The patient’s chart is sacred. Personal history of the disease, pathology reports from biopsy, and scans related to a new cancer diagnosis are just words until I give their meaning to the family. I hold the papers in my hands reverently. They contain life and death information. I understand the responsibility I have to the patient and family in front of me. I am just one physician, one small part of a process and diagnosis creating this heart breaking drama.

As I explain all of the details and plan of care, I know they are just words. The space between my voice and their awareness is a broad chasm and the only real substance within that space is one question. “Will I live?” The “chart” becomes heavy. It is filled with all their hopes, real fear, confusion, shock, disappointment and pain. I respect this. Patients hang on every word, facial expression, mannerism, smile of assurance and hand of comfort. Physicians understand this sacred trust.

There is something else: expectation. When Margaret asks, “How can I survive this?” The children wonder, “Will she be in pain?” The husband says, “What can I do, how can I help?” We will work together as a team with the patient’s own strength to carry Margaret and her heavy basket of grief. We are all called on to lighten her burden. Other physicians and our staffs will converge for her benefit. Expertise, wisdom, the newest protocols, as well as comfort measures will be brought to bear. She is not alone.

I ask Margaret, “What is your expectation?” She softly says. “I know I won’t live long but I want to live well”. This is important. She does not want months of therapy. Her disease is stage 4 of an aggressive cancer that will not be cured regardless the treatment.

And so, a plan is hatched that includes non-invasive immune therapy, minimal radiation for pain and palliative care to avoid stealing her time from her family. Margaret may only have a few months, but her wishes and her own expectation – not ours are what matter.

I have great expectations for Margaret- that she will craft her time, have loving people surround her and peace in her heart . She is in control and I expect us to follow her lead.

What expectations do you have for a life well lived? Please share and you will open another’s eyes to possibilities.