A guilty secret from a patient’s past

He was an old physician, and I was a young specialist, sent to see him after he had been hospitalized by his primary doctor because his chest X-ray showed a lesion.

When I introduced myself and told him why I was there, he asked me if I thought he had cancer.

I would have preferred to answer after taking his history and examining him. But I had already reviewed his X-ray and responded honestly. I told him it looked very suspicious.

Over the years, I have had to inform many people that they may have lung cancer, so I was prepared for any number of responses (“How long do I have to live?” . . . “I can’t have cancer.” . . . “Are you sure?”).

But what he said next shocked me: “I was expecting that. You know, I deserve it.”

I strained to keep the same expression as I wondered how this could be. After all, he and I were members of the same healing profession, sworn by the Hippocratic oath to work for the benefit of the sick and to “keep them from harm.” What had he done to feel he deserved cancer? Surely he knew what pain and suffering this diagnosis might bring.

I sensed he had a need to tell his story, so I proceeded with my doctor-patient interview. His primary doctor had requested I come to a diagnosis of his chest abnormality. But in the process I knew I would learn a lot more.

He was an 84-year-old retired surgeon. He had been admitted to the hospital with cough and weight loss.

He had been a heavy cigarette smoker, and he noted that he started smoking when he enlisted in the Army in 1940. I had met a number of veterans during the course of my practice who told me that the Army gave away cigarettes during WWII, and my patient was one of the ones who got hooked.

He was discharged from the service after the war, finished a residency and went to work at a VA hospital. He thought he would stay a short time but ended up there 35 years.

I was about to ask about his retirement, when he suddenly said, “That’s where I did those terrible things. If I have cancer, that’s why.”

I didn’t have to ask him to tell me what he had done. He went on freely to tell me -- to describe what he called “experiments.” At that time, physicians didn’t need to ask for consent or go through an ethics committee in order to study human beings. One study he was involved in entailed placing barium (a white chalky substance) in the back of sleeping patients’ throats. The next day, X-rays were done to see how many of them had breathed in the barium.

Some of the men choked violently, my patient said. One veteran died of pneumonia and scarred lungs. After this happened, he stopped doing human studies. He said that he had never forgiven himself.

When he had finished his story, there was a strained silence. I thought he had done a terrible thing. He had inflicted pain and suffering, the opposite of what a physician tries to do. I did not tell him this. I completed my examination and left his room.

He did have lung cancer. I arranged a biopsy of his chest lesion, and it came back as small cell carcinoma, the most aggressive type. I went back to see him and to tell him the results.

He was not surprised. He told me that he felt at ease and that he would refuse any treatment.

Without treatment, my patient’s life expectancy was less than six months, possibly three. With treatment, he might live as long as a year but would have to endure intensive chemotherapy, which was sure to bring debilitating side effects.

Then he thanked me for helping him. I assumed he was referring to my effort to establish a diagnosis.

The next day, I heard the announcement of a “code” on his floor of the hospital. Someone had suffered a cardiac arrest, and a team of doctors had been mobilized to attempt resuscitation. I later learned that it had been my patient and that he had died.

I slept poorly that night, thinking of what I might have said to him to make him feel better. His death had made it certain that I would never have the chance to tell him I didn’t think he “deserved” to have cancer. He had made a serious mistake, but he also had devoted the rest of his life to the care of his patients.

I did not yet know what I have since come to believe -- that my silence had provided what my patient needed most.

The next night I awoke suddenly and said out loud, “He told me.” I realized then that he had been waiting to tell someone his secret. And I had been there to give him his wish.

He had expected condemnation, and I had neither judged him nor said anything especially profound or placating. I merely listened. Through his remorse, he taught me a lesson I hoped never to forget.

I realized that despite the seriousness of someone’s illness, a physician can still, somehow, find a way to provide comfort. In this patient’s case, it was simply by listening.

Dr. Francis V. Adams is a pulmonologist in New York City and the author of “The Asthma Sourcebook” and “Healing Through Empathy.”