In the middle of this loud and gloomy Corona time, the world-famous children’s oncologist and former head of the University Children’s Hospital Tübingen, Dietrich Niethammer, died at the age of 80 in February 2020. Only now, after a year and a half, did I find out about it by chance. His scientific achievement with hundreds of specialist articles on bone marrow transplantation, which he helped develop, is outstanding.
But it will stay in my memory mainly because it changed medicine.
When I began my surgical training at a large Frankfurt hospital more than forty years ago, during one of the first visits I learned about a rule in surgery that should not be broken: seriously ill patients were given no information about their diagnosis, least of all not about their possibly bad prognosis. Instead, one talked around it, used imprecise formulations or said the untruth directly. I found that quite normal at the time, human and gracious, so to speak, but over time it became more and more difficult for me to withhold the truth from my patient.
Then something terrible happened. During a visit, a patient with stomach cancer asked the chief physician how his operation had gone. He looked into the file, said some encouraging words and mumbled “extra muros” to me. Outside, he said I should speak of “malignant cells” and that the operation could completely remove the tumor – although the opposite was the case. After half an hour the round was over and I went back to the patient.
The room was empty. The window was open. The patient jumped from the 10th floor. I was horrified, felt guilty. I left the patient alone. From then on, against all the rules, I stuck to the truth when patients asked me about the diagnosis or prognosis, even if it was often not easy for me. Because the truth is always an opportunity, even if it is sometimes only very small. There are no gracious lies.
And then I was able to listen to Dietrich Niethammer at a conference almost twenty years ago. At that time he offended his pediatrician colleagues because he was passionate about not keeping the truth about their illness, including death, from children and adolescents. He was able to show us that the supposed “consideration” only serves to protect adults, but with catastrophic consequences for the terminally ill children. The children almost always knew how things were going, but they were silent, they wanted to spare the adults! With shocking case histories, he showed how dishonesty disrupts and ultimately destroys contact with sick children and adolescents, how they have to withdraw more and more into themselves and die lonely, without a hold in their relationships.
Sometimes it’s the small changes that have a big impact. One such small change was the way in which the truth is dealt with in medicine. That changed because there were doctors like Dietrich Niethammer. He will be remembered by everyone who knew him as a sensitive and exemplary pediatrician who, against all odds, campaigned to enable children and adolescents to deal honestly with illness and death.
Read more: Dietrich Niethammer: When a child is seriously ill – On dealing with the truth. Suhrkamp, Berlin 2010. € 8.90
