Breaking bad news

Here I just had one of the most intense and emotionally-charged sessions breaking horrible news to a guy and his family. As you could imagine, when a healthy man, in his sixties who has been selling shoes in Queen Victoria market every weekend until yesterday, is told after a rapid series of events that his life will now not see past the next few weeks.

His wife, his son and daughter, grandson, and nephew and niece were there to listen too. And no, there is no chance he will be able to fight his cancer and win.

Walking out here are some of what went through my mind:

  1. Have some water first before you enter the room, especially if you’ve had a long day seeing other patients.
  2. Deciding whether to stand up or sit down can be tricky. It is nicer for the patient on the bed to be at the same eye level with you, but the family members standing around will find it easier to step over you.
  3. Warn a few nurses first before going in, so that when a group of family members start sobbing and bawling their lungs out around an Asian dude they will not be too alarmed.
  4. Skirt the peripheral questions even though they can be very valid and even if you can answer them well. Those are good questions, but we can talk about them later. Stick with the main issues, keep the points short and then step out. Take charge of the conversation.
  5. It helps to look older, more professional, and probably less skinny. Oh well, maybe one day. I could have worn a necktie, though.

I realise, too, that while I sit comfortably in my room tonight, good headphones wrapping around my ears and a familiar cup of hot chocolate beside me, their world is totally shaken and turned upside down. Forever. I can still picture his wife screaming at me in disbelief.

6 responses to this post

  1. // reply // #

    Sounds awful, having to do that. I find it challenging, both emotionally & spiritually, to face those type of situations. And always wondering when it will be my turn or my family / close friends on the other side of the consultation… Hope you’re okay Joe. I’m sure you did well to be professional and compassionate despite being skinny!

    • // reply // #

      Thanks for asking Winnie, I don’t let these things (including the skinny part) affect me too much. You’ll have more of these encounters next year when you start working… it is a privilege I think. Anyways, I hope you’re enjoying Manila!!

  2. OD
    // reply // #

    man, i could imagine how the situation was like from what you’ve written. Bro, you sure are brave to be a rad onc. When i was in oncology clinic a few times last year, I had to follow the doctor into the room and watch the ‘breaking bad news’ part quite a few times. Feels like oncologists have to break bad news almost every (clinic) day. What I got from those sessions was that a box of tissue is necessary in every consultation room in oncology.

    • // reply // #

      a box of tissue is essential in oncology clinic rooms not just for tears — good for removing dentures, doing nasendoscopes, eating chocolate, my snuffly nose, and PR examinations!

      • Anonymous
        // reply // #

        haha! very useful tissues. I’m having a lecture today (professional development) on ‘Breaking Bad News.’ In the pre-reading they talk about using SPIKES (Baile, Buckman et al, Oncologist 2000,5(4): 302-11) to break bad news. SPIKES 1. Setting up interview 2. Perception of patient 3. Invitation by patient 4. Knowledge to the patient 5. Emotions of the patient 6. Summary and strategy. I look forward to it.

        • Family
          // // #

          Thanks, a good illustration of the difference between text book and ‘field’ experience.

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