Bearing Bad News
From my third year med school rotation in Surgery.
The disappointment on my face was visible, even through the surgical mask. I never knew how well eyes communicated inner feelings, until I started rotating in the OR. Apparently, my chief resident knew as well. He saw what I felt. Knowing full well that the stomach cancer was nonresectable, he looked up at me and without saying a word, told me that there was nothing else to do - nothing else to try. I was even more helpless, as a third year med student who knew the books but little else.
I knew this man briefly. Far too briefly due to the demands of a busy clinic schedule and the reduced resources in the current age of managed care demands. I knew of his name, of his wife's name, and of his occupation. I met him once and in that one meeting - I saw the fear and desperation that was cloaked by a stoic acceptance. He thought surgery was his last chance, as did his family.
After we scrubbed out, my chief asked, "Hey Rich, have you talked to patient's families after surgery before?"
"Yes, I have - but only to give them good news."
"Well, I have to run to take care of an emergency in the other side of the hospital, can you do me a huge favor?"
"Sure." But my level of fear was raised in my voice - I'd never told a family that their loved one would most likely die in 3-4 months.
"Its not that hard," my chief continued. "Just say like you mean it and be honest. Its at these times that honesty and empathy is most important."
With that, he left, leaving me to my own devices.
I took the long way back to the ICU room where the patient and his family were residing. More than once, I ran into the wall as I stared at the ground, trying to come up with the words to communicate to the family and the patient. I was scared. In the elevator, I repeated to myself over and over, "Mr... I'm afraid to say," or, "I wish I could bring good news..." Either way, anything I thought of sounded crass, dishonest, and almost too slick. I knew that this moment is the moment families and individuals remember and keep with them. They remember your face, your emotions, and your words. They remember looking for some sort of glimmer of hope in what you say. They look for the signs of impending doom as well.
What if I messed up and all they could think about was how bad I was, how horrible my bedside manner was? What if I got nervous in front of a roomful of family members? What if I'm just not cut out to do this kind of thing?
I stopped for a moment and thought about that harder. All of a sudden, I realized the selfishiness in those thoughts. Who cares about me? That man is going to die. In 3 to 4 months, he will fit into his life all he has ever wanted to do in his life, all the while doing it under a constant cloud of uncertainty of death and a constant reminder of his illness when receiving his care. My thoughts and my lot in life is nothing in comparison to what he has to go through. How self-centered was I to put my fears and self-esteem ahead of his.
For a moment, in the hallway that leads up to the ICU, I stood quietly. The thought of the memories of his childhood, the remembrances of the joys, and the thoughts of the lows overwhelmed me. I'd never felt this much sorrow for a stranger. The least I could do was to tell him the truth. Tell him what he needed to know to move on. To put this moment behind him - a moment I could never put behind me. The ICU doors opened.
Walking into his room with a lump in my throat that stifled my every breath, I stopped to observe the family. As tears began to well in my eyes, I sat down next to him and said, "Hi, my name is student doctor Ha... how are you feeling?" With that, an hour and a half of words and emotions I'll never forget passed.
About four months later, I received a letter in my med school mailbox. It was addressed from the wife of this patient. He had died. Without movement, I read through the letter - he had died comfortably in the presence of his family. In the last paragraph, his wife said this:
He wanted you to know, that in that instant when the news was contrary to his wishes, he found comfort in your words and your caring. When I asked him how he knew, as you had not said much, he simply said, "It was in his eyes - his eyes gave away his sorrow." Your sincerity and honesty touched him, when he thought he would feel despair. I hope you move on from that day as Doctor Ha, you were his doctor at that moment - never a student doctor.
Through the years, people have asked me why I chose medicine. Was it that I was a generous person with a good heart? Was it because medicine is a marriage of science and altruism? Or were there selfish motives behind it? I can say now that the first two reasons are true. The last - partially true. I am selfish in wanting to be a doctor - but not for the standard selfish justifications. I am selfish because it is only in Medicine that you can share with a person their moments of greatest joy and their moments of deepest sorrow. And its during these memorable moments that the commanlity of humanity and altruism is confirmed. Nothing else will ever get me as close. Nothing.
The disappointment on my face was visible, even through the surgical mask. I never knew how well eyes communicated inner feelings, until I started rotating in the OR. Apparently, my chief resident knew as well. He saw what I felt. Knowing full well that the stomach cancer was nonresectable, he looked up at me and without saying a word, told me that there was nothing else to do - nothing else to try. I was even more helpless, as a third year med student who knew the books but little else.
I knew this man briefly. Far too briefly due to the demands of a busy clinic schedule and the reduced resources in the current age of managed care demands. I knew of his name, of his wife's name, and of his occupation. I met him once and in that one meeting - I saw the fear and desperation that was cloaked by a stoic acceptance. He thought surgery was his last chance, as did his family.
After we scrubbed out, my chief asked, "Hey Rich, have you talked to patient's families after surgery before?"
"Yes, I have - but only to give them good news."
"Well, I have to run to take care of an emergency in the other side of the hospital, can you do me a huge favor?"
"Sure." But my level of fear was raised in my voice - I'd never told a family that their loved one would most likely die in 3-4 months.
"Its not that hard," my chief continued. "Just say like you mean it and be honest. Its at these times that honesty and empathy is most important."
With that, he left, leaving me to my own devices.
I took the long way back to the ICU room where the patient and his family were residing. More than once, I ran into the wall as I stared at the ground, trying to come up with the words to communicate to the family and the patient. I was scared. In the elevator, I repeated to myself over and over, "Mr... I'm afraid to say," or, "I wish I could bring good news..." Either way, anything I thought of sounded crass, dishonest, and almost too slick. I knew that this moment is the moment families and individuals remember and keep with them. They remember your face, your emotions, and your words. They remember looking for some sort of glimmer of hope in what you say. They look for the signs of impending doom as well.
What if I messed up and all they could think about was how bad I was, how horrible my bedside manner was? What if I got nervous in front of a roomful of family members? What if I'm just not cut out to do this kind of thing?
I stopped for a moment and thought about that harder. All of a sudden, I realized the selfishiness in those thoughts. Who cares about me? That man is going to die. In 3 to 4 months, he will fit into his life all he has ever wanted to do in his life, all the while doing it under a constant cloud of uncertainty of death and a constant reminder of his illness when receiving his care. My thoughts and my lot in life is nothing in comparison to what he has to go through. How self-centered was I to put my fears and self-esteem ahead of his.
For a moment, in the hallway that leads up to the ICU, I stood quietly. The thought of the memories of his childhood, the remembrances of the joys, and the thoughts of the lows overwhelmed me. I'd never felt this much sorrow for a stranger. The least I could do was to tell him the truth. Tell him what he needed to know to move on. To put this moment behind him - a moment I could never put behind me. The ICU doors opened.
Walking into his room with a lump in my throat that stifled my every breath, I stopped to observe the family. As tears began to well in my eyes, I sat down next to him and said, "Hi, my name is student doctor Ha... how are you feeling?" With that, an hour and a half of words and emotions I'll never forget passed.
About four months later, I received a letter in my med school mailbox. It was addressed from the wife of this patient. He had died. Without movement, I read through the letter - he had died comfortably in the presence of his family. In the last paragraph, his wife said this:
He wanted you to know, that in that instant when the news was contrary to his wishes, he found comfort in your words and your caring. When I asked him how he knew, as you had not said much, he simply said, "It was in his eyes - his eyes gave away his sorrow." Your sincerity and honesty touched him, when he thought he would feel despair. I hope you move on from that day as Doctor Ha, you were his doctor at that moment - never a student doctor.
Through the years, people have asked me why I chose medicine. Was it that I was a generous person with a good heart? Was it because medicine is a marriage of science and altruism? Or were there selfish motives behind it? I can say now that the first two reasons are true. The last - partially true. I am selfish in wanting to be a doctor - but not for the standard selfish justifications. I am selfish because it is only in Medicine that you can share with a person their moments of greatest joy and their moments of deepest sorrow. And its during these memorable moments that the commanlity of humanity and altruism is confirmed. Nothing else will ever get me as close. Nothing.
posted by Richard at 11:18 AM
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