"You have a brain tumor"

You might think that for neurologists this is something we say "all the time", but it's surprisingly and thankfully infrequent. My guess is that even neurosurgeons don't even have to break the news very often, since they are seeing someone who has been referred because of the knowledge of a tumor.

A capsule of a recent event went something like this – I'm asked to see someone for some intermittent weird sensations in a hand and later also in his face. This comes and goes. Exam is quite normal in all respects, even for any signs that there is any loss of sensation in his hand. So, what is this? A stroke or TIA? I recently saw a woman with a similar story, also negative exam, and she had a thalamic stroke.

This time, a very obvious tumor. Keep in mind that, as far as medical terminology is concerned, "tumor" just means "some kind of mass". A blood clot in the brain is a tumor. A fatty deposit somewhere is a tumor. The tumor that most people think about medically would be called a "neoplasm".

At any rate, this man's MRI very strongly suggested a neoplasm. So now it comes down to breaking the news. I confess to some tossing and turning that night. I learned about the finding by phone in the evening, but there was no point in calling him on the phone, rushing into the hospital to spill the beans. How will he take it? Be upset? Be upset at me? Break down into inconsolable sobbing? You never know.

Like so many things that you cogitate about, worry about, feel your stomach churn about, it was something of a nonevent. Nonevent to me, but there can be no doubt it was an important event to him regardless.

My experience-based advice is this:

• Do not shy away from this.

• You must have control of your faculties when you break this news. You cannot be involved in your own internal conversation with yourself while you are divulging this kind of news.

• Be attentive to body language and every other sign of severe distress. Many people simply clamp down emotionally when this sort of news comes, so the only sign of an intense problem may come from the involuntary things they do as you explain what you know.

• Be in no rush to leave. Wait for a sense of how they are handling it. Wait for verbal reactions. Wait some more. Ask for some feedback, especially if you're not getting much.

• Regardless of how complete you think your interaction was, you must plan to come back to ask if there are more questions. You have just hit this person with what amounts to a stun gun.

• There is no reason to explain much of anything in detail. There is no value in sketching out the range of what this "might be". It is what it is, and what you need at this point is something definitive that will only come from the pathologist after a biopsy or resection.

Like so many of these things, it was not as bad as I had envisioned it could be in my ruminations, but nonetheless I needed those ruminations to prepare myself mentally.