Trapped in the fixing mentality

For the most part, this book addresses pivotal moments in the trajectory of a patient with serious illness. This chapter is an exception - it's about the conversations that happen in between the big events. These conversations are more common than giving serious news; they happen all the time between patients and physicians who are willing to talk about living with a serious illness (and if you are reading this book, you're one of us). This chapter doesn't apply to a patient who has a car wreck, is taken to the ICU, develops multisystem organ failure, and dies there a few days later. The subset of patients we are addressing in this chapter are those who live for some time with the knowledge that they have a disease that will ultimately prove fatal, such as cancer, HIV, hepatitis, congestive heart failure. Patients with these illnesses live, as one put it, “with a sword hanging over your head.”

For these patients, who have what we call “outpatient serious illness,” adjustment to living with the illness, sometimes lumped with “coping,” is a huge piece of work, and one that leaves many feeling profoundly changed. We hear, for example, some of these patients talk about changing their priorities, experiencing love, finding deep friendships. Note that we are not advocating that physicians who deal with serious illness try to be therapists.