At our same-day surgery center, we sometimes administer blood transfusions to patients being treated for cancer. One woman has been getting more frequent transfusions now that her condition is deteriorating. Yesterday she remarked how "all this blood is being wasted" on her and"maybe it should go to someone else" who could truly benefit. I asked if she wanted to talk more, but she said no. Should I have done more to encourage her to talk?-J.C., ARIZ.

I think you handled this well. First, you did the right thing by offering your listening heart to her. She may have been just "testing the water" by verbalizing something she's been thinking about for weeks.

Second, you respected her unwillingness to say more. You didn't make this about you or your need for her to talk. Trying to pry into her intimate thoughts would have caused only resentment and mistrust. She simply needed to know her statement was heard and validated.

When she visits the center again you might say, "Last week you mentioned your thoughts of futility about the blood transfusions. Do you feel like sharing any more about that today?"

If she says yes, offer her information about when repeated transfusions are warranted for patients with advanced cancer-for example, when the patient clearly benefits from transfusions. In general, transfusions aren't justified if the patient fails to benefit, has adverse reactions, or declines the procedure.

Let your patient know you'll support whatever choice she makes and that you admire her courage, both in her battle against cancer and in her contemplation about stopping intervention.

Sometimes patients aren't asking for our permission to stop, but rather for an authentic acknowledgment of their bravery against an invisible and relentless foe.