A surgical intern has participated in 86 year old Mrs. Byrnes's abdominal surgery, where extensive metastases from ovarian cancer are found. The surgeons take biopsies, confirm the diagnosis, and close her abdomen, knowing that her case is not treatable. Later that day, it falls to the intern to inform Mrs. Byrne of what they found.

The author describes how he avoided the task, finding other chores to do, appealing to the attending physician to not make him talk to the patient. The attending insists, and the author finally finds the nerve to talk with his patient. Much to his surprise, she has already suspected that she has cancer, tells him not to be upset, and assures him he did his best. The author discovered that learning to be a doctor meant being open to learning from his patients.


Many students are terrified at the prospect of failure, of giving bad news, and of dying patients. This essay helps students to put these issues into a different, more manageable, perspective.


This essay is from the "A piece of my mind" section of the journal.

Primary Source

J. Amer. Med. Assoc. 264(16): 2121 (1990)