A doctor remembers the first time he had to tell someone they were terminally ill.
I was 22 years old and in fourth year medical school, working on a general medicine floor. On the service was a 17 year old boy named Colin, who had been admitted for investigation of headaches, vomiting and blurring of vision. During the morning rounds we reviewed his CT scan. It had shown a malignant tumor, a type which was inoperable and for which there was little chance of a cure.
The family did not yet know the diagnosis, let alone the prognosis.
Dr. Jones, the consultant neurologist approached me and asked if I’d ever had to tell someone they were terminally ill. Actually at this point in my career, and my life, I don’t think I’d ever had to deliver any really bad news of any kind, let alone a terminal diagnosis to someone who was only a few years younger than me. I told the neurologist that I had not. He told me that it was something I would have to get used to, and asked if
I would let the family know the results of the investigations. Alone.
I didn’t question his decision, though in retrospect I’m not sure that a clinical clerk should have been relaying this serious a diagnosis without at least a senior resident being available. I wasn’t sure I really had the knowledge base to discuss the family’s questions intelligently.
I pondered what I should do for hours, studying up on all the probable pathological diagnoses and their prognoses, anticipating any possible issues the family might want to discuss. Then I thought about how I would feel getting this kind of news. I realized that specific questions would probably be the last thing on my mind after hearing the words “MALIGNANT BRAIN TUMOUR”.
The next morning I met with Susan, a young female pastoral care worker, and asked her advice. She offered to be present when I gave my patient and the family the bad news. I arranged to meet Colin and his mother that afternoon at 2:00 o’clock.
This had to be one of the longest days in my budding medical career. The hours passed in slow motion and the minute hand inched snail-like towards two. I saw Susan coming down the hall and we both entered a private room on the floor where I’d asked the family to meet us.
Entering, I saw Colin sitting to the left, a slim, pale teen with a mop of long chestnut hair. His mother, who seemed older at the time, but was probably only in her early 40s, looked drawn and anxious. She knew something was up, and she knew it wasn’t going to be good.
I felt like crying. Mom didn’t ask my credentials, though I probably didn’t look much older than her son.
Drawing a deep breath, I told mother and son that the CT scan had shown a nodule in the brain. I let them digest this for a minute and explained that the appearance was that of a malignant tumor, or cancer, and that it did not appear to be in an area where surgery would help. I tried to sound competent but sympathetic. I felt like crying. Both
Colin and his mom looked like they were ready to do the same.
“Does this mean I’m going to die?” asked Colin.
“We can try to shrink the tumor with radiation,” I replied, “but it’s not likely it will be cured by this.” That was it.
“Is there anything else you’d like to ask?” No more medical questions, just a mother and son with blank looks of incomprehension and fear on their faces. Susan, my friend from pastoral care took mum’s hand gently. At this point I got up and excused myself, letting Colin and his mom know that if they had any more questions not to hesitate having me paged. I left the room hearing sobs as I closed the door behind me.
Later in the afternoon Susan approached me. She smiled and said, “If I had a terminal illness, I’d would want someone to tell me just the way you did, George.”
“But I didn’t say anything special or meaningful,” I replied.
“It’s not what you said. It’s how you said it.”
Those words reassure me hugely. I began to comprehend that most people are going to be affected more by your tone of voice, and the expression on your face when getting bad new. These things are far more important than the exact words used.
To use the oft-quoted phrase by Nietzsche: “That which does not kill us, makes us stronger.” This was probably the most trying thing I’d ever had to do but it was an experience that set the tone for all future encounters of a similar nature.
I like to think that I continue relay bad news in a caring and sensitive manner. This continues to be one of the most important things a physician can do.
Photo Credit
“Above and Beyond” James Jordan @ Flickr.com. Creative Commons. Some Rights Reserved.
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What a powerfully-written and touching piece! Being present and compassionate is so important when delivering bad news or giving comfort. It also speaks volumes that you went and spoke to a pastoral worker beforehand for advice and made sure she was present when you shared the news. That gesture on its own says so much about how you view your role as a physician. Your patients are lucky to have you.
Thank you for your kind comments Helena. I’m glad you enjoyed the article.
Thank you for this post! You are so very right! It is not what you say .. but how you say it that makes such a huge difference.
Almost two years ago I lost my husband to cancer. It all happened so very fast … 2 long, confusing and stressful months of being ill, scheduled tests and procedures .. only to find out … accidentally …. by a surgeon when he said “your melanoma has wrapped itself around the aorta and against your heart and cannot be resected”. He thought we had already been told about the cancer … we had not! For us it was a painful, shocking and difficult way to find out. For him … an embarrassing moment realizing what had just happened.
We were referred to an oncologist … I will never forget the kind, heartfelt and compassionate way in which Dr. Lee, let us know that nothing could be done ….. What a difference this sweet man made for us, simply by showing us genuine empathy and compassion, with his eyes, his tone of voice and his body language. What a blessing this man is to his patients!
Thank God for people like you and Dr. Lee, who can somehow bring a ray of warmth at such painful times!
Thank you for your comments. Sometimes I hear of the insensitive way that bad news is broken to patients and I picture my own Mom or Dad receiving an ominious diagnosis in this manner. It does my heart good to hear of physicians such as Dr. Lee who show true compassion.