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Breaking bad news

Breaking bad medical news is one of the tough jobs of a doctor, an uncomfortable act to execute. But often, doctors do not have a choice. They understand that impending death of a family member or the diagnosis of a terminal disease are life-changing events for a patient and family who will return home as different persons that day. And the harbinger of such news are the unfortunate doctors.

Despite tremendous positive changes in medical education, this is an untouched, neglected subject in the curriculum and is left to the communication skills and experience of the treating doctor. While some unfortunate news can be declared slowly over a period of time, which often helps the patient and the family digest the facts and acknowledge the inevitable, some bad news has to be declared immediately.

A few years ago, a septuagenarian was brought to me by her family for increasing difficulty in walking due to a spine fracture. She had almost become confined to bed. We had a detailed discussion with the patient and her two daughters and son about the pros and cons of surgery vs non-operative treatment.

Her ever-smiling husband had Alzheimer’s disease and could not participate in the treatment decision. The pleasant lady wanted to get back on her feet soon and urged her family to agree to surgery. The surgery went well and the following days were remarkably satisfying for all of us. The happiness in her face was immense when she started to walk finally after being in bed for weeks together.

On the day of her planned discharge, I received a call in the early hours that she had suddenly crashed. She had become breathless in the midnight, and though the crash team of doctors started resuscitation within five minutes, she died by the time I reached the hospital.

Despite preventive medications, some elderly patients develop blood clots in the leg which can cause sudden cardiac arrest. As I came out of the ICU, we called her family inside the counselling room and explained the turn of events. I searched for the most soothing and comfortable words to break the bad news.

The daughters, who were with her in the hospital, could understand the upended sequence of events. Her son arrived an hour later from his native place and the first words he uttered to me were, "Doctor, you killed my mother." With anger and sorrow writ on his face, he lamented the loss of his mother. His sisters expressed their regret to me for his comment. After some time, he came to me, held my hands sobbingly and profusely apologised.

In such situations, there are no two ways of breaking the news to the dear ones. It has to be divulged in the most courteous and empathetic manner with a heavy heart. It is the most unpleasant moment for a doctor — breaking the bad news to a patient and family. Such news, though ghastly, cannot be sugar-coated, understated, partly concealed or discarded. There are some branches of medicine which are walled off from this vexatious experience, while there are some unfortunate doctors such as intensive care specialists who do this daily.

Some doctors find it a mind-numbing experience and try to pass the buck to intrepid doctors in the team, or delay the news or wait until the family themselves understand the gravity of the situation. Every profession has its share of good and bad which comes as a collective package. Breaking bad news tops the flip side of being a doctor. There is no pleasure in doing so. In fact, the extreme despair and sorrow that is associated with such instances linger in the minds of doctors for weeks, months or even years. In an interview, cricket maestro Sachin Tendulkar once said, "I have hit innumerable sixes but I don’t remember many. But all the instances where I had got out is well etched in my memory."

Doctors heal thousands of patients in their career but instances when they lost their patients or divulged earth-shattering news to a family never fade in their memory.

rishiortho@gmail.com

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Printable version | Mar 4, 2021 2:37:25 PM | https://www.thehindu.com/opinion/open-page/breaking-bad-news/article33642578.ece

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