I want, over the next few postings, to attempt to deal with an issue which is likely to arise from time to time in the lives of most people, irrespective of colour, creed, nationality, health status or basic need. How many times over the past few months, weeks or even days, have you heard some reference being made to the need to “be positive”? It may have been directed toward you personally; to a third person, or you may have used it yourself – doubtless with the best of intentions – and all, of course, in an attempt to offer (or be offered) support, encouragement or “counsel”.

“Now stop that Mary; I’ll not be having any of that negativity on my ward thank you”. Sister’s words were clearly audible, on the stair head where I was standing, just outside the open ward door where I was standing. Pausing for a moment to allow the ‘dust to settle’, I entered the ward and casually moved about, speaking for a few moments to patients who were without visitors. Eventually I came upon Mary who, though clearly having been recently distressed, responded to my general inquiry with her customary smile and politeness.Nevertheless, it quickly became apparent that she wished to talk and accordingly, I suggested we use a small room just off the main ward, which I knew to be vacant. Over the next few days, at some point but mostly in the evening, we returned to the little room to continue our discussions. I was a familiar figure around the wards of several hospitals in the area and so my regular presence ‘raised no eyebrows’.

A week later, I happened to ‘bump into’ sister as she was returning to the ward for the afternoon/evening shift. “How is Mary?” I inquired. “Oh she’s fine” sister replied. “In fact, she’s probably being discharged right now”. Then pausing for a moment she added hesitatingly, “Sometimes I don’t quite know how to respond or what to say for the best. Mary was really quite weepy when she was admitted to the ward a week ago and – well – I decided to be quite firm with her. Judging from how she was then and seems now, it certainly seems to have done the trick.

The confusion and misunderstanding that can arise over and around the use of terms like “negative” and “positive” can sometimes be further compounded by the ways in which we use language. The next paragraph of this blog will carry a verbatim and spontaneous quote passed on to me by a colleague from a patient, who had actually been given some good news, but who – because of assumptions being made to the effect that she possessed a degree of knowledge (which in fact she did not) perceived and interpreted it as bad news.

We have, from an earlier blog, seen that at biopsy, a tiny sample of living tissue is removed for microscopic examination and analysis. Where cancer cells are present as – say in a malignant breast lump – it is also necessary, promptly to determine the degree of spread, if any. Cancer cells travel through the lymphatic system and the nearest lymph nodes (which in reality are small filtering devices) to the breasts, are situated in the axilla or armpit. It is very likely therefore that lymph nodes in the axilla will be sampled and where this procedure is carried out, “positive” means present; whereas “negative” means absent or clear. The following is a verbatim report of one patient’s brief encounter with a member of the oncology clinic’s nursing staff.

“When sister told me that my lymph nodes were negative, I was shocked and after she left me the bad news really began to ‘sink in’. I just shook from head to toe. When my husband visited in the evening, I told him and for a while we just couldn’t speak. Then he went to see sister, who now changed her ‘tune’, saying that she had given me good news and how she hoped that by telling me without delay that my nodes had proved to be negative, might help me feel a little more positive. Now neither of us know what to think”.

Even for someone – if I may say so – as experienced in dealing with patients and their concerns as, at any rate after all these years I ought to be, it is difficult to know how best to begin to ‘tease out’ and identify the root of such confusion. However, let me at least make the attempt: first of all, a question. Is “being positive” (as most people seem to employ the term) always have to do with overt, i.e. evident and observable behaviour, such as smiling, being assertive, decisive, conforming with what people seem to be requiring from us? (The latter would appear to amount to, being out-going, doing approved deeds, appearing to think happy thoughts and in general, making all the right ‘noises’). in the meantime, give the issue some thought. Thereafter, I shall attempt to contribute my response to the question posed, in my very next blog to you.