The doctor is making rounds and you are "rounding" with him. At the end of the long hall, you enter the room and move to the bedside closest to the entry while the doctor walks around to the other side of the bed.
He is here to tell the patient what the patient already knows. Softly he speaks the words I've heard many times before. "We have exhausted all resources. The chemotherapy bought some time but your cancer is back. You might want to get your affairs in order", the voice drones on never rising or falling with inflection.
Sometimes the patients hand reaches to hold my hand tightly as he listens to what is being said to him.
Occasionally the family requests the doctor to consult them with any medical information before telling the patient. The doctor complies and notifies the family members before the patient. Usually the patient already knows he is terminal simply by the severity of his illness. On occasion, rare though it might be, the family decides to not allow the doctor or the nurses to inform the patient.
I have not met any medical professionals that agree with this decision. The patient isn't a child. We feel they have the right to know and the opportunity to get their affairs in order; to make contact with friends or family. You are not sparing the patient. They already suspect. You are not protecting them. Your decision to deny them these final decisions in their lives is misdirected. You will do a dance around the truth with the person and those final days that could be shared with conversation to be remembered will be strained and uncomfortable. The patient will know you couldn't face the end with them. This final sharing of lives lived together is lost to this couple.
Family members visiting, children and siblings have to smile falsely and share in this charade. Everybody knows, including the patient. Everybody has to ignore the elephant in the room and the visits become uncomfortable.
Soon the visits by friends and family will become too uncomfortable for everyone. The stress of keeping "the secret" will prevent those visiting sharing any real conversation and laughter.
The end will be a relief for everyone involved in the charade and the guilt from that relief will follow.
Take a moment to think about being a participant in your role at the end of life of a loved one. This is a path each one of us will tread someday. There can be laughter along with the tears.