Breaking bad news: a doctor’s perspective
Squeak. Squeak. Squeak.
My mind could focus on nothing but the irritating noise of my sneaker on the newly waxed hospital floor. I stole a glance to my right, only to quickly direct my eyes back in front, keenly aware of the frightened mother walking next to me. The hallway ahead of us was endless and that shoe just would not stop squeaking.
You see, only minutes before, I had met this mom for the very first time. I walked right into her son’s hospital room, quickly introduced myself, and asked her to follow me. Follow me down the endless newly waxed hallway to the Post Anesthesia Care Unit where her 4-year-old little boy was sleeping off the medicine that held him still enough for the MRI. The MRI that would change his life.
In medical school, I sat through years of endless, mind-numbing lectures of pathophysiology, pharmacology, embryology. I looked under the microscope in histology, dissected a human corpse in anatomy, and learned how not to offend when asking about sexuality. Never once did I sit through a lecture about how to tell a mom that her son is going to die.
I read an article recently about physicians delivering bad news. It stated that the majority of physicians have received no formal training in effectively communicating bad news. The article went on to say most practitioners learn through trial and error, often by watching role models during training. In fact, as a second-year resident, I sat with my attending physician at the bedside of an infant who had been violently shaken by the mother’s boyfriend. I watched intently as she looked directly at the mom and delivered the bad news. She was direct and clear and gave no false hope of the infant’s poor prognosis. But more importantly, she modeled compassion, empathy, and sorrow as she sat with her arm around the mother, silently crying beside her.
So in that moment, sitting in the PACU with a mom and her sleepy little boy, I was not Dr. Rivers. I was Kristie, mom to a 4-year-old boy of my own. I understood the terror in her eyes as I slowly and clearly delivered the news of her son’s large inoperable brain tumor. And then I was quiet. Because all the words in the world could not explain away the unimaginable horror that was between us. And as the magnitude of it all sank in and she fell to her knees, I reached out to her with tears in my eyes, unable to comprehend the how and why. I needed no formal training as a doctor to understand the pain and terror that those words conveyed to the mother of a precious little boy. And it hurt. In a tear-your-heart-out kind of way it hurt. And no formal training could ever prepare a doctor for that.