Year in Review: My Bad News

8/20/2013 As much as being a resident sucks with the shitty schedule, nothing drains the happiness out of my bacon-flavored soul like delivering bad news. Yeah, I get upset when I have to miss out on seeing friends, going out, or what have you, but I'm over it quickly. With this, it's like you have to recover from it. I'm not sure if there is another job-related activity out there that even comes close. Not only do you have to deal with whatever reaction the patient or their families go through, but you have to deal with yourself. If we were robots, then it would be a piece of cake, but we're not. Our own emotional and psychological fortitude, if I may, is just as important in survive this conversations. There's two conversations that come to mind that relate to this. The first was a gentleman who presented with lower abdominal pain and lack of bowel function for about 3 days. He came into the ER and got a CT scan which showed an obstructing lesion in his colon. Yup. Cancer. So, I get called from the ER to see the patient and and I diligently gather all my information before meeting him. He was a very nice guy with an equally nice wife. After talking and examining him, I asked him what his understanding of the situation was. He tells me that was just told that "there was something with his colon and surgery had to be consulted." Now something that vague turns people into nervous wrecks. Unfortunately, this seems to happen a lot in some hospitals. Whatever doctor saw the patient first just decides to pawn off any responsibility of actually talking to the patient and explaining their condition whoever they consult. I'm sure it's happen to people who read this. Why? Probably because they themselves are not comfortable with these conversations. And yes, they may be attendings who have been practicing for years and still won't bring themselves to it. So guess what? It falls on me. At least I'm awesome and can handle it. I explain to the patient that he has a mass in his colon of which I cannot say is cancer with absolute certainty, but it's very likely. And, it took me a little bit to use the word cancer, because I was uncomfortable doing so. I don't want to bring distress, pain, or worry to my patients. Words like cancer and death shock someone. Thier mind locks up and focuses on that one word. They don't listen to anything else you have to say, because to them, their life was just given an end point. I don't want to be the cause of that, but I have to be honest. I owe it to them. I'm not going to pawn off that responsibility to someone else. I don't think anyone ever gets comfortable with this situation. In time, we deal with it better, but it is tough. Imagine the awkwardness and hesitation you have when you want to break up with someone. Not fun, huh? And as technology has gotten better, we went from breaking up in person, to over the phone, to email, to text message. Sometimes we kind of just avoid the person until whatever relation fizzles out. Though, probably guys do this more than girls. We try to distance ourselves as much as we can from the other person so we don't have to face their reaction and the consequence of our decision. We want to avoid feeling bad when we see the pain we cause the other person. And that truthfully makes us selfish as hell. But now imagine that same feeling but multiplied with the fact that instead of ending a relationship with someone who will eventually move on, you are talking about a life ending. And you can't do it through texts. I don't think they've come up with the right emoticon for it. So with this guy, the positive was he was a surgical candidate. The mass could be resected and he could undergro whatever treatment he had to. After going through the barrage of questions from his and his wife, I feel like I was able to help them understand the situation and give light to the fact that there is something we can do. It was hopeful. I was on service during his stay and it was always nice when they would specifically say hello or bye to me when we rounded as a group. For whatever it was worth, however I led that conversation, I did it in a way that they felt they could trust me and felt a connection with me. And that's invaluable. The second conversation was actually with a patient's family member. The patient was an unfortunate soul who fell and suffered such severe brain trauma that he had to be given CPR out in the field. By the time he got to me in the ICU, he had no neurologic function. Brain dead... though not confirmed so we did what we could to prevent further injury. I was the chosen one who had to call the sister. What I wasn't aware of, was that I would be the first person to talk to her. She had no idea her brother was in the hospital. She was shocked, of course, and confused as the story didn't make the most sense. At first, I tried to cushion the news of her brother's situation, but I quickly realized it wasn't right. She was under the impression he would be waking up and getting out of the ICU in a few days. So I had to just say that it was extremely unlikely he would ever wake up. The metaphorical bus hit her. Her voice cracked and I could amost hear the tears start pouring out. Her words stammered non-stop. The tone of worry in her voice was replaced with fear, dread, and panic. I had caused that. She was going about her day until she got the call from me. I tried to comfort her as much as I could but a person can only do so much, a person can only take so much. Her last words were, "I'm sorry I have to go, I'm about to throw up." I felt like crap. And it's not like when you break up with someone, you feel relief. A weight has been lifted. Freedom tastes so nice. On to the next conquest. No. Instead, you carry it, and it's on to the next dying patient. I don't imagine doctors carry all the bad conversations, deaths, and mistakes they've had, but I'm sure its a lot of them. I'm sure they can remember patients right down to their full names, ages, and hobbies. All that weight on our backs keep us grounded, focused, and attentive--wary of the pitfalls and mistakes of the past. And that's good, but it can destroy us. Having reminders of those lives lost is like having dementors slowly draining us of a will to keep going. It is what it is. And luckily for every patient I have to say good-bye too, there's many more who will take my hand and thank me for whatever small part I played in their recovery. And that's invaluable. “I guess I came over here to tell you how proud of you I am. Not because you did the best you could for those patients... but because after 20 years of being a doctor, when things go badly, you still take it this hard. And I gotta tell you man, I mean, that’s the kind of doctor I want to be.”— J.D.