What the doctor didn’t say
By: Craig Dresang, CEO, YoloCares
Warning: This story is personal.
A friend of mine who I have known for nearly 40 years recently died in a Sacramento hospital. We met while attending graduate school in Chicago during the late 1980s. Chuck grew up in San Mateo but ventured to the Windy City for the university’s international reputation in his field of interest. His parents immigrated to California from Indonesia when they were in their 20s. His mother introduced me to lemongrass, coconut milk, and rendang. To this smalltown kid from Wisconsin, it all seemed so exotic and delicious.
Since we both lived in a campus dormitory for graduate students (our tiny dorm rooms were next to each other) we spent substantial free time together. He was obsessed with the diversity, quantity, and scale of Chicago’s architectural marvels. During winter weekends, in bitter cold weather of 10 degrees below zero, we would spend hours walking through and exploring Chicago neighborhoods. Every trek felt like a big adventure. We would usually wind up at Bagel Nosh, a favorite local neighborhood deli, for hot coffee and a cinnamon raisin bagel smothered with cream cheese.
Back then, like many economically challenged students who did not come from affluent families, we did our share of dumpster diving . . . searching for treasures discarded by the thousands of companies and businesses located on the perimeters of Chicago’s Gold Coast. One time, Chuck found a boxed full-length fur coat, in perfect condition, discarded by a posh furrier on Oak Street. We imagined that some zillionaire customer must have returned the fur and the store likely had a policy of not selling returned items. His mom’s birthday was a month away, so he packed up the find and sent it to her. His card read, “Happy Birthday. You will need this when you come to visit.”
I will never forget a phone call I received from him in 1989. He called to let me know that he and his family were safe. He had just moved back to California and was at Candlestick Park, attending Game 3 of the World Series between the Oakland Athletics and San Francisco Giants, when the Loma Prieta earthquake struck. When I heard the news of a magnitude 6.9 quake near Chuck’s home I was concerned. His call was a welcome relief. All these years later, Chuck’s voice is still clear in my head: “I’m okay. I just wanted you to know.”
In early 2025, I received another “I’m okay call” from Chuck. He had just received a daunting diagnosis from his doctor. He called, not just to tell me the news, but to reassure me that he was going to be fine. “My doctor said I’ll get through this,” he said. However, when I learned that his cancer was aggressive and had already metastasized to his lungs, liver, and brain, my hope eroded. I have known Chuck’s physician for my entire 13 years in California. He is a well-respected geriatrician and even serves as an advance care planning champion. Therefore, I had confidence that Chuck’s medical team would have important end-of-life conversations with him and his family at the right time. But just to make sure, I made a personal call to his physician who told me, “He’s not ready for hospice, and we’re not planning to have that conversation yet.” Chuck died three days later!
On some level I get it. Physicians are hardwired to save lives and cure diseases. For some, telling a patient that treatments are not working is admitting failure. Doctors help people live, not die. And, yet, in a perfect world all physicians would embrace the idea that their job is to help a patient live fully . . . until they die.
In all fairness, many physicians can run into barriers when referring a patient to hospice. The family may not understand what hospice can do for their loved one or how hospice supports the whole family. Some think hospice is only used in the last days and hours of life. Cancer patients tend to prefer doctors who deliver optimistic messages. A 2025 study in JAMA Oncology revealed that physicians who stay on the sunny side are rated as more compassionate and trustworthy.
Another recent study published in JAMA Network Open points out that emergency department physicians are adept at predicting when a patient is likely to die and can facilitate patients’ access to hospice care earlier in the course of their illness.
Contrary to popular belief, patients should access hospice or palliative care the minute they receive a terminal diagnosis. Exceptional care begins with understanding a patient’s goals. It begins with the clinical team listening to the patient . . . how they feel and what is most important to them.
A study by the former National Hospice and Palliative Care Organization showed that patients with terminal illnesses can live longer if they receive hospice care earlier in their diagnosis. Their pain and symptoms are also better managed, which affords them a better quality of life. Those patients who lived longer did so because they received exceptional attention, monitoring, treatment and psychosocial care.
The fundamental ethical principle in healthcare of “do no harm,” or primum non nocere, does not mean withholding important information that can prepare patients and help them make more informed decisions about their care. It means speaking truth . . . no matter how painful or difficult.
When in doubt, both doctors and patients err on the side of optimism. The assumption is that treatment will work. Delivering hard news, particularly to longtime patients, can be painful. Often, doctors want to deliver what patients are hoping for.
I wish my friend Chuck knew, or understood, what was coming. Having a final and transparent conversation with him could have been good medicine for both of us. I know that his family agrees.
Facts about YoloCares hospice:
- Care is always free. Regardless of health coverage, patients never receive a bill for anything. Not ever!
- Care is delivered wherever the patient calls home.
- The earlier a patient receives care, the better their chances of living longer and having a better quality of life.
- Physicians can rely on YoloCares medical/clinical team to facilitate difficult conversations.
- Quality of care matters. YoloCares quality scores rank in the top 1% nationally and in California.
For more information visit us at www.yolocares.org
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