The courage to be honest

Introducing people who stand for true values.

"It takes courage to tell the truth when it displeases you. Therefore, courage is an element that complements the truth, as is consideration for the one who learns the truth or the one who does not want to learn the truth at all. Because there is also a right not to know." (Ulrich Wickert in "The Book of Virtues")

It is a state of emergency, a moment of life and death. For the women who are about to hear the diagnosis, there are no nuances. Black or white, heaven or hell. Benign or malignant. And therefore every nuance matters. Anke Kleine-Tebbe will keep an eye on it. Five, sometimes eight times a week, the head physician at the breast center of the DRK Kliniken Berlin in Kopenick has to confront women with the diagnosis of breast cancer. It will not speak of a tumor, will not disguise anything with words. Absolute honesty, that’s her claim, that’s what’s expected of her as a doctor, the 48-year-old says.

Before each conversation, she pauses for a moment, gathers herself, concentrates, then invites the patient into the room. It’s a clean, bright room with white furniture and a few splashes of pink and purple. Drawings of her brother hang on the walls. Sometimes this is a distraction, says the doctor, because the women are initially interested in the artist and the paintings.

Morgenpost by Christine Richter

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The conversation usually begins innocuously. Perhaps with a question about whether the patient had slept after the examinations, how she felt. A warm-up phase. Only then comes the decisive sentence. "I’m afraid I don’t have any good news for you."That is the moment when the floor opens up under the patient and the free fall begins. Suddenly nothing is the way it was. The women either react with resignation, like the 65-year-old, who says tonelessly: "I thought so." Or stunned, like the young girl, in her early 20s, who had not expected this diagnosis for a second and now breaks down crying.

The honesty with which doctors today inform patients about their condition was not always a matter of course. More than 30 years ago, the diagnosis often remained in the dark for those affected. This is shown, for example, by a story told to the doctor at another clinic by a young woman who was afraid of sharing her grandmother’s fate. The 70-year-old had been admitted with suspected pneumonia. Eleven years earlier, the old lady had been diagnosed with breast cancer. After an amputation, the cancer seemed defeated. But now the X-rays showed that metastases had formed in the lungs. The doctors gave her another six months. The relatives were asked whether they should tell the patient the truth. They were given ten minutes to make their decision. After a tour of the hospital park, they decided not to tell her the truth.

With a diagnosis of chronic bronchitis, the 70-year-old was discharged, visibly relieved. She started smoking and traveling again. Everyone encouraged her to do what she felt like doing. They lied to her face with the best of consciences. Shortly before the six months were up, her condition deteriorated so quickly during a stay at the Baltic Sea that she had to be taken away immediately. Five days and several injections of morphine later, she died in her daughter’s apartment. Until the end, she tried to cope on her own.

"A case like this would be unthinkable today," says Anke Kleine-Tebbe. In fact, it often happened in the past that the diagnosis remained hidden. The doctor, the authority in white, would take care of it, the patients assumed. Things have changed completely. Today, the person affected is the contact person. This also decides who is allowed to find out about the family members.

"What did the lie lead to??", the doctor says. The old lady had certainly had a nice six months. But it was the daughter who suffered. Among them, not having been honest, not being able to say goodbye to the mother and not being able to settle matters beyond death. She does not want to judge what is better or worse, but today the patient’s right to self-determination and his or her right to decide whether or not machines prolong his or her life by means of a living will are what counts.

Suffering does not become smaller when it is distributed on other shoulders. Honesty has its price. In these two cases, either the patients or the relatives pay for it. But one thing always remains the same: Courage, the doctor believes, must always be mustered by both sides for the conversation. The one who speaks the truth honestly and knows that he can destroy life’s dreams within seconds. And the one who hears it and faces the truth, accepts it, has to live with it.

Sometimes it is more polite not to tell the truth

A dilemma that you can easily avoid in other situations as well. Isn’t it sometimes more polite not to tell the truth?? A saleswoman, for example, will tell the customer exactly what she wants to hear. "The dress is made for you," this phrase is her path to sales success.

Politicians handle it similarly. In the election campaign, they speak with the people’s voice, once in office, counting budget budgets, austerity retreats and party discipline. The disillusionment of the flattered only comes when the saleswoman has already settled her accounts and the politician is sitting in parliament. In advertising, too, we are knowingly fooled into believing that things are pretty. Strangely enough, the cream cheese, the chocolate bar or the lemonade taste completely different at home than they apparently do on the lush green mountain pasture or on the white sofa in the thoroughly styled townhouse.

"Goal-oriented," is what Anke Kleine-Tebbe calls this approach to honesty. She can accept this fibbing, exaggeration or concealment to a certain extent. It belongs to it, everybody knows it. For sure, lying out of politeness or flattery is also socially accepted – in small talk, among colleagues and on the countless talk shows.

Honesty is a tightrope walk. Honesty with oneself and with the other person. Also in the partnership. She tends to leave something out or not say it so clearly in order to spare the other person, says the doctor. Honesty can also hurt. "Honey, you look awful today" – a saying like that doesn’t make anyone happy together, she thinks.

In other areas, she does not compromise with honesty. After several relationships with men, she fell in love with a woman in the second semester of her medical studies, and "that’s how it stayed". It took her a year to tell her mother, who "wasn’t very enthusiastic. The Charlottenburg resident has now been living in this partnership for 26 years. Berlin makes it easy for her, she says. Sometimes, when she has a party, she invites friends and colleagues to her home. Then she opens a door to her private life for those who don’t know her that well. In the actual situation, she says, the guests then realize that their partnership is no different from anyone else’s at all.

Anke Kleine-Tebbe actually wanted to become a pediatrician. But when she realized that the children are often only tricked so that the doctor could give the injection in a distracted moment, she changed her mind. She wanted to work with patients in her job, to accompany them, to strengthen them, to respond to their feelings. "The cancer diagnosis is a very intense, intimate moment," says Anke Kleine-Tebbe.

In Berlin, 2500 women are diagnosed with breast cancer every year. Today, the disease is curable in more than 85 percent of cases. In most cases, they are treated at one of nine citywide breast centers. "The advantage of our small team in our breast center in Kopenick is that I know all patients personally," says the chief physician. This makes it possible for her to respond to them during the preliminary examination, in the diagnostic discussion and during the therapy.

All women want to know the diagnosis

Anyone who comes to the breast center has an unclear finding. Either the women palpated a lump or the gynecologist did. "Everyone who is here wants to know where she stands, whether the change is benign or malignant," says Anke Kleine-Tebbe. She has not yet experienced a woman who did not want to be confronted with her diagnosis. "Don’t tell my husband," on the other hand, is a phrase that comes up now and then.

However, every woman reacts differently and accepts the disease differently. One elderly patient had to be advised by her doctor to undergo amputation. For these cases, she has a coffee table book on the shelf behind her desk that shows strong, positive women bare-chested after a mastectomy. "These are great pictures that give courage," says the gynecologist. She asked the patient if she wanted to see her. But the woman, in her mid-60s, did not have the strength to do so. Three days later, at the pre-op interview, she was able to face the truth after all. "I would have thought that would be worse," was their reaction.

The cancer diagnosis of the young woman, who had not expected it at all, was particularly close to her heart. She firmly believed it was a cyst, a common benign change. Carefree, she endured all the examinations such as ultrasound and tissue samples. Anke Kleine-Tebbe already saw how the clinical signs of cancer were becoming more and more pronounced. In other cases, she would have already voiced her suspicions. Not so in this case. She initially kept her initial assessment to herself, until there was no longer any doubt after the tissue examination. As carefree as the young girl was at first, she looked black in the face of the diagnosis. "I’m still so young, can I still live my life??", she asked in despair.

One-third of women break down in tears after saying "I’m afraid I don’t have any good news". Anke Kleine-Tebbe then goes through the feeling of sadness with them, sometimes can’t shake it off even in the evening. Sports help her, she says, to let off steam, to leave all thoughts at the door of the gym. She knows from experience that a few days later the intense feeling of hopelessness and sadness can be transformed into strength, which makes the patient clear-headed. Then they are ready to take up the fight.

This is the moment when she gets a lot back, says Anke Kleine-Tebbe with a smile. Because then she sees what she has achieved with her honesty, with the clearly formulated diagnosis: that the patients are honest with themselves, in that they allow their fears and have questions, draw hope, face the therapy, find their way back into life. And embrace the new life.

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