there is a fair amount of talk about how to break bad news. truth be told i think i'm fairly good at it. sometimes, however it can leave quite an impression.
i was a community service doctor in qwa-qwa. i was working in casualties when they came in. two young children had been playing on the side of the street with a spinning top when a drunk driver came careening off the tar and ran them down. apparently in his drunken state he couldn't negotiate the turn.
the patients were cousins. we shuffled them both into the resus room and closed the door. one was about four and the other was six. the bigger one was dead. the smaller one had only minor abrasions. we covered the body of the big boy and cleaned and bandaged the wounds of the little boy. then we waited for the family.
a side story here was that the drunk driver who realised he was in trouble asked me to only draw the blood for alcohol levels the next day and lie about it. he even offered me money. he didn't specify how much. i was amazed at the inherent selfishness of people. there was a dead child in the resus room and this man was only concerned about the consequences as they pertained to him and him alone.
finally two family members arrived. the old woman was the grandmother of both children. her daughter who was with her was the mother of one child and the aunt of the other child. we moved them into a closed room where i was to speak to them. there was not going to be an easy way to do this, but i remember thinking that i really hoped the mother was the mother of the living child. it would make my job easier and their job when they got home more difficult.
i started by explaining the nature of the accident. i went on to explain that these types off accidents can cause severe injury. i then as gently as possible said that one child was already dead when he arrived and we couldn't help him, but the other child was ok. the mother immediately looked at me directly, something she had not done up to that point and asked with desperation both in her voice and etched into the lines on her face;
"which one? which one is dead?" the grandmother did not react outwardly, but a tear rolled down her one cheek.
i remember clenching my jaws, hoping that the woman before me was the mother of the living child and not the dead one. the news would still be bad, but at least for her personally there would be a good slant on it.
"the older child is dead."
it looked like someone shot her. her entire body contorted and she dropped to the floor. she started screaming. the grandmother didn't move, but the tears flowed more freely down both her cheeks. between the screams of the mother of the big boy, for that is what she was, the grandmother simply said;
"this is a terrible and difficult thing"
i was shaken. i didn't want to let the casualty staff see me cry so i swallowed hard, wiped my eyes and went back to work. besides casualties was full and i didn't have the privilege of taking time off to get over my trauma. anyway it didn't compare to the woman lying crumpled up on the floor of the office sobbing .
Wednesday, December 31, 2008
breaking the news
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You docs have really tough jobs. I'm glad I'll probably never have to tell a mother her child is dead.
Selfishness and waste - 2 things that as I get older I understand less and less. Mankind leaves such a big footprint when they forget where they are treading.
I can't help but ponder if the driver also got to lie "crumpled on the floor ... sobbing", and if so, why!
Another good post Bongi. Thank you.
They do leave an impression on us don't they? Such needless sorrow.
This would be so heartbreaking.
That's absolutely terrible. For what it's worth, I don't know anyone in medicine (man or woman) who doesn't cry from time to time. It just means that you are healthy. I am still studying (though almost finished) so I haven't had to deliver bad news yet, but I have been present before when equally catastrophic news has been delivered and received. Delivering the news is not a part of my future job that I look forward to. What I think must be the hardest, is to go on treating the drunk driver in a proper and professional manner while he's on your ward. I personally have the hardest time keeping my cool when I don't like a patient. I deal with the stress of the encounters by telling 'you'll-never-believe-what-that-crazy-person-said' stories about it later--probably same as you. So I think that telling and hearing and reading these stories is a good part of the stress management process. For everybody. Anyway, happy new year Bongi. please keep writing.
One of the things I have forced myself to do is to stay longer than I want to after giving bad news, longer than I feel comfortable with. I've seen doctors who unload horrendous news then are obviously in a rush to get out, leaving others to mop up the emotions for them.
I want to stay (I was going to say "like to stay" but that's not accurate) until in some way or another the family gives me leave to go. After the wave of emotions there are frequently some kinds of questions that come up, some medical, some maybe only administrative (like what do we do now?), but I want to get a sense of what's going through their head as they try to cope.
It's not that I'm a masochist, but only that I see the family as part of what I am evaluating and treating as a physician. My job's not done just because the patient died. It's also a form of respect for the human whose life was just lost, that perhaps at this moment at the end of their life someone gives their family a measure of the comfort they need.
greg, great comment. i try to stay until i feel the pain. otherwise it's just not real and i'm lying to myself about what i'm doing.
Bongi, excellent writing. You always transport me straight to the there & then and move me with your posts. I even got goosebumps, just as I have had before when breaking the news myself. Isn't it dreadful!
Fantastic Delivering the news is not a part of my future job that I look forward to. What I think must be the hardest, is to go on treating the drunk driver in a proper and professional manner while he's on your ward. I personally have the hardest time keeping my cool when I don't like a patient. I deal with the stress of the encounters by telling 'you'll-never-believe-what-that-crazy-person-said' stories about it later--probably same as you.
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