Palliative care consultant and writer Dr Kathryn Mannix has just released her latest book Listen: How to find the words for tender conversations. With permission from HarperCollins Publishers New Zealand, here is a short extract from Listen about how to get started when having difficult conversations. To win a copy of Listen, please email firstname.lastname@example.org with your name by Tuesday 23 November and you’re in the draw. Good luck!
It can be difficult to start a conversation about anything that raises strong emotions. It doesn’t matter whether it’s asking someone out on a date or talking about our funeral arrangements with our dear ones: sometimes our own emotions and sometimes our concern about theirs hold us back. Finding a way to begin that allows both people in the conversation to feel confident of being respected and heard sets a tone of collaboration for the rest of the discussion.
‘Doctor Ma’am, have you got my scan results back yet?’ Mr Majumder has asked me this several times a day for three days, every time I pass his bed as I tend my patients on this surgery ward where I am completing my first year of being a Real Doctor. Six months in a surgical ward has convinced me that I am a physician and not a surgeon at heart, and yet I love the technical skill I am sometimes privileged to watch as a surgical assistant in the operating theatre.
Mr Majumder has become alarmingly yellow. His brown skin has taken on a vaguely grapefruit-coloured glow and the whites of his eyes look like lemon slices. The scan is part of a battery of investigations: as the results of blood tests, X-rays and biopsies come back, I am assembling a picture that describes why Mr Majumder is jaundiced. And I know it won’t be good news. The scan result will be the last detail in the picture, and then the surgeon in charge of his care will be able to tell him what is already becoming clear: Mr Majumder has cancer in his pancreas, and he will be lucky to live another six months.
Usually I smile ruefully and say, truthfully, ‘Not yet Mr
Majumder! But when I do, you will be the first to know!’ But today I know the envelope is in the office, and the time for that conversation is approaching.
Mr Majumder is visited twice each day by his devoted wife and one of his brothers. His wife wears rustling silk saris and walks like a queen; her calm grace dignifies the plastic chair beside the bed. His brother wears a business suit and never sits down. He cracks jokes, shuffles from foot to foot like a nervous foal, talks loudly, claps his brother on the arm and hurries away, wiping tears away from his eyes once he turns the corner away from the bed area. Mr Majumder takes extra painkillers before visiting time. ‘I don’t want them to worry about me,’ he tells the nurses. ‘I must not cause them any burden.’
I approach the bed on heavy legs. He smiles at me hopefully. My mouth is dry; my smile feels false. A voice in my head informs me that my demeanour is screaming ‘bad news!’ to the whole ward. I try to ignore it.
‘Mr Majumder, I think we should have all the test results back today,’ I begin. I am too junior to be the bearer of his bad news; I don’t have enough knowledge of the disease, and any possible treatments. Or so I tell myself.
Mr Majumder holds my gaze. I feel myself blushing. My stomach flips. What if he asks me outright?
‘If it’s good news, Doctor Ma’am, I would like to hear it soon,’ he says. ‘If it’s bad news, then I would prefer my brother to be here.’
I don’t know what to say. The brother never pauses for breath: he talks and talks so that there is no room for conversation. Anecdotes, jokes, have-you-heard-the-one-about . . . Mr Majumder’s brother is terrified. How could he support Mr Majumder?
‘Is your wife visiting later?’ I ask him. He says yes. ‘She’s an excellent wife. She is a good mother. She visits me every day.’ He pauses, a frown playing across his face before he continues, ‘I take great consolation from her goodness.’ I can imagine how her quiet gentleness would console him. I am about to suggest that perhaps
his wife, rather than his brother, might be here to talk with the surgeon when he says, ‘And that is why she must not be told any bad news. She must have hope. She must be able to take care of our children without sadness.’
He knows. He already knows. Relief and dread compete in my mind; what should I say?
‘Mr Majumder, I’ll get all the results together and make an appointment for Mr Castle to see you and your family this evening when he finishes operating. He usually talks to his patients and their families at six p.m. Is that convenient for you and your . . . brother?’ I nearly said wife. Oh, I want his wife to know.
He agrees. He is kind enough to ask me no more questions. The stage is set for later. I have done my best. But I have ducked an opportunity to explore what he might have guessed; I know it, and he knows it, and I know he knows I know he knows. Surgery seems simple compared with communicating well. I have so much to learn.
It can take courage to begin a potentially emotional conversation. Concerns that deter us from getting started include thoughts like
‘What if I get emotional?’
‘I won’t start because I don’t feel calm enough.’
‘What if I make them feel upset?’
‘They might want to ask something I can’t answer.’
‘How will we be at the end of this conversation? What if we’re both distressed?’
‘What if they don’t want to talk about this with me?’
All of these are realistic, important ideas. They show us that getting started isn’t the only hurdle: there are other things to consider like how to check that the other person is willing to join in, how to navigate the conversation once it starts, and how to get it to a safe place, whether or not the discussion is complete, before leaving.
© Listen: How to Find the Words for Tender Conversations
By Kathryn Mannix
Published by HarperCollins