Consults:
Wow..initially I wasn't sure where you were going with the Spirit Slaying title (we had a charismatic preacher uncle when we were little kids). But wow.. sorry. Bad news is hard to deliver and harder to hear.
Please tell me she wasn't left all alone after you dropped the bad news.
how utterly sad.
I wish there was no bad news to ever deliver. I am sorry.
No one said life was gonna be easy. So, it sounds more to me like this was of a moral nature more so than a medical nature, no? That former can be tougher to broach than the latter, but either way neither one is "easy."
Thanks for saying what needed to be said. That's a new principle I've adopted within the last year. It led me to have one of the most difficult talks with my dad I've ever had in my life, but it needed to be said.
To quote a lyric from that eloquent singer/songwriter Tupac Shakur:
"And it's crazy, it seems it'll never let up, but please... you got to keep your head up "
Oh dear. I am sure this part of the job NEVER gets any easier. Don't know how you do it.
One question: Why was the decision made to hold on to "all the truth...holding up inside of us for weeks?"
While it totally sucks to deliver bad or difficult news at any time (regardless of whether it's "your" patient or not) it would seem sharing proactively rather than waiting on a "bomb" would've been a better plan.
While I admire your honesty in admitting your reluctance to convey the bad news and accepting "ownership" of something that wasn't necessarily yours, I'm disappointed and disheartened. In light of your usual history of taking others into consideration, you didn't here. It comes across that you were pretty resentful/angry with "owning" something that wasn't necessarily yours and took that out on the patient's wife. I hope I'm misunderstanding.
I've been reading your blog for a while now (got here from Mackenzie's) and this is why. I admire your courage and the beautiful way you have of saying the hard things. It's true that we all live together on this earth and what hurts one hurts us all, isn't it? We just can't separate ourselves from this race of Adam. Thanks for taking the time to figure out the way to say it. I love your visual examples of floating words. Sometimes there is beauty in pain and I am thankful for the reminder.
words are always inadequate.
What are you afraid of?
I completely understand what you mean....and I will NOT criticize. I won't offer any hints of advice either, for you know the road you travel and how hard it can be. I often wonder after discussing bad news with a patient if I didn't give it enough thought or spoke too freely. It's an area I will continually seek improvement on. God bless you. You inspire us all.
Anonymous, from your response I am gleaning that maybe you have never been in the position where you have had to give bad news. From my short career as a resident, i have learned that I cannot assume that all patients want to receive information the same way. I have had several patients tell me if it's bad news, don't tell them, or their family. They live in a world of hope, where maybe for this one woman it gives her two more weeks of loving her husband; two more weeks of being allowed to cling to the person he once was, an excuse to not have to start acknowledging or regretting or denying the situation that truly is. And maybe that is what she needed in those few weeks of silence.
One of the most important things i have learned so far in my training is that no one patient is the same as any another. Delivering bad news is just one of the many times when you have to just follow your heart and do what you hope and believe is the best thing for that patient and his family. So dont judge or be "disappointed" that 6yearmed didn't act the way you think she should have; you weren't there, you didn't know that patient or his wife, or what you hoped in your heart was best for them.
Sometimes reality stinks. I'm sorry you had to deliver reality.
The above comment was a result of my wife hijacking my account.
I just wanted to ask what you had to tell her. I guess it's more dramatic if you don't say...
You're wrongfully assuming that I've never been in the same situation; I've had over 25 years in the delivery of patient care.
I concur with your assessment that every patient is different and everyone receives and processes information differently (e.g., there is no "cookie cutter approach") and that is definitely a factor to consider. However, from what I can see through here (which may or may not have "all of the facts") the wife was presented with a total bomb to process. Would it not have been better to provide and/or lead her to this day and this moment rather than summarizing what seems to be weeks worth of information in a 10 minute conversation? In so doing allow the patient/wife to choose how they want to spend their remaining time (denial, "unfinished business, etc.)rather than taking that choice, that 2 weeks of time, away from them?
I wasn't "judging" per se, merely observing. While your entry was honest (and I respect, admire and appreciate that) it also seemed a departure from your usual approach.
My comments are rhetorical by the way, I'm not necessarily looking for you (or anyone else) to respond-- just offering up another perspective.
Giving bad news is one of the hardest things we have to do as residents. There is no good way to teach someone how to do it. You just have to dive in, with inadequate words, awkwardly stumbling through. I always feel inadequate. I never feel like I do it well. But sometimes, hard things need to be said. And I think that usually, directness is the best way.
I recently had to tell someone they had lung cancer. Small cell. I was straightforward. Afterwards, I felt like I didn't do it well, wasn't kind enough, or something. And I probably wasn't. I left him reeling. And confused. But I kept seeing him daily in the hospital, kept supporting him through his biopsy and discussions with specialists. And even though I didn't do that part well, we still bonded. He had no doctor prior to this admission, and since he needed somewhere to follow up, he asked if he could see me.
One nice thing about working in a hospital is that as we take care of these patients daily, we are given chances for redemption. We mess up one day, we come back the next, ready again to care for our patients as we best know how. And we learn from our mistakes.
Don't beat yourself up - just keep going back.
You are courageous. I have received that terrible news, and I'd be grateful to know that the one who delivered it was as transparent as you have been. Or as sad when they felt they hadn't done it well. In truth, the one who hears that news may barely remember what's been said. The room tilts and the roar in one's ears drowns out all the other words. Listen to Aubrey. She's right. But you probably knew that.
dearest sister.
how brave you are! i know you may disagree or just think that you were doing your job, but i must tell you... YOU ARE SO BRAVE!
i'm feeling very melancholy and empathetic right now. for you. for our brother. for the world. and all i can do right now is listen to the song "restoration" over and over again. i think i may have sent it to you, if not, let me soon.
sometimes this world and its sin and the awful ramifications of its darkness are so overwhelming and hard to bear. but dear sister, there IS light. there IS restoration. and there IS hope.
i am so PROUD of you!
I love this post - to me, it's a poetic description of the "what" of life-altering news.
The doctors can debate the "how" - it's an important question, and I appreciate the rigor with with the doctors on this comment string have evaluated themselves.
But I agree with Marty. From the patient's side, there is no easy "how." The room does tilt and roar, whether the news is delivered with compassion or blunt force.
I learned of my invasive cancer in a foreign country, from a department head for whom English was at least his third language, if not fourth. There was no opportunity for subtlety: he read the diagnosis, looked up and said, "So. You have cancer."
Four words changed our world permanently. If he had said forty or four hundred, the change would have been no less dramatic or permanent.
Wow, what a sad post. I appreciate your recognition of how you did this truth-telling, and how it could have been done better. While there is never a 'perfect' way of delivering bad news, there are ways to make it better. To establish real presence with the person to whom you share bad news, life altering news. I appreciate when a relationship is established, when every bit of news along the way is shared - and in this case it seems you didn't have the option, as the person wasn't "your" patient - I appreciate it when the person in power (the person holding the bad news) attempts to be my equal by sitting at my level. There's no perfect way, and you know that. And I really appreciate your recognition of a better way, and your acknowledgment that when that isn't possible, you feel something because of it. Good luck figuring out how to do this in your career - in your life.
You know - I've received the bad news a couple of times now and honestly - I don't expect the doctors or nurses to be my counselor, pastor or shepherds - I need them to be straight forward, honest and very very clear in what they say. It is NOT a doctor's responsibility to tend to my emotions - they need to be truthful and do their doctor job to the best of their ability. I figure this isn't going to go over with most people but as has been pointed out - until you been in my shoes - you do not know. Don't beat yourself up about how you did what had to be done -
Mackenzie introduced me to your blog...it has been sometime since I visualized anything from words so vividly...thank you for being honest
First, I thought it was a great post and I just want to share an experience I had just last week.
My dad was in the ICU following bypass surgery. Once we were allowed to see him, his nurse sat with our family and explained how things work on that floor.
She then made this statement, "we don't sugar coat things here, we will always tell you exactly what was going on". I thought this was such a great thing to say...it gave me the confidence that I was staying informed yet for those in my family who didn't want the gory details they knew that they shouldn't ask a question they really don't want the answer to.
When it comes to the real bad news, well there's never a good way to get it or receive it. I don't envy your position one bit.
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