explanation the Science builds around that opinion.
Many scientific theories and axioms have taken, nowadays, the
place of the former religious Authority. You have to agree
with them if you want to build a career at the University or
if you want to be published in a “serious” magazine.
Just as the Churches did in the old days, the ‘Academics’ teach
the people what they SHOULD now believe about the universe, if
they want to avoid a conflict with the ‘spiritual’ Authority.
Those scientific dogmas (or paradigms, as they were recently
renamed), are presented to the people as the Truth. And they
ARE really the Truth . for those who BELIEVE in them.
As long, of course, as the present believers won’t loose their
‘faith’ in them. And choose a new scientific Truth to believe
in (also doomed — of course — to disappear sooner or later.).
This has always been and will probably ever be the behaviour
of the upper intellectual class.
Why do I insist so heavily upon this point?
Because the Holistic approach of the reality (and of course
of the Medicine) proceeds from an other paradigm (another
belief about what is real) than the paradigm of the majority
of the contemporary scientists.
But I’m sure it has been enough for today. We’ll surely talk
again about that big problem. In one of next issues.
