One of the things I dislike the most about my job is expectation management. You know, making sure people don’t expect miracles and get depressed when they don’t happen, because that could make things even worse than they already are.
For example, today I had my first follow-up with a patient that we diagnosed with a progressive interstitial lung disease…basically, his lung tissue is slowly turning into scar tissue. (Scar tissue does not pass oxygen the way lung tissue does, and while functional lung tissue can turn into scar tissue, scar tissue can’t turn into functional lung tissue….so I guess you can see where that’s going.) We did a couple of things at his initial appointment that got him feeling a lot better: he’s now on portable oxygen, so he can walk upstairs to his apartment without having to stop on each floor, etc. Which is awesome.
But what kills me is that then he turned to me and said, “Doc, I feel like my body is breaking down the disease in my lungs, and it’ll just keep getting better.”
And my heart sank. Because then I had to bring out my ugly, ugly truth-needle and pop that poor, hopeful bubble. Because he’s not going to get better. This thing will kill him far earlier than he should have died. Of course, I didn’t say that in as many words. But I did have to tell him that his lung disease wasn’t going to go away, that we can manage things and try to keep them the way they are now, but that this is probably the best it’s going to get.
I. Hate. Killing. Hope.
But it’s better to trim it down a little to a more of a realistic view now that he can grow to accept, than to let his expectations eat him alive and make him end his life with anger, confusion, depression, and betrayal.
Honesty is still the best policy. Even when the truth is ugly. Because people deserve to know what’s going on.
I can only hope that they understand.
(And once again, it’s always the nice people that have the worst diseases.)
(Today was not a very good day.)
(I feel like there are probably a lot of other viewpoints about this issue; what do you think?)