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 ...