Day One Talk: Part 1
I remember the moment when I learned that one of my close family members had cancer.
For some reason though, the memory that really sticks with me is from the morning after: I drove to the hospital, just like always. I parked in the garage, just like always. Then I got on the hospital elevator, just like always. But when I got off the elevator, suddenly I was no longer a medical student preparing for rounds, but a visiting family member of a cancer patient. As I looked out the window, watching the cars and people below — rudely going about their business as if nothing had changed in the world — I realized that I had crossed a threshold and that life was never going to be quite the same.
I am sure that the parents of our pediatric oncology patients (not to mention the children themselves) feel something similar, but even more powerful and overwhelming.
One of the key jobs of a pediatric oncologist is to successfully guide families through this critical period. A new diagnosis of cancer is often a medical emergency, with diagnostic procedures to be performed, antibiotics to be given, and treatments to be started. Perhaps equally importantly, it is also a social emergency. For this reason our team at Texas Children’s Cancer and Hematology Centers includes social workers and child life specialists who can help with this life-changing transition. We believe that the medical team who takes care of a child (and family) in these first few days can make a huge impact on how comfortable the patient and family will feel about their disease and with the medical team moving forward.
A new cancer diagnosis requires that a huge amount of information be conveyed from the medical team to the family in a very short amount of time, including the sometimes complex diagnosis and treatment options and the review of a multitude of consent forms for treatment and research studies. The paperwork can be daunting, for both physicians and families. The culmination of these events is the “Day One Talk", where the medical team and the family (including the patient, depending on their age and family preferences) sit down to explain the diagnosis and plan moving forward and answer the family’s questions. Each oncologist has their own strategy for giving this talk, and their own style of conveying the information. All of them need to serve several critical functions however…
I’ll write about my approach to this in Part 2.