Breaking bad news
There is no feeling quite like the first moment I enter the room, when I know and he doesn't. It's sort of like opening the door to the "family room" after an unsuccessful CPR, when everyone is looking at you sort of hopefully, searching your expression for a clue to your next words. Only in this case, he really has no idea at all that you are about to tell him probably the worst news he has ever had. Or ever will have. It's surreal.
I don't know why, but I always say "I'm sorry" first. I guess it sets the mood. But it's also the absolute truth. I really am sorry.
I then say that we found a mass. It's probably cancer.
You have to say the C word so it sinks in how serious it is. Probably everything I say after that goes unremembered, but I have an unfortunately well-rehearsed speech in which I tell him that we won't know for sure until further tests are done, and what sorts of things he can expect to face. I never tell anyone "how long they have" because they may get in a fatal car accident on the way home, or they may be one of the lucky ones.
But I will tell them that most people won't live for 5 years if it is brain cancer - but only if they keep insisting on a time frame. As big as this one is, less than a year is more likely. But what a dificult year that will be. I really don't like to give prognoses, but I have seen over and over that many doctors won't, so generally people have unrealistic expectations. If nothing else, I am a realist and I don't pull any punches. I tell it like it is, because I would want to know everything if our roles were reversed.
The last thing I tell him is to not give up, because the ones who fight are the ones who have the best chance at beating it. And to make the most of whatever time he has left on this earth. Good advice for all of us, really.
I don't know why, but I always say "I'm sorry" first. I guess it sets the mood. But it's also the absolute truth. I really am sorry.
I then say that we found a mass. It's probably cancer.
You have to say the C word so it sinks in how serious it is. Probably everything I say after that goes unremembered, but I have an unfortunately well-rehearsed speech in which I tell him that we won't know for sure until further tests are done, and what sorts of things he can expect to face. I never tell anyone "how long they have" because they may get in a fatal car accident on the way home, or they may be one of the lucky ones.
But I will tell them that most people won't live for 5 years if it is brain cancer - but only if they keep insisting on a time frame. As big as this one is, less than a year is more likely. But what a dificult year that will be. I really don't like to give prognoses, but I have seen over and over that many doctors won't, so generally people have unrealistic expectations. If nothing else, I am a realist and I don't pull any punches. I tell it like it is, because I would want to know everything if our roles were reversed.
The last thing I tell him is to not give up, because the ones who fight are the ones who have the best chance at beating it. And to make the most of whatever time he has left on this earth. Good advice for all of us, really.
posted by scalpel at 4:39 PM
4 Comments:
Truly, it's not ever easy. And it's hard not to revert to rote phrases: hope for the best, plan for the worst. But there's wisdom in that. And I think it's the rare patient who doesn't want to know the truth -- and if they really don't, they'll supress it. So even when family asks me not to tell the truth, I insist as much as I reasonably can, that avoiding it doesn't work.
I don't know if you will see this now but just want to say this is a great post and your patients are blessed to have you.
Hi there, just found your blog, so apologies for commenting on a very old entry.
Interestingly, there's research coming out now which seems to show that maintaining a positive outlook/fighting attitude results in no survival gain in patients with malignancies. At least here in Oz.
It's no wonder the popular press and cancer support groups don't like to hear that.
I just saw this patient last week, and he's still alive and functional 3 years and counting after his large glioblastoma multiforme was resected.
And he still remembers what I told him that day.
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