Singing Loudly

Death is probably the most difficult human condition for anyone to completely understand. When confronted with death people go through the various emotional stages of denial, isolation, anger, bargaining, depression, and acceptance. Movies, plays, tv shows, often get it wrong when they try to tackle the discussion between a doctor and patient about death and dying. One of my friends was diagnosed with terminal cancer. He wrote the conversation with his doctor with his girlfriend after the meeting.

With his permission I'm going to explicate the conversation in the way that a writer would want to do when they are looking at their own dialogue. Does it make psychological sense? Is it the way people converse? Are the characters reading cues from each others and following the conflict of the situation in a psychologically accurate way? There seems to be quite a bit going on in this conversation that can teach people a lot about conversations.

A few days ago he emailed me his recollection of the conversation that occurred between the doctor, himself, and his girlfriend. It started normal with the doctor asking him how he was feeling; he told him that he has improved. The doctor then said that the surgeons are happy with his recovery and broached the subject of his discharge from the hospital. There was a bit of a pause and the Doctor comments that his family is also thinking about his discharge, and asks "Has anybody had the opportunity to talk to you about..."

Although the sentence is not grammatically complete and is followed by a silence, my friend responded nonverbally by pointing to his girlfriend to speak. She replies affirmatively and names Mrs. Parker. The Doctor then solicits a more elaborate response about the content of the interaction by saying simply "about"? My friend then verbally indicates that the Doctor is to speak to his girlfriend because "she relates to what -- what went on." The doctor replied to him with "Oh." After this the doctor asked him a third time, tying this version to the previous two by elongating and emphasizing "about" when he asks explicitly if they discussed hospice.

It was clear that the doctor was using a psychological method of "elicitation" where the doctor tries to get the patient to volunteer information. When that wasn't working he employed a question that specifies a theme that was absent from the previous answer. This narrowed the relevant issues. The physician proffers the idea of hospice which is a topic associated with death and dying. My friend and his girlfriend did not respond to the death and dying aspect of the Doctor's question about hospice.

The girlfriend's response to the questions actually moves away from hospice care and hence from the dying process. Initially she responded to the question with a "No." Then she indicates that Mrs. Parker inquired about moving back in with his family for Robert. The emphasis on "family" suggest this as a contrast with the hospice topic. The Doctor replied in a delayed fashion with "I see." The the girlfriend claims that Mrs. Parker also discussed "life support" with them, which further displays a contrast and marks a difference between her interpretation of the conversation with Mrs. Parker and the topic (hospice) that the Doctor has offered with his line of questioning. Going back to live with his family can also suggest a less serious prognosis for him than does hospice. Nevertheless, the girlfriends talk about "life support" preserves the general topic of the illness while shifting the focus from hospice care.

In response, the Doctor says "I see," waits, says it again, waits, repeats it a third time. Of course, together with the "I see"s and the silences, this fishes for more information about their meeting with Mrs. Parker without the need to ask them directly about the details. My friend and his girlfriend, however, provide responses that implicate topic closure: the girlfriend produces an agreeing, general gloss of the conversation, while my friend aligns with her assessment.

After this exchange, the doctor asked him about his plans for leaving the hospital. He says that he is probably just going to go home again. The doctor tells him that he might consider entering a hospice program because it is a good program for patients who have had cancer; this shift reinforces a topic related to death and dying, thereby alluding to the terminal illness. My friend rejects the option of hospice, claiming that this would be inconvenient to his family and would upset them. The Doctor then asks him what he sees "as happening in the future." This is overtly asking for an assessment of the future.

After a silence, the doctor reformulates his question: he asks if my friend is "hoping that he'll get better." Both my friend and his girlfriend provide resoundingly positive reactions, which shows their desired recovery image. (Recall that earlier the Doctor characterized the surgeons as pleased with his recovery.) Here the doctor may have invited my friend and his girlfriend to adopt an optimistic outlook, which thereby partially accounts for their strong alignment at this point.

The doctor then offers a contrastive assessment, asking if my friend has considered the possibility that he "might not get better." My friend rejected this by saying that he had such "second thoughts" in previous days, thereby suggesting that these "second" thoughts are less significant or less valid than his ideas about getting better. The doctor then says "cause that's something that I've been" and reaches to hold his hand, "kind of concerned about." In the hand reach the doctor may demonstrate nonverbally that he is broaching a serious topic. The doctor then reminds them of how long my friend has been in the hospital. This brings common sense knowledge that suggest that long stays generally indicate serious problems. My friend remains silent.

The doctor's talk here seems to function as something similar to an incomplete syllogism. Here the doctor sets up the first two parts of the syllogism by noting that (1) My friend had been hospitalized for three weeks and that (2) such long hospitalizations generally indicate serious problems. Formally, my friend maybe be invited to complete the syllogism, without it being stated, by concluding that he has serious health problems. The doctor does this in such a way that he doesn't bluntly inform my friend of his condition and more gently forecasts the news.

When my friend and his girlfriend are silent, the doctor proposes an completion of the syllogism by once more using litotes and telling them he his concerned that "there's a possibility that things might not go so well" for my friend. Again, the doctor cautiously shifts from allusive to more explicit talk about the future. There is a lot of silence and the doctor then turns from the possibility of nonrecovery to the importance of palliative treatment. My friend then shifts to a series of four thank yous.

This conversation, which I don't dialogue in full, was a very informative exchange. Part of way my friend has allowed me to write about it is because he recently found out that the cancer, somehow, went into remission. He is doing much better now.