When the words, “We think you might have blood cancer” and, “A subspecialist will come see you to discuss further testing” cut through the air, she seemed unbothered. However, we understood we were at a crossroads only when our patient told the medical student that she did not believe she required a needle in her bone for her hypertension. After all, her daughter had hypertension and she had never required such testing.

The patient was visiting from a foreign country, presented with dizziness and headache, and was admitted for hypertensive crisis. She was additionally found to have an elevated protein gap, anemia, and lytic lesions as well as a pathologic rib fracture on chest radiography, leading to work-up for multiple myeloma. Skeletal survey, serum protein electrophoresis, serum immunoglobulins, and kappa/lambda were all consistent with the disease and the hematology department was consulted for bone marrow biopsy, which confirmed the diagnosis. To our surprise, she had never known anyone with cancer. She did not comprehend the connotations of the word cancer, in terms of morbidity, mortality, and treatment options.

    We assume so many things in our daily life. While we rush about taking histories, examining patients, typing up notes, ordering medications and tests, calling consultants, teaching, and discussing cases, we assume that patients have a basic understanding of health and disease. We assume that patients know what cancer is when we tell them they might have cancer. It takes only one case to realize that sometimes you have to take a step back and explain things at a primary school level. “Our body is composed of systems, those systems are made up of organs and those organs are made of cells that work together. Those cells also live and die, sometimes they do not die like they are supposed to, reproduce more than they should and cause trouble.” It was a moment filled with surprise, drama, and enlightenment.

    It has never been more evident to me, that sitting down and asking, “What do you know about . . .?” before explaining what we know should apply to the most basic medical concepts to successfully diagnose, educate, and treat our patients.