148 Becoming a Patient
had an MI on the highway, reported that he disclosed information only
allusively. ‘‘I don’t say, ‘I have health problems’—that’s not the way I like
to think of it—but ‘I’ve had events.’ ’’ To acknowledge health problems to
both himself and others remained hard, ever since he first experienced
and ignored symptoms on the highway and continued driving. Yet he felt
uncomfortable remaining wholly secretive or silent with others.
Colleagues may know certain features, but not others, about a doctor’s
disease. Deborah felt ‘‘The less I say, the better.’’ She did not mention the
results of tests to colleagues, and even lied about them, vigorously trying
to separate her professional and personal lives.
I’m usually very talkative. But my illness can really jeopardize me.
I try not to say anything. People ask me how I’m doing. People
know I go for tests, but I don’t tell them what my tests show—
good or bad. When people ask, even if I am doing bad, I say
‘‘good.’’
Deborah thus dissembled, but felt she had to. She told people only what
she felt they needed to know—not more—because of fears of gossip. ‘‘I
keep a façade. People talk a lot. If they ask me questions, I just say it’s not
important. I’m not going to get support from here.’’
Deborah and others assessed carefully where it was safest or best to
seek support. However, colleagues may be genuinely concerned, and re-
sent these barriers.
Those who considered telling colleagues struggled, too, with when to
disclose. Most difficult was whether and when to tell when applying for a
job. Like many others, Roxanne, the gastroenterologist with cancer, wres-
tled with the pros and cons of when to inform her boss. She finally did so
only after she had been definitively hired.
After I arranged to have this position here, I came to give a talk.
That’s when I told my new boss. I did not want to hide it. He’s a
good guy. If something did go wrong, I wanted him to know. I
didn’t mention it during the negotiation, though. I had thought of
it, and now regret that I didn’t. I didn’t want to be deceiving. I’m
an open person. But it might be a problem in terms of confiden-
tiality and security. I haven’t told anyone else here.
Such professional secrecy can rub against one’s general openness as a
person, a trait that many value in themselves. Hence, silence now can
cause added conflict.