That's another big theme that... the whole theme of communication with patients, and patient relations generally was purely implicit. It was what you picked up by what you saw for good or ill and, and I suppose what your own nature was. No, I mean, I don't think at all, I don't think anyone discussed the question of how to break bad news, what to do with dying patients, and they were all things which I found terribly difficult and, and painful and, you kind of had to learn as you went along, and although I think because of my age, I think there's a lot of... a certain amount of nonsense about the intensity and level of... of modern discussions. I do think I would have probably done it a lot better than I had done... if I'd had some teaching about, about it. You go, tend to go on making the same mistakes which...
[Q] On the other hand you've done a lot of deep thinking about it probably.
Yeah, yeah. Yeah. I think also things like patient's responses to bad news, denial. I think I told you a story about, a patient which told me what denial was about. When I... my second job was the, the surgical professorial unit with, again, a very excellent boss called Robin Pilcher, not widely known in the world, but a brilliant diagnostician, a very stern man. He seemed very yield... unyielding, unbending, but he was an okay chap and, and the children loved him. And there was a man who came in with cancer of the bronchus, widely spread to everywhere, totally untreatable, even now. I mean, cancer of the bronchus, as you know, hasn't come on all that much.
[Q] No.
I mean there's, there's treatment for one form of it, but it's amazing that most of it is as bad as it was when I was a student. So, what... I asked the ward sister to ask his wife to stay after visiting hours because I wanted to have a chat with her and she came with her sister. So I explained as best I could what the situation was and I think I came to the point, which is hard to do as you know, and told her what the... you know, it was really bad news and he didn't have long to live and stuff and there was a pause and she turned to her sister and she said, 'Thank God it's not TB'. And that taught me more about any textbook or any teaching or any lecture about denial. I mean obviously you knew exactly what was going on, but... and we've all had millions of experiences like that, but that, and I think really it's the individual episode that sticks in your mind. I mean I've listened to a million lectures in my time and I can't remember any of them, but I remember that woman perfectly clear, and I remember other things of the same ilk where you thought, that's what's, you know, what's important, what's going on.
