Adventures in Medicine

Medical School and Beyond!

Breaking the Bad News

on June 26, 2016

There is one thing we all have in common…at some point along life’s journey we will die. For some this occurs early on in the journey and for other people it is very late in the journey. This results in those in the medical field, most of the time physicians, must give the bad news about the death of a loved one or of a serious illness to patients and/or families.

I had my first encounter with giving bad news during my very first rotation (IM). During one of my first shifts in Weiss ER a patient was brought into the ER in cardiac arrest for at least 20 minutes. After the Attending physicians worked on him for a few he was pronounced dead in the ED. When his family arrived it was up to my attending to inform the family of their loss and she decided it would be a good learning experience for me and tasked me with the delivery of the bad news. However, the police officers who found the next of kin and brought them to the hospital had already informed them of the death of the patient.

My subsequent encounter with death occurred when I was in OB/GYN. Late one morning we had a 18-year old patient come in with her mom for her first OB appointment. After going over the routine first visit questions and exam she went back out to the waiting room for her 8 week ultrasound and pregnancy confirmation. About 40 minutes later the ultrasound technician solemnly walks into my preceptors office asking for help as she was unable to find a heartbeat.

The three of us walked into the ultrasound room where we could see both the patient and her mother were visibly upset as they were aware of the lack of heartbeat. Again the technician placed the ultrasound wand and searched but was unable to locate a heartbeat. With the visual and auditory confirmation of the lack of heartbeat my attending offered her condolences to the patient as she explained that for some unknown reason her baby has died in utero.

To a new member of the medical profession it did not seem like my preceptor was phased by having to tell her patient that she lost her baby. Upon discussion she told me that it gets easier each time as you learn the best way to deliver the news and how to be able to read the patient and add additional information or support if needed. She also explained the importance for being there to answer any questions the patient or her family may have as they process the loss of the child. Miscarriage is not uncommon in the first trimester of pregnancy. It only seems more common nowadays because expectant parents are able to find out sooner that they are expecting.

For me this was a difficult experience. It took all I had not to start crying in the ultrasound room as I watched the ultrasound and realized the tech was right…no heartbeat was present. This little life was gone and never going to be able to experience a first breath, crawling, walking, talking…nothing. The urge to cry only intensified when the patient and her mom started crying. I could only imagine the pain they were going through. The loss of a loved one is never easy. I have friends who have struggled with miscarriages and I have seen first hand the pain they had to endure. I just can’t see how telling parents they lost their baby before they were able to hold it ever gets any easier.

Most recently, during my surgery rotation, I had a patient who came in for an evaluation for breast cancer. This patient was in her 80’s and had changes on her mammogram with a history of breast deformation and nipple retraction for the past couple of years. By the time she presented to us my preceptor was able to palpate a mass on the opposite breast as well. Upon walking out of the exam room my preceptor told myself and the other student that without a doubt in his mind that patient had at least stage 3 breast cancer probably stage 4. Even still she was sent for a biopsy before she was told she had cancer. Once the positive results were back my preceptor called the patient to inform her of her diagnosis once again being available for any questions she or her family may have.

No matter the stage in one’s life bad news about health is never easy to give. To many people their health is something that is important to them and learning about a breech in their idea of their health can be devastating. As a 14 year-old learning about my diabetes diagnosis I felt like my entire world was crashing in on me. I could not, for the life of me, figure out how I would survive. What 14 year-old wants to change their life to adapt to a new normal?

As a profession, physicians, need to be compassionate. For them telling families about the loss of a loved one or patients about a serious illness/disability/diagnosis might get mundane but for those hearing the news it is fresh and life changing. Therefore, the compassion shown to the first family or patient a physician ever informed needs to be same compassion shown to the last family/patient informed about the ‘bad news’ right before retirement. Knowing your physician cares and is there to answer questions and help be or find a support system helps to digest the news a little better. All in all, it should not get easier with each delivery because each ‘bad news’ delivery is different but still needs to be done respectfully, professionally, and with a sense of compassion.

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Bek Moody

ROLLING THE WAVES

my journey in this world

finding joy in everything

Redeeming Naptime

homemaking, parenting, grace, and Jesus.

As He Comforts Us

Marriage, Miscarriage, and the Goodness of God

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