The power of Good bye

When I was a third year medical student, on my Neurology rotation, I met a young man, about 34 years old, who had been referred to our hospital for further management of his disease. Basically, the hospital that he had just spent four days in getting his diagnosis was not equipped to fully handle his disease and had sent him to a hospital that could. I remember this patient encounter particularly because of how powerless I felt and how I had to "lie" to the patient (and his family's face).
This patient had not been acting like his usual self over the past two months, and without getting into too much identifying information, he had changed from a quiet, soft-spoken man to one who was forgetful, inattentive at work and given to anger outbursts. A CT done at the first hospital revealed a huge mass (read tumor) infiltrating most of his frontal lobes. The frontal lobes are parts of the brain that are responsible for so called executive function: the ability to know when actions are socially acceptable, to understand the consequences of one's behavior, etc. The CT explained why this young man had been exhibiting such bizarre behavior.
I was on call that night and it was my duty to see new patients that had been accepted onto our service and assist the overnight resident in making a plan. After a look at an MRI which had been ordered, a discussion about how this mass was most certainly a GBM (pretty much the worst kind of brain cancer you can get) and the fact that this young man would probably not live beyond the next two years (WITH aggressive treatment), I was dispatched to this young man's room, Neurological tools in hand, with the task to take a "history and physical".
In the room, the young man was sitting on the hospital bed, hair disheveled, but looking composed. His father, his father's brother and his father's brother's wife were sitting at the foot of the bed. I introduced myself, explaining that I was a third year medical student and that while the "real doctor" would be in shortly to see their son/nephew/nephew-in-law, I was here to expedite the whole process by making everyone's life easier and getting this routine stuff out of the way.
I did not realize it then, but I know now I was apologizing for what essentially I came to medical school to do: to learn how to interact with patients, gain pertinent information from their story and physical exam and work towards treatment. I knew this young man was so very sick, that his family must be upset in a way that I could not fully appreciate and yet here I was, learning off their pain. I felt like an intellectual vampire. Most importantly, I felt like a fraud. The family thought I was a contributing member of the team (and you can argue this all the way to the bank that I was, but we shall agree to disagree, for now) and that I was there to help them. In my mind, I was there because it was a required clinical rotation and a part of my curriculum.
Nonetheless, I did what I was there to do. Because I was learning, and because I like to explain things as I do them, it took me about an hour and a half to complete this patient encounter. To compare, on the practical exam I just took January 12th, that uses standardized patients, or patient actors, we are given 15 minutes to gain the same information. Through this 90 minutes, I tried to be professional: calm, methodical, friendly. I included the family in the conversation when I could and asked social questions also - who were they, where were they from, what did they do? I also told them about me - my goals, my background. I cannot remember if I attempted humor, but I think I may have, because at some point, there was laughter. Looking back I am ashamed to think that I was insensitive enough to joke, but I can only assume that I had assessed the situation and decided it was appropriate.
After all this was done, I knew it was time to lie - without lying. To withhold information.
"Is my son/nephew/nephew-in-law going to die soon?"
"Until we get more definitive tests I can't really say" (Yes, probably)
"Why is this happening? Is it genetic?"
"There is some research that shows certain types of tumors run in families. It's hard to say at this point if this is the case, because we are not sure what type of tumor this is" (I don't know, I don't know...I'm only a medical student. I'm...sorry)
"What happens next?"
"The next step is to take a sample of the tumor and perform laboratory tests on it to determine what kind of tumor it is"
"You mean he's going to have brain surgery?!"
"Yes. I know this is difficult. However, the surgeons here do this sort of procedure all the time and your son/nephew/nephew-in-law is in good hands" (Please don't let me say anything wrong, please God, make them stop asking me all these questions, I'm only a medical student!)
And so on.
When I felt I had answered all their questions, I turned to leave. The young man's uncle indicated that he wanted to talk to me outside. I felt afraid and flattered. Did I say something wrong? What is he going to ask me outside? Will I not know and look as stupid as I feel? And also: he wants to talk to me outside? Me? That means he must value my opinion. He actually thinks I'm a professional.
It turned out he wanted to talk more into detail about his nephew's bizarre behavior and what it meant. I was able to answer some questions and for those I could not, I said I would find out.
Over the next week I saw this patient and his family everyday. I listened, I answered their questions. I helped as much as I could. As I was wrapping up my rotation that week, I felt I had to say bye, but I could not. I felt more like an intellectual vampire than ever. I felt they would be angry with me. That they had opened themselves up to me so much and only for me to leave - on to my next rotation - the next week. I could not bring myself to explain that I would be leaving. Friday came and I had still not said bye. I had two competing thoughts all day. Tell them! They deserve to know. Don't tell them! How can you just leave like this?
In the end the decision was made for me. I had to leave for lecture and I had not said bye.
I often think about this young man and his family. I think about them and I feel guilty. I feel guilty because even though I was able to build such strong rapport and advocate for them, ultimately I let them down. I betrayed their trust. I wonder what they thought when the little medical student they could talk to for hours on end, because no one else had the time, about their suffering, their pain...just did not show up the next morning. Did they feel hurt? Confused? Angry? I imagine this must be the case. I wonder often also, where they are now, what they are doing and how he is doing with his disease. I wonder and I regret.