Truth versus Lie

After the bitter experience with the gentleman with liver cancer, I am trying to be more truthful to my patients who are on terminal Care.
A 65-year-old Widow,the mother of a son and daughter, came to me with painful swellings on her neck. She had been investigated in another hospital and was given a prescription of medicines to be taken for one month. She was brought to me by her brother because she was not happy with the treatment she got from that hospital. Her brother is an old patient of mine and have tons of faith in me.
I went through the investigation reports. Everything possible have been done including CT Scan and a biopsy. The final diagnosis is there printed clearly. The swelling was the spread of a worst kind of Cancer and no treatment options were available. She had barely few months to live. I was hesitant to look up to her face. So, again and again I shuffled the pages of the file and finally had to look up at her expectant face.
Should I give her false hope? Or should I blurt out the cruel truth? Or say some truth but hide the rest?
I choose the first option. I told her that she will be alright soon and gave her a prescription for medicines to be taken for 2-weeks and asked her to come again after that.
But my mind was in a turmoil. I know what I did was wrong. I wanted to tell her brother the truth first. So after a minute, I asked my assistant to call back her brother for a clarification. Then I told the truth to him. He was devastated and started crying. I just sat there with an empathetic look. Then I asked him how she will take it if I tell her the truth. He said he don't know. Then I explained why it will be better if I tell her the truth, at least a half truth. I told him that she can have her last wishes fulfilled and have a peaceful death. He agreed and asked me to tell her as much as I wish.
Then I asked her to be brought in. I told her that the swellings in the neck are cancerous and they are inoperable, but medicines may help. So, I asked her to take those medicines and come back to me after 2 weeks. She took it much better than her brother. Then came the dreaded question. How much time I have, to live?
I evaded the question. Did not give a direct reply. Said nobody can say that. If medicines worked, she may live long (I know that was a lie). Then she said she would like to continue to do her part time job as a cleaning assistant so that she can support herself financially. I told her that she can work as long as she feel up to it. If she find her work very tiring, she should stop.Then she cried for some time and left promising to come after 2 weeks.
I feel that 'the truth' even though it created a temporary mental trauma, will certainly help her to face death.

Can a doctor lie?

You may always think of a doctor as the most truthful person.But in many occasions Doctors are forced to lie.
I still remember the face of an elderly Gentleman who was suffering from terminal Liver Cancer.The family did not want to disclose the truth to the patient.Each time he come for a consultation his face search my face questioningly.Several times he had asked me about the gravity of his illness and always I had given him false hopes.Fortunately I was not at his bedside when he died.Few months later his Son came to me for something.I asked him about his father's last days.He said it was terrible.His Dad while dying was blaming his son for not giving proper care.He also blamed me for not finding out the correct diagnosis.
I have heard that in Western Countries they believe in disclosing everything to the patient.In a way that is good.The patient will know the truth and will be able to fulfill his last wishes and die peacefully.In India the Society and the family always tries to hide the truth from the patient.They believe that the patient may not be able to face the truth and may suffer from severe mental trauma hearing the bad news. But I feel disclosing the truth is better.What do you think?

Crisis averted?

Doctors working in Government run Hospitals in my native State Kerala has called off their proposed strike yesterday. The working conditions of Doctors in Government sector is so poor that only a hand full of new pass outs from Medical Colleges join it.The demands of Doctors agreed to by the Government may help in persuading those who work in that sector not to leave it.But will it help to attract new recruits?Chances are low as there are much greener pastures waiting them elsewhere. This raises a doubt.Is the current Government really interested in Public Health?