The quiet room
The 'quiet room' was used to follow up cancer diagnoses given in the surgeon's consultation. This was common knowledge to everyone in the waiting room. The specialist nurse observed that leading people to the quiet room was like 'putting up a signpost to say "bad newsgiving this way" '.
Once inside, the degree of privacy stood in stark contrast to the main consulting room. There were few interruptions (the nurse bringing tea; a surgeon confirming a biopsy result); any interruption constituted an intrusion, and apologies were always made. The specialist nurse would begin the consultation in the quiet room with an invitation to the patient to reflect on what they had heard: sometimes verbally, for example, 'What do you think to that then?'; sometimes simply through offering a cup of tea, or emitting a sigh. Patients would regularly express, in response, concerns unvoiced in the main consulting room. The patient in Extract 2, who presented as in agreement with the surgeon's recommendation to have the operation, expressed a rather different view in his consultation with the specialist nurse, which opens as follows:
Extract 5 a
Pt: I don't like the sound of all that
N: Don't you ...
This opening, when compared with Example 2 above, illustrates how the quiet room afforded space and priority to patients' expression of their concerns and reactions to the news and treatment decision presented in the main consulting room.
From this opening, the consultation proceeds with the patient listing several concerns, regarding radiotherapy, having to spend a long time in hospital, and a worry that his teeth won't fit so he'll 'look a right idiot'. At a later point, the patient returns to the question of radiotherapy, saying that he had expected the surgeon to mention something else like this:
- 1 Pt: well let's get the operation over first. (0.3) .hh then hit me with something
- 2 else.
- 3 (.)
- 4 N: Right.
- 5 (1.3)
- 6 Pt: Mmm.=
- 7 N: =Mmm
- 8 (1.2)
- 9 Pt: Another question is how long do I want to stay alive.
- 10 (3.9)
- 11 N: And how long do you want to stay alive.
- 12 (2.8)
- 13 Pt: Not that long actually,
- 14 (0.7)
- 15 N: °Ri[ght°
- 16 Pt: [I'm seventy-six (now). (2.1) I'm not (0.3) crowing about me age. (.)
- 17 but I'm ( ) surprised I've reached that age,
- 18 (0.8)
- 19 N: Yeah.
- 20 (0.4)
- 21 Pt: [Right well what kind of a life does it leave me at the end=
- 22 N: [Mm hm
- 23 Pt: = of it.
- 24 (0.5)
- 25 N: Right.
- 26 (1.2)
- 27 Pt: I've no desire to be a vegetable. sitting in a (0.7) nursing home.
- (Consultation, B-348-134)
The space for reflection afforded by the quiet room leads to the patient voicing feelings and concerns about the unexpected mention of radiotherapy (lines 1-2), whether he wants to live much longer (line 9), the potentially disfiguring and disabling treatment (line 21), and about the quality of life after an operation (line 27). As mentioned previously (see Extracts 1 and 2), patients' restricted forms of contribution in the main consulting room compared to the quiet room demonstrate how space constrains or opens up patients' expression of their concerns. Extract 5 shows the patient is in the position of determining the topics and questions for his consultation with the nurse, through his expressed concerns, which the nurse, in turn, pursues ('and how long do you want to stay alive?', line 11).