The Checklist

You have checked and double-checked. You have

gone through each step and every permutation

even as you stand in the shower. But somehow,

despite that, you haven’t had the success you expected.

When you have to tell someone that the treatment

has failed, when your voice softens and you can

barely get the words out; when the person asks

what that means, what can we do now, what

are you saying to me, you try your best to be calm.

Because what it means is often that the cancer

can no longer be controlled. And to say that, to put

the words into the air, is something no one wants to do.

Often, you are met with tears but, sometimes, anger.

One cannot predict the emotions that will be brought

to the surface, or the speed at which they will erupt.

And you can say we all come to that time, but it is

different when that time is staring you down.

I sit. I speak slowly. I try my best not to cry because

the doctor crying is never perceived as remotely helpful.

I sit. I listen. I offer whatever I can to be somewhat reassuring.

Outside the hospital, I am always careful, always watchful

when driving out to head home. The hospital is a place

of great stress, of great emotions, and people are often

arriving or departing carelessly. You have to be watchful.

When the student asks again how to do it, how to break

the news, I tell her to trust her own gut, to trust the cues

between herself and the patient. She wants a guide, a

checklist, but nothing like that exists. It has never existed.