One of my friends who works in a hospital told me an interesting true story about his work parking experience. Each day, he parked his car in the same spot in the hospital parking garage. Each day, as he entered the garage, he turned right, then left, and into his preferred parking spot without considering any other spot. One day, he was upset to find that his spot was taken by another car. He had to drive around to find a vacant parking spot but failed. Later, while he was still trying to park, he asked a parking attendant for help; the attendant pointed to a vacant spot right beside his car. Seeing the vacant spot surprised him. How come he did not see this option while following his familiar route in the garage?
The same thing happens often in our clinical practice and study. When we are new in an unfamiliar environment, we are careful, sensitive observers, thinkers, and explorers. Once we become familiar with that environment, we have established invaluable ways of knowing the setting and of extracting information from the setting. But as we become familiar, we also have risks such as assuming what is present in the environment and assuming causative factors and outcomes. In short, we could risk not seeing the “empty parking space” and miss seeing what needs further exploration and explanation.
Several years ago, I was engaged in a research project involving cancer patients at end of life. In this study, we were exploring the changing symptom patterns of patients who were terminally ill. The symptoms under study included fatigue, pain, and depression. In some clinical situations, we solicited symptom information from family caregivers because of the severity of the patient’s condition. I remember clearly one husband describing his experience of taking care of his wife who had advanced breast cancer. His wife maintained high levels of hope and expectation for living longer. With purposeful intent, she ignored her worsening situation even as her oncologist reminded her and her family about her short period to live and about the benefits of palliative care. Although done kindly by the oncologist, the husband described how this conversation was deeply unsettling for the family. The husband added that the last right they wanted to own was to know the truth. He acknowledged that the oncologist was professional, kind, and helpful in what he did but that the family preferred a lie and a hope if only for several more days.
The husband’s words impressed me very much. It is the unique personal identities and clinical context of cancer, of the treatment, and of each family that make cancer care and research such individualized procedures—tailored in some regard to each patient and family. Each study and each care experience is a different story and requires different personal attention from the researcher or the clinician. The successful experience in one case may not translate into the very next situation. There is the unfamiliar in each of the situations. We may be able to do credible research and provide good care if we follow our familiar procedures, but we could miss opportunities and experience the missed although obvious open parking spot. We need to purposefully work to remain new in familiar experiences, to prepare our minds in advance for exploration and discovery so that we can hear and study even the unspoken words or hopes of cancer patients and their family and, together with them, seek solutions of comfort that also contribute to our knowledge base.