Having joined a brand new position with the promise of leadership intertwined in the responsibility metrics, relationships with team members become a palpable entity and reconciling these abstract concerns with the demands of the role looks set to assume mythical proportions. The first referral from the oncology team itself becomes a minor event, with the potential to foretell a story. So here goes – a young male patient with a metastatic soft tissue sarcoma who had been admitted to the ward was discussed as a possible candidate for a liaison. He had been made aware of the diagnosis, however whether the extent of the disease had become clear to him remained unclear. The possible impact on his family also remained a concern.

The first discussion with the oncology team prompted the beginnings of a nagging query, were too many individuals talking to him about his disease at the same time? Is there such a thing, analogous to the sensory overload, that one feels while watching a blockbuster movie, where all your senses are numbed by an avalanche of beautiful actors in impossibly gorgeous landscapes, all too in your face, when the story starts seeming superfluous to the glorified, meticulously manufactured construct and becomes impossible to follow.

Further probing revealed the existence of an entity referred to as cognitive overload, seen in those recently admitted, reviewed and started on multiple medications. That it remains under-recognized and seldom acknowledged is no surprise. The fact that it has not yet been relegated to the dustbin of banal oft-repeated catchphrases – which contains terms such as avoidance, denial, cultural reticence and other important-sounding lexical terms (sure to make one sound like a specialist) seems like a miracle.

Was restraint warranted in this setting? Fortunately, or perhaps timely, this patient was referred to the palliative care physician (or the self-anointed senior specialist!!) with the aim of discussing the plan of management (emphasis on goals of care). After multiple attempts and full disclosure, he repeated that he did not want to know about his disease. His right to govern his informational environment stands respected.

Disclaimer – Every attempt has been made to safeguard the identity of patients referred to in the vignettes and any circumstances arising out of this moral treatise are completely unintended on the part of the author. The author does not intend to cause any harm to another individual’s or organization’s reputation and has tried his level best to ensure that identities are fiercely protected.