Promises

There are many lies around us and everyone has told a lie. They never stop coming. I’ll admit, I’ve told lies and that’s the truth. Now, as a physician I can’t lie. I have to tell the truth to patients, especially when the news is bad. I don’t seem to have difficulty with that. Much has been written on how to deliver bad news. I try to be sensitive to each situation and try to do all the right things when delivering news. I try to address a patient’s fears and I try to make time to answer questions and keep an open line of communication. That doesn’t seem hard for me. I try to be considerate and supportive and I don’t lie in these situations. It’s easy to tell the truth even if it is not welcomed.

Nobody likes people who tell lies, especially for self-gain. These types of lies are obviously not welcomed and are frowned upon. These are the types of lies we tell our children to avoid. But then there’s a whole area of grey between lies and truth that I’ll refer to as ‘innocent lies.’ These are lies we’ve all made at one time or another.

Lies that originate because we don’t know the right way to deliver news, because we want to protect someone from being hurt, lies that seem to have little consequence. The extent of this grey zone varies depending on each individual’s interpretations. I recall talking to a teacher about how I was going to tell my four-year-old daughter that her grandfather was dying. I was worried she would ask me, “Are you and mommy going to die?” I knew I didn’t have a good answer. I remember talking with my daughter’s teacher who said she was always truthful with her own young children. She had told them she and her husband could die at any time, just like someone they knew who had recently passed away. But I was not so brave. I was afraid of telling my daughter the truth: “Yes, we will die and we may die even when you are young. There’s no guarantee as to how long we will be here on earth.”

Why was I afraid of telling the truth? I was afraid of her experiencing the fear of abandonment or unnecessary anxiety, which could ultimately prove harmful. Chances are in our favour that we will experience a long life together for many years to come. And if life goes well she’ll be able to be there when we get buried or cremated. So why create unnecessary fear in her heart? Why cause worry in her? I felt that she didn’t really have to grasp the realities of life so immediately. They will reveal themselves at the appropriate age according to her development, I thought. So I never told her. I told her something more hopeful that would give death more meaning, something that would give death life. I gave her a sense of hope. I didn’t tell her straight out that we will die one day and she’s never directly asked me. I didn’t volunteer. I’m sure we will talk about it openly when she’s ready or when I’m ready, whichever comes first. But the teacher chastised my approach. I could see she thought I was avoiding the truth, therefore, lying.

In many cultures the folklore of ‘heroes’ exists. ‘Good doers’, such as Santa Clause, the Easter Bunny, the Tooth Fairy, etc. Are these lies we tell our children, too? I don’t think so. These figures have an uplifting quality to them and fill our lives with wonderment, hope and magic.

I think some people think of a magician as the ‘Master of Lies,’ but I don’t agree. In reality we are very honest about what we do. Honest magicians, who are out to entertain, tell the audience that they are going to try to fool them, and aim to do so. If you go to a magic show that’s what you honestly expect. To be fooled, not lied to. A big difference.

I don’t want to be a proponent of lying and to even suggest innocent lies are fine; in fact I didn’t even like telling them when I’ve done so. It doesn’t feel right and I feel there has to be a better way. Big obvious lies weaken a person. Smaller innocent lies may confuse a person. Are we telling them because we don’t know the way to deliver the truth? To entertain? To give hope? Make life magical? I don’t know the final answer.

When I was a medical intern I was having a discussion with my medical supervisor/mentor regarding death and fear. I quoted something I heard in a medical lecture in my first year of medical school regarding death and fear. When a person is dying, there are three things that people are afraid of:

1) Dying without Dignity
2) Dying in Pain
3) Dying Alone

Reference: On Death and Dying by Elisabeth Kubler-Ross

I told my supervisor that I would tell the patient that from a medical perspective we had the means and know-how to make sure that we can help to maintain a person’s dignity. We have substantially appropriate medical treatments so that no one should die in pain. But regarding the third point… that brought about a new discussion altogether. My preceptor asked me how I would deal with that? I responded by saying, “I’d make sure his family and friends were there through his/her palliative phase, and we would provide the resource and time of notification so that they could be there with him at the end. Then my preceptor pushed me further by saying, “What if he didn’t have any family or friends?” I valiantly said, “I would be there in his dying hours.” He asked me if I would promise this to the patient? And he prodded me by saying, “What if you had something more important like your wife’s or daughter’s birthday?” I responded by saying, “Well, I would leave the birthday party and I know my family would understand my reasoning.” He didn’t stop questioning me. “Well, what if on your way you were stuck in traffic?” Now I was thinking, ‘are you serious!’ and my response was full of ahhh’s and umm’s, “I don’t know, I guess I would try to be there.”

He then said to me, “Don’t promise anything you know you can’t deliver… it’s not the right thing to do.” That was the end of the conversation. For years after, I thought about our little ethical duel. So that left me wondering whether he was telling me, “Don’t give anyone false hope.” And to that question I’d say, “It’s not false hope if you generally have the true desire to fulfill that task.” I always err on the side of having hope as opposed to not having it.

What do you say to someone who has no one on earth to comfort them, especially if they are not at peace with their maker? ”I’m sorry, my friend, I can’t promise you that you will die with someone present, you may die alone.” That would be cruel and life-taking, not live-giving. There are many things that could fill our hearts with fear. I don’t think I need to give examples; we are all capable of coming up with those on our own.

So, this whole notion goes back to the notion of making and keeping a promise. When someone says, “I’ll see you this Saturday,” and you say, “Absolutely, I’ll see you there,” you are making a promise. An implied promise. Promises are selfless and the general intent is to help or support others.

Now we all know at times a person is unable to make or complete a promise because “life happens.” So promises can be broken, unintentionally. People who get disappointed because promises are broken don’t understand the implied fluidity of that type of promise.

My daughter may ask me when she is older, “Dad, when I get married, will you walk me down the aisle?” My instinct and first response is, “Of course.” Not necessarily, “Well, I plan to unless I’m dead, then you’ll have to get someone else.” So getting back to the dying patient I referred to earlier. I would keep my original intent that I would be there for him. I don’t consider it lying if it is generally true. It provides hope. Anything that provides hope is promising. When you take away hope, what is left?

Is giving false hope a lie, too? What are your thoughts on the innocent lies and promises? I’d like to hear them because I assure you I haven’t figured it out… and that’s a true promise.