Sunday, 17 February 2008

Breaking The Bad news

Social and cultural factors in additions to the rules and regulations are different here from back home, as a result we have to talk to people in completely different way, they expect certain words and jesters, which we’ve got to give them.

While doing a course before being qualified as a doctor in U.K, I was praised by my other colleagues, not for being the best doctor but for being a very good actor.
I was able to use words through which I could show great sympathy and not commit myself in any legal issues.

Thinking about how to talk to the patients and preparing scenarios about how to break the bad news gave me a very good confidence and pushed me forward.

Yet, reality is always quite different;

The first time I joined a discussion between my consultant and a patient who has a sinister problem, I kept quiet as I was only observer, at the beginning I thought that my consultant wasn’t going the right way, as she started talking about the problem itself rather than repeating the story from the early beginning, which I was taught before.
Yet, going on talking to the patient, I realized that I misjudged the consultant’s approach, she was able to give a great amount of sympathy and made the patient trust her and be quite confident that she was doing her best to help him as much as possible.
She kept showing her sympathy until the last moment when they reached the end of the road, he thanked her while his tears were coming out, she immediately hugged him, I really wanted to hug him also as I felt how he and she were feeling.

Well; to do it myself it would be much harder than what I imagined, that was what I got from that session.
A couple of weeks ago, we had a teaching session with the priest of the hospital about the same subject, the guy asked to do simple thing which turned into a nightmare.

He asked every one of us to put 10 names of the ones who would be concerned if something wrong happened to him.

Well; I first managed 4 names of my family putting my mother at the top, then my uncle and two aunts, my friend (N), and the only concerned one in this country.
Ok, I could manage 9 names.

The horror started when he asked us to remove the ones who are less important accepting their death to save the more important ones.
I immediately apologized refusing to go on with the test.
I realized that I’m not the strong hard hearted guy I imagined myself, all the girls around were able to do it, but I definitely couldn’t and I would never dare doing it, I admit that my mother is the most important one in my life but to sacrifice someone’s life is another matter I would never imagine.

The guy then asked everyone to hand his list to the one sitting beside him and to remove all the names leaving only one, it was pretty easier task.

Here we could get his message; how dear the ones are is something no one could appreciate, the pain of losing someone close to the heart can’t be estimated unless we go through it.

A couple of days ago, I had a patient complaining of tummy pain, looking after his tummy we realized that the problem wasn’t with the tummy, the guy consciousness started deteriorating and there was bleeding inside the brain, while rushing to manage that problem, we had to transfer him to a specialized hospital, I was asked trying to get copies of his records when I saw the family coming to me asking how he was doing, I managed telling them about his current problem and the plan to transfer him as we’ve prepared a bed for him somewhere else to get the best care.

As soon as I went back to the Resuscitation room which was 30 seconds walk, my senior colleague told me that we don’t need the copies anymore as the guy was brain dead.

I just tried to avoid looking into their eyes, 30 seconds ago they got different information, and now he’s gone!!!

Another colleague was in charge breaking the bad news, I tried to avoid seeing them, yet, it happened and I met them few minutes later, the wife looked at me with astonishment and pain, she didn’t say a single word, but I couldn feel her saying(didn’t you say……….?!!!).

(I’m sorry); the only thing I could reply.


Marshmallow26 said...

Hello a&eiraqi,

I am sorry to hear that, but this is doctor's life and you will get used to such scenes, so get tough and brave when it comes to face a sitiuation like that.

God be with you dear.


Jeffrey said...


My brother-in-law and two of my nieces and two of my nephews are doctors, so I recognize your story very well from talking to them. It's tough. It was a very interesting blog entry. Thanks.


Jeffrey said...


Oh, I thought I'd add the name of a book, written by a doctor, that covers many of the issues that you're dealing with:

How We Die: Reflections on Life's Final Chapter, by Sherwin B. Nuland. It was a bestseller here in the States. It's an engaging mix of both personal biography and clinical descriptions of how and why people die.