The Waiting Room We Don’t See

THE PALLIATIVE LENS

By Andrew Esch

4/7/2026

My friend Dave has a mass on his kidney.

The kind that looks, and behaves, like renal cell carcinoma.

They told him about it in December.

His surgery is next week.

Not because it needed to be.

Not because anyone thought waiting was better.

But because of vacations.

Because of volume.

Because there always seemed to be ten other explanations for why it couldn’t happen sooner.

There is a special kind of suffering we create for patients like my friend that flies under the radar.

    •    It is not tracked on flow sheets.

    •    It doesn’t trend in the chart.

    •    It doesn’t trigger an alert.

    •    It doesn’t get billed.

It lives in the space between.

    •    Between the scan and the call.

    •    Between the biopsy and the result.

    •    Between “we’ll schedule that” and “we know what this is.”

And we ask patients to live there.

Delivering Bad News Isn’t the Hardest Part

We spend a lot of time teaching clinicians how to deliver bad news.

There are frameworks. Acronyms. Workshops. Simulations.

    •    Sit down.

    •    Use signposting.

    •    Acknowledge the emotion.

    •    Pause.

All of that matters.

But if I’m honest, after years of doing this, the hardest part isn’t the conversation.

It’s everything that comes before it.

The Days Before the Words

A patient gets a scan.

“Something showed up.”

Not enough to explain.

Not enough to ignore.

So we order more imaging.

Or a biopsy.

Or a referral.

And then we say it:

“We’ll let you know.”

What we mean is:

We’ll get back to you when the system allows it.

What they hear is:

You’re on your own with this until then.

The Cruelty of Uncertainty

We have normalized this.

    •    The waiting.

    •    The scheduling delays.

    •    The asynchronous handoffs.

    •    The quiet gaps where no one calls.

But for the person living inside it, this is not neutral time.

This is:

    •    Googling at 2 a.m.

    •    Replaying every symptom

    •    Rewriting your future in your head

    •    Wondering if this is the moment everything changes

It is fear without edges.

At least with bad news, there is something to hold.

Something to name.

Something to begin to process.

But waiting?

Waiting is shapeless.

And it expands to fill everything.

We Call It Workflow

We say:

    •    “Pathology takes a few days.”

    •    “Radiology has a queue.”

    •    “The surgeon’s schedule is full.”

All of that is true.

But none of it feels true to the patient sitting at home, staring at their phone.

We have built systems optimized for throughput, documentation, and liability,

not for the human experience of uncertainty.

The Scanxiety We Underestimate

We’ve even given it a name now: scanxiety.

But naming it hasn’t changed it.

Patients still walk around carrying a question that no one will answer for days or weeks:

• Is this cancer?

• Is it back?

• Is it worse?

And we let that question sit there.

Unattended.

What If This Is the Part That Hurts the Most?

I’ve delivered hundreds, maybe thousands, of serious conversations.

And what I’ve come to realize is this:

The suffering often peaks before we ever sit down together.

By the time I’m in the room, the patient has already lived through ten versions of the worst possible outcome.

They are exhausted.

Not from the news…

From the waiting.

We Would Never Prescribe This

If uncertainty were a medication, we would never prescribe it like this:

    •    Indefinite duration

    •    No symptom control

    •    No follow-up

    •    No accountability

But this is exactly how we deliver it.

Every day.

What Would It Look Like to Care About This?

Not in a vague, “we should do better” way.

But concretely:

    •    Shorter turnaround times for pathology and imaging, not as a luxury, but as a priority

    •    Proactive communication, even when we don’t have answers

    •    Naming the wait itself as suffering

    •    Owning the gap, instead of disappearing into it

Sometimes the most humane thing we can say is:

“I don’t have the answer yet, but I know how hard this part is, and I’m not going to leave you alone in it.”

The Part of the Job We Don’t Talk About

We like to think our work is in the room.

    •    The conversation

    •    The disclosure

    •    The plan

But a lot of our impact lives outside of that moment.

    •    In the silence we allow

    •    In the delays we accept

    •    In the systems we tolerate

The Lens

We measure quality in days, metrics, and outcomes.

But patients experience care in hours, nights, and unanswered questions.

And right now, in that space between knowing and not knowing, we are asking them to carry more than they should.

Not because we don’t care.

But because we haven’t built a system that treats waiting as something that matters.

We should.

Because for our patients, it already does.