Filipe Coutinho, MD
As a medical oncologist and palliative care physician, I have spent years preparing for difficult conversations. I’ve guided patients and families through the uncertainty of cancer, helped them navigate complex decisions, and sought meaning amid shifting prognoses. As an academic, I teach future clinicians how to communicate serious news with clarity and empathy. I know how to structure these conversations, how to listen deeply, and how to sense what remains unsaid.
But none of that prepared me to deliver a cancer diagnosis at my own kitchen table.
It began on an ordinary weekday, between consultations and case discussions, when my phone rang. A radiology colleague’s voice was calm: “It’s consistent with malignancy.”
The biopsy result wasn’t for a patient; it was for someone I love.
I froze. Despite having reviewed the imaging and mentally prepared myself, hearing the words aloud transformed everything—turning suspicion into confirmation and a physician into a family member.
I finished the day mechanically—prescribing, documenting, and maintaining an outward calm, while inside I was anything but composed. That evening, I sat across from a loved one and uttered the words I had said so many times before, but this time, they felt unbearably heavy.
“It’s cancer,” I said.
A silence followed. “But it’s early, right? It’s treatable?”
At that moment, I wasn’t the clinician with staging algorithms or survival data. I was simply a family member trying to offer steadiness amid fear. I wanted to reassure, but I knew too much. And that knowledge, once a source of confidence, now felt like a burden I could not set down.
A Blurred Identity
As clinicians, we live with ambiguity and speak fluently in our dialect. We offer honesty tempered by empathy. We learn, over time, to balance candor with comfort, to provide information while recognizing that what people most seek is reassurance, not data.
At work, I speak in terms of progression-free survival, response rates, and treatment intent. I use risk calculators and evidence-based frameworks. But at home, these tools felt foreign. I couldn’t turn a family dinner into a multidisciplinary case conference. I couldn’t reduce my fear to statistics.
In that space, my professional identity blurred. I didn’t want to become the family’s oncologist. But I couldn’t stop interpreting every delay, every appointment, every new symptom through a medical lens. The result was emotional dissonance—part caregiver, part clinician, part silent witness.
This experience echoed what other physicians have described when illness enters their personal lives. As Klitzman noted in When Doctors Become Patients, clinical knowledge often fails to shield us from emotional vulnerability.1 In fact, it can heighten it.
Carrying the Silence
The morning after the diagnosis, I returned to the hospital, clinging to routine—coffee at sunrise, another by midmorning. I told myself it was for caffeine, but really, I needed something to hold on to.
Clinic began. I moved through prescriptions and consultations, performing structured empathy. But inside, I was unraveling. The usual tools, such as algorithms, checklists, and calm explanations, felt like a thin shield over something raw.
Midway through the day, a patient asked gently, “Don’t you ever take it home with you?”
My usual answer, “You learn to manage it,” stuck in my throat. I was already carrying it, like an app running in the background, weighing on my chest.
“Some days are harder than others,” I replied.
He nodded, imagining a heavy caseload. I was thinking of the scan I couldn’t unsee, the words I couldn’t unhear, and the person I love now living in uncertainty.
That week, everything felt sharper. I noticed tremors in my hands and silences in speech. I had always aimed for empathy, but now their fears mirrored mine.
My clinical approach has shifted. I began to ask different questions: What matters most to you? What are you most afraid of?— FILIPE COUTINHO, MD
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Evenings had become quiet drives home. I was too tired to talk and too restless to sleep. I drank more coffee, stared at screens, and avoided telling colleagues—not out of secrecy, but because I didn’t know how. How do you explain that you guide others through fear all day, then return home to your own?
Physicians are trained to carry the weight, not to speak of it. I wore professionalism like armor, even as it grew heavier. As Gilewski, Raber, and Sledge noted, when home becomes the source of stress, “there may be no place to turn,” and the burden of knowing too much can leave “emotional wounds that never completely heal.”2
Eventually, I confided in a trusted colleague. She listened and said, “It’s different when it’s yours.”
She was right. When illness crosses into our personal lives, detachment crumbles. The boundary between doctor and human dissolves. Sometimes the hardest part isn’t the diagnosis, it’s the silence we feel compelled to keep.
Relearning Through Vulnerability
Over time, I found a new rhythm: not one of certainty, but of presence. I learned to accompany uncertainty rather than control it. I became more comfortable with silence, less focused on finding the perfect words, and more attentive to the space between them.
My clinical approach has shifted. I began to ask different questions: What matters most to you?What are you most afraid of?What do you understand so far? Consultations became less about delivering plans and more about witnessing grief, less about risk management and more about connection.
I had spent years teaching empathic communication, often citing Epstein and Street’s view that it fosters trust and emotional connection.3 But now, I was living it with a different urgency. I came to understand, more viscerally than ever, that what patients and families remember most is not the plan itself—but whether, in the moment their world shifted, they felt heard, understood, and supported. This experience reshaped how I talk to my children about illness. I use clear, honest language. I let them ask difficult questions. I no longer equate strength with composure. I allow them to see my vulnerability—something I once kept separate from my professional identity but now recognize as essential to both parenting and medicine.
The cancer diagnosis in our family remains a part of daily life. It has altered our routines and reframed our conversations. It doesn’t define us, but it has left a lasting imprint.
The Quiet Work of Staying
I still wear the white coat. I still deliver serious news. But now I carry something deeper: the memory of sitting at my own kitchen table, holding the gaze of someone I love, and struggling to speak the words I once believed I had mastered.
Each clinical encounter has become more than a plan or protocol; it is a meeting of lives, of stories layered with fear, love, and hope. I see not only the patient but also the quiet strength of those who sit beside them, ask the questions they are afraid to ask, and stay long after the consultation ends.
Sometimes, the hardest diagnosis to give is the one that touches your own life. Yet it is also the one that most clearly reveals what medicine truly is—not only a science, but a sacred act of presence.
And now, I understand this: even when I cannot fix it, I can stay. Even when the future is uncertain, I can offer steadiness. And in that quiet, enduring closeness—at a kitchen table, in a hospital room, or along the way home—there is still healing.
DISCLOSURE: Dr. Coutinho reported no conflicts of interest.
REFERENCES
1. Klitzman R: When Doctors Become Patients. New York, Oxford University Press, 2007.
2. Gilewski T, Raber M, Sledge GW: The oncologist as the patient with cancer or relative. Am Soc Clin Oncol Educ Book 32:561-563, 2012.
3. Epstein RM, Street RL: Patient-Centered Communication in Cancer Care: Promoting Healing and Reducing Suffering. Bethesda, National Cancer Institute, 2007. NIH Publication 07-6225.
Dr. Coutinho is a medical oncologist and palliative care physician at the Médio Ave Local Health Unit in Santo Tirso and in Vila Nova de Famalicão, in Portugal; Coordinator and Guest Professor in Medical Oncology at the Faculty of Health Sciences of the University of Beira Interior, Covilhã, Portugal; Founder and Chair of the Geriatric Oncology Working Group for the Portuguese Society of Oncology; National Representative for the SIOG; member of the Young SIOG Governance Team (2024-2026); and member of the Cancer and Aging Research Group.
