Saturday, February 03, 2007

when the truth hurts

I don't often have to break bad news to patients. It happens much less often than you'd think. I give people advice that I know is unwelcome, I warn them of future lifestyle-related problems. I diagnose urine infections, chest infections, depression, panic attacks, high blood pressure and myriad rashes. But when it comes to giving the really bad news, when it comes to telling people that they have an imminently life-threatening disease, I am usually not involved. The patient most often has been referred to a specialist, or has ended up having tests done in hospital. I am rarely present for the 'moment of truth'.

I have needed to deliver awful news on occasion, though. Once, a patient 'Veronica' came to me rather than returning to the hospital clinic, for her head scan results. It was too much hassle to go all that way, she told me, and besides she needed to be on time to collect the kids from school. Her husband 'Phil' sat with her as I phoned the hospital. I spoke with the hospital doctor, as Veronica and Phil sat watching me.

"There are several presumed tumours - they're large, and they're deep. Looks like *GBM (*glioblastoma multiforme - a particularly nasty brain tumour). Don't think they'll be operable", reported the hospital registrar.

I thanked the doctor on the end of the phone. I carefully replaced the receiver. I slowly explained the findings to Veronica and her husband. I'll never forget the first words out of Veronica's mouth - she was in shock - 'How funny! I've just been to a charity lunch to raise funds for cancer patients!"

That was almost ten years ago, and Veronica has long since passed away. I was reminded of her, though, when I had to give some bad news to 'Rita' last week. I was reminded that there is no good way to give bad news. I also realised that I will always sag under the burden of carrying such a dire message. I wished I would not be forever recalled as the bearer of the terrible news. I wished most of all that there was no bad news at all to deliver.

As much as I try not to 'take my work home', some thoughts just follow me on the drive anyway, trailing insidiously behind me like some noxious vapour. When I reach home, and especially when I lie in bed at night, the gases swirl and mist around me, and I can't sleep for the fog.

What will happen to Rita? I don't know. It's out of my hands now.


Motherkitty said...

Yours must be one of the most difficult jobs in the world, being the bearer of really terrible, life-ending/threatening news. I suppose that's why some people don't want to know the "truth" about their condition but would rather live their lives in bliss. Is ignorance really bliss?

As for me, I would want to know everything, good or bad, so I could prepare myself and my family.

(Wasn't this so easy for me, a healthy person, to say? I can't imagine what it would be like to receive a death sentence because of a physical condition.)

Yes, your vocation is difficult. But, I also see that if I had to receive such bad news, I would rather receive it from someone caring like you than some cold, indifferent physician who just wants to cut and run.

Remiman said...

It's easier to leave widgits at work. When you interact with people for a career, and you're a caring sensitive people person to begin with, it's near to impossible not to take it home with you (good or bad dealings).
We had a good friend and neighbor a few years ago dx w/ glioblastoma multiforme. I worked with her via hypnosis to help her deal with her sense of helplessness. She fought a valiant struggle for 7 yrs. Enduring many surgeries, but in the end secumbed leaving two young children. My wife worked with her at the end to make audio tapes for her son and daughter to listen to as they grow-up.
Yours' is a horrendous responsibility! Thankfully you do it with compassion and kindness.

John Cowart said...

Hi Jellyhead,

Last night a tornado hit a town just south of us. 19 bodies have been found so far and over 800 homes destroyed.

It's easy to see such news on tv and look at only the devastation.

I find it helps to focus on all
those helpers at work clearing debris, feeding the hungry, bandaging the injuried. I see a lot more helpers than victims.

Thank God you are one of those helpers. I wish you peace.

meggie said...

Oh Jelly, thanks for sharing that.

I have often wondered about how it must be to have to deliver bad news like that. Knowing most of our GP's have been wonderful caring people, I know they must suffer an 'afterburn' effect, just like everyone else does.

Your description of the feelings & thoughts was so accurate.

mackeydoodle said...

I don't think I could ever do brings me to tears just reading about it.
Big ((((hugs)))) to you today Jelly.
May I prescribe a day of fun & folly with the Jelly Jr's to chase the blues away?:)

shellyC said...

Oh Jelly I can imagine that must be so hard to be the bearer of bad news. Of course it must be even harder to try and leave all those thoughts at the clinic - well for a doctor like yourself. Who I am sure SO many bloggers wish you were our GP! Of course there must be many more doctors who deliver bad news and think nothing more about it.

Kerri said...

Oh Jelly, what a mix of overwhelming feelings this must bring. Your descriptions of them brought a lump to my throat and tears to my eyes.
It takes a special person to be a physician of your caliber. We all wish we had a Dr. with your caring nature.
Sending (hugs) to cheer you up xox

TUFFENUF said...

Jelly, we all love you so much. Thanks for all of your shared stories, and especially this one. It makes us remember that life is so short and fragile. Thanks also for the comments on my blog; we did hire a "senior consultant" while I was at my mothers house, and she pointed us in the right direction.

thisisme said...

Jelly, thank you for sharing that. It must be so difficult for you to give the bad news to your patients, but they are lucky to have someone who cares about them giving the news, and not a complete stranger.

T. said...

In the end Jelly, they won't remember WHO gave them the bad news (well they might), but what will more likely be remembered will be the manner in which the bad news was delivered.

For me, it was an ER doc who was backlit from the hallway and I couldn't see his face. He told me about Bug and then proceeded to pat my knee.

I found the whole thing hysterically odd. Of course, that was the shock of the moment, but that's what I remember.

I am sorry your job contains this particular duty sometimes. But I am sure that if someone has to get the bad news it is best delivered by someone as kind and compassionate as you.

Thank you for sharing.

Heather said...

You have such a gentle nature, Jelly. I am sure there is no person who could possible be more compassionate when sharing such news.

Alice said...

One thing Rita has is an empethetic doctor who will listen to her concerns as time goes by. You will be a rock of strength to her in whatever time she has left.

Knowing that you are doing the very best you can for each patient may not dispel those mists of worry, but it hopefully it will help you through the difficult times.

jellyhead said...

Thank you all very much. When I read all your comments, they brought tears to my eyes. You are all so lovely. I am so glad to know each and every one of you.

Abandoned in Pasadena said...

Jelly...I worked in a surgeon's office for many years and bad news, of the worst kind, is never easy and although some patient's died, I still hold their memories close to my heart.

When nice people die against their wills, through no fault of theirs, you soon learn to stop nagging about the little things at home and look at the big picture and appreciate what you have.

Thanks for the reminder to make everyday count.