Sunday, August 26, 2012

Bad News . . .

This week in medical school we had what I can now call without qualification the most moving and powerful session of my entire medical school tenure so far . . . in some ways I am hesitant to write about it because I'm not sure I can do it justice in print. But I'll try.

The session was entitled "Breaking Bad News" and focused on the difficult interaction that we will all have as future physicians breaking bad news to patients. My concern with such sessions is that they  can be full of platitudes and well-meaning, but somewhat packaged, attempts to comfort a hypothetical patient. This was anything but . . .

After a solid introduction by one of our faculty, we were introduced to two parents, both of whom received devastating health news about their children. The first parent was a mom who learned by genetic testing that her child would be born with Down's Syndrome. The second was a man who found out that his 8 year old son had an aggressive form of leukemia. Their entire stories were compelling but I want to focus on two moments:

For the mom, the moment of truth was the decision on whether or not to maintain the pregnancy. At one point, she asked the doctor what she would do. I have wondered about this scenario before. Is the doctor's job to be neutral and simply give the most helpful information or is there a place to share personal opinion about the choice one would make? The doctor said she would not continue the pregnancy. The mom was ultimately offended by this. She felt the doctor should have been neutral . . . and yet, she asked. So there is also the tricky issue of the patient's contradictory impulses; they are human after all. Bertolt Brecht, the German theater practitioner, spoke of "embracing our contradictions." The doctor, it seems, must somehow lead and follow the patient at the same time! She kept the baby and he is now a vibrant 4 year old. She spoke of how the experience changed her, giving her an almost supernatural patience with other people and appreciation of others and difference.

But what really got me was the man's story. Let's call him Cliff. Cliff had an 8 year-old Matt (not real name) who was diagnosed with leukemia. The story was tragic as Matt ultimately did not make it. But what was extraordinary was a moment Cliff described where his son was in a coma and he had a chance to go up and speak to him but did not. His best friend insisted on going to talk to him and there was an immediate change in heart and rate and oxygen saturation. Matt succumbed not long after that. Cliff was devastated that the doctors did not tell him just how serious Matt's condition was when they induced his coma. He struggles with how badly he wanted to speak to his son one last time and how he wished he could have done what the best friend did and just speak. Watching Cliff describe this story was incredibly moving. It was pure, human emotion. No attention-seeking here or self-indulgence, just a man daring to relive a devastating moment and sharing that with us so that we could learn. At one point, Cliff said "You have no idea how powerful you are in this situation." By this point, I had tears rolling down my own face. Some of this reaction I know was being a parent myself. Anything affecting kids has always hit me harder since having Christian and Cameron. But I was also just moved; I felt so privileged to hear this man's heart. Our faculty member described these moments as "sacred" and that is no understatement.

The only problem with such sessions of course is that it is extremely hard to transition back to the nuts and bolts of textbook content! You just want to process . . . and maybe that's what I'm doing now. I want to use that power that Cliff referred to wisely and empathetically. Nothing else I am doing matters as a physician if I miss that.

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