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Some years ago I cared for a nine-year-old boy with a deadly brain tumor. I have never known a child with that tumor to survive more than a year. One of my partners had the difficult task of telling his parents the diagnosis and prognosis. This doctor had told them the whole truth and nothing but. I know his style—patient, thorough, compassionate.

Young Kyle went through radiation treatments. With that and the help of steroids, most of his symptoms went away. About a month after the treatment ended, I repeated the mri to see where things stood. The pattern of black and white and gray said that nothing had changed. How much nicer it would have been if all the sinister shadows had disappeared, if only for a little while. How, I wondered, would I tell the family this?

Kyle was in the room when his mother asked the results. "I have some good news," I told her. "The tumor has not progressed." Well, my hopeful spin was true—half true. But neither had the tumor gone away.

That evening Kyle's mother and I were guests on a local television talk-show. Kyle was there, too, sitting between us in a spiffy three-piece vested suit. At the end of the interview, his mother said directly to the camera, "I have to tell you what happened today. Today Doctor Komp told me that my baby is going to be okay. There was another doctor we called 'Doctor Gloom and Doom,' but Doctor Komp told me my son would be okay."

How could I correct her in front of her son, in front of the television audience? I smiled weakly, regretting that I had so softened the news that she had drawn that incorrect conclusion.

When Kyle died, the family did fine, even with the less euphemistic doctor they called "Gloom and Doom." But I've been thinking about my choice of words ever since.

There is so much bad news in this world that seems to beg to be softened, especially in the field of medicine. This verbal softening-up process intends to console the hearer, but more often it comforts the euphemizer rather than the "euphemizee."

Euphemizing risks the dissolution of the truth, and sometimes it covers up danger.

One morning in Chicago I set off early from my hotel to mail a package and met two friendly police officers standing on the street corner. I asked them if there was a post office nearby.

"Whew!" said one cop shaking his head. "Not around here."

"Where's the nearest post office?" I wondered aloud, looking to his partner who might be more informative.

"Not within walking distance," his partner answered. "About six blocks that way," he said, waving his hand in the direction somewhat vaguely south.

"Not within walking distance," both officers repeated. "ups will be open at 10:00 a.m. Why don't you just wait?"

Why wait when six blocks is not too far to walk? Having the time and needing the exercise, I set off past handsome banners that proclaimed "Illinois Medical District." The flags pointed to the illuminated crisp medical towers of South Ashland's Bedpan Alley.

There were many churches along my route to the post office. Bullet-shaped holes marred the simple glass cross on a Lutheran house of worship. A sign was broken off another church, but her boarded doors still proclaimed her watchword: "As for me and my house, we will serve the Lord." Hard to serve God on South Ashland, it would seem. Hard to come within walking distance.

My path took me down the streets of Cook County's encatchment area. Encatchment area—that's medspeak for the 'hood that fills the bedpans of this Chicago Hope. When I was a young doctor, Cook County had 3,000 active beds. Today fewer than 500 beds remain open for the sick of South Ashland who are sicker now than they have ever been before. I wondered whether visiting nurses need police escorts here as they do in the neighborhood that surrounds New Haven's Pill Hill where I work. It's not easy to serve those who have been managed-cared out of those 2,500 other beds.

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December 7 1998, Vol. 42, No. 14