The diagnosis

So after being told by the GP that he was 99.9% certain that nothing sinister was occurring in dad’s lung, I was a lot happier but still worried. My concerns grew as dad’s ‘pneumonia’ still did not resolve with another set of antibiotics. He went to see another GP in his practice who then arranged for dad to be admitted to hospital to have some fluid drained off his lung. 500ml was drained & dad had a CT scan whilst he was in hospital. The doctors had sent some of the fluid away to be analysed. The doctors came to remove dad’s chest drain so I popped off the ward. Unbeknown to me, the doctors decided to talk to mum & dad about the results of the CT scan whilst I was gone. I came back & mum informed me of what the doctors had said. The CT had shown something in dad’s right lung but at this stage there was a number of things it could be. Mum recited about 6 differential diagnosis’. One of these was heart failure, and the rest are now a blur. That is, apart from the last possible diagnosis. Mum quoted directly what the doctors had said …. “or lastly, another possibility is that this might be a lung cancer”. As a specialist nurse, I knew straight away that the doctors were highly suspicious of a cancer. From my parents point of view, they had been given a list of differential diagnosis’ which could all have been possible. My parents had not been informed (or had it emphasised) that the diagnosis that was most likely was the lung cancer. Had the doctors checked my parents understanding on what they had just been told, then it may have become clear that my parents still believed that this was not lung cancer. I believe this is where there was a major breakdown of communication. Mum and dad were trying to remain positive and were placing all their bets on this not being a lung cancer. I wanted mum and dad to remain hopeful until we had a definite diagnosis, but I also felt really let down that communication could have been better on such a sensitive topic.

Dad was discharged home from hospital whilst we waited for the results of the fluid that was drained. We were told that there was a high possibility that there would be another fluid build-up in dad’s lung which would require further drainage. Therefore, we were to go straight back to A&E if dad did become breathless again.

The day after dad’s discharge, I went to see mum and dad at home. Dad was doing ok but clearly still unwell. This is when mum showed me what dad’s discharge paperwork had said. Diagnosis: Lung Cancer. Mum was absolutely devastated. It confirmed what I already suspected, but now we were placed in a really difficult situation. Dad had not read his discharge paperwork. It was his health and he certainly had a right to know what was going on. Should we show the paperwork to him and shatter all of his positivity? Or leave it on the kitchen worktop so it was available for dad to read if he wanted to, but not actually highlight to him what it says? We chose the latter option knowing that dad would most probably not read it. Maybe we were shying away from telling dad, but I honestly did not believe that I should be the person who had to break the news to dad about his diagnosis. Neither should we have been put in that situation by the doctors. To be told you have cancer by reading it on discharge paperwork shows a complete lack of compassion in my eye.

How was I feeling at this point? Absolutely devastated! Words cannot describe how I was feeling. A complete mixture of feelings. I was so hurt at the poor communication. At the same time, I was trying to remain hopeful that the results of the fluid came back negative for cancer. If cancer was not detected in the pleural fluid, then dad’s cancer might not be as advanced as I feared. However, if this was to be the case then I knew that further investigations (a biopsy) would be needed to confirm cancer. I knew that lung cancer is usually detected in the advanced stages because people are usually asymptomatic until the advanced stages. I was praying this was not the case for my dad. I put my nurse hat on, and was researching medical journals to look at the prognosis of lung cancer when cancer cells are found in pleural fluid. What I found was not good! I had to remain positive for my dad’s sake. It was so hard.

Maybe not quite everything has been negative about this experience of poor communication…

From my nursing point of view, I have learnt so much from this situation. In my nursing role, I frequently have to break the news to people that they may have cancer. I have always tried to be as honest as possible. This recent experience on the receiving end of a cancer diagnosis has shown me how important it is to check people’s understanding of what I am saying. Better communication to my parents could have given us such a better overall experience.

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