Only in Silence

The oncology floor can be a silent place. Unlike the cardiology floor, with its insistent telemetry beeping, or the incessant bustle of the general ward below. Silence can be healing, and the oncology floor reveres all forms of healing it can find. Yet some voices ring loud on this floor. As an intern, I would grimace into my scut list as oncology attendings intoned dire diagnoses and exhorted still-reeling victims to altruistically enroll in clinical trials. I mutely ground my teeth listening to the relentless stream of probabilities and adverse reactions flooding into the shocked silence of a child baffled by his or her metamorphosis into a cancer patient between breakfast and lunch. The practiced script unwound, preemptively striking down every potential worry already foreseen. But sometimes what was unspoken was even worse. Silence can give patients space to comprehend, digest, formulate questions, and enunciate fears. I believe in the silence of the "great empty cup of attention." Still, ethics can founder in silence.