Sometimes grief just walks out of a room; walks, runs, storms or marches.
There are two humans in a room; with magnolia walls, green plastic armchairs, framed flowers in watercolour and an unbranded box of tissues on the table between them. I say ‘hello my name is’ and explain what it is that I do here in intensive care. I ask what they understand about what has happened so far, to their mother. I listen and fill in some gaps in the story, before progressing to the main event.
I am the human with the news; the bad news. I am the chief in charge of the breaking. So, I’m supposed to always ask myself; how could I have done that better? How could I have thrown a grenade into that person’s life and not have compelled them out of the chair and out of the room?
They tell you to break the bad news ‘well’ and I often wonder what it is that this means. I have judged that I have done it better, many times. This is not the first pin that I have pulled from a grenade, it is not the first one I have thrown. You might already think, despite the paucity of information I have given you, that you could have done it better. You might be right. Even if it just makes you feel better to think that you would have had some sort of higher control over this sort of situation; you’re welcome to that feeling, I have no use for it.
And well means well for who? Who are we trying to keep sane? That other human’s mother is being plucked from her life and who am I to try and conquer her gut wrenching reaction to that truth?
Who are you to say that she was ever mine to control? This death, this grief; neither exists at my bidding.
I tell the daughter of not yet twenty that their parent is dying today, that they will never wake up and know life as I think they would have liked to know it. I tell her that truth, and then I tell her something beautiful; something about comfort and care and peace.
But grief shifts in the green plastic armchair. Grief closes its eyes, shakes its head and refuses to take receipt of the bomb. I give them silence and then I tell them that I am sorry, for their situation and that I can only imagine the hurt that they must feel.
Grief replies that they are not hurt, grief tells you that they are annoyed.
Grief has every reason to be annoyed.
So, sometimes grief runs out on you.
Sometimes there is a room with two humans, who will only ever share part of this one day in their whole lives together and breaking bad news, means breaking something.
Sometimes it must be that the other person was always going to run out of that room.
By the Secret Doctor
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Beautifully written. Insightful, gentle, compassionate and reflective. I think you broke it the best way you could. It is always a grenade, but, if you throw it gently, people can put themselves back together afterwards, and can come to you for help with that.
Beautifully said and so true, thank you Secret Doctor.
Well done for your compassion and fellow feeling. When the bad news bomb goes off, one is left deaf and reeling, and may not be able to interact with the person who delivers it. With time and hard acquired insight/learning the blown up person/parent/carer/child realises that the bad news bringer was not the bomb maker or the detonator, but the bomb defusal expert, who on this occasion was not successful, and we can feel for them too.
So well written. We may never be thanked for delivering bad news but we will always be remembered for how we made them feel.
Thank you. Not a topic that we raise enough. And often, it is simply that the news is bad, not the way we break it. Grenades cause collateral damage and sometimes I think the breaking of news went particularly badly when the truth is that I was caught in the blast; affected, touched by the grief. I need permission to seek tea and empathy, not least from myself. Let's keep talking and listening.
Good contribution. Been breaking bad news for almost 40 years in an different situation to you - often in clinic telling a person for the first time they have cancer and sometimes that it cannot be cured. One always thinks how might I have done that better, but after all this time, I think I have exhausted the options. Only advice is to be honest and as upbeat as possible - even in the bleakest position try to be positive about something. Reactions can be extreme and sometimes aggressive - deal with it. They have a right to behave as they want to.
PS. Do not bother with 'breaking bad news' courses, run by people who have never done it!! 2 secrets, experience and common sense.
It isn't often that you read something written by one who has also been there, done that and got the scars to prove it. It may not help but I was once told by a senior colleague after having 'thrown the grenade', and feeling the fall-out, that the moment that it doesn't get to you is the time to give up. That is when you have lost your empathy; you've stopped understanding and feeling the impact of what you have had to do. Breaking bad news can break both parties.
Thank you for a very emotional blog from a specialty I hadn't particularly thought of as so feeling/caring. I do wonder though whether, perhaps, you are ashamed of those feelings and that that is why you hide in anonymity? I think you should be very proud that you care and no-one can take that away from you. You have an important role and I don't think any of your patients' NOKs/loved ones will ever forget you. I'd like to wish you all the best and if circumstances ever dictate that I am in one of your plastic chairs, I hope it's you that sees me. Julie-Anne Gabbott
Dear Julie-Anne Gabbott
Thank you so much for your thoughtful comments. Please know that I don't hide in anonymity. The anonymity is not there to protect me and something that came with the platform that I write from, rather than sought by me. Thank you again for your kind word and I am pleased, if I may be, that you have been able to see intensive care as a speciality with a lot of feeling,
The Secret Doctor
There is no right answer. So much medicine, especially if we follow the evidence and stick to what we know, is upsetting. Having generated a string of complaints breaking bad news (in the same way that 99% of my patients seem to value) I'm under investigation as a failing doctor, and now I find the demands of honesty and compassion that much harder to rise to...
I don't know that I understand the last comment about being a failing doctor. If you do your best and you give a damn for your patients/go that extra mile, then no-one has the right to criticise you. You are most definitely NOT a 'failing doctor' and especially not if you are drawn to such blogs as the above. With all best wishes.
Lovely, moving and penetrating article. Thank you. Just a reply to anonymous who advises not to go on courses about breaking bad news by people who have never done it. I have been working with one of the UK's best regarded medical training course companies for some years, and I co-wrote and currently run an Advanced Communications skills course which deals in detail with this subject. I am a consultant physician, and I have been there, done it and got several t-shirts. I would be surprised if there were not others like me. There may well be other courses run by people who do not have the experience, but please do not throw out the proverbial baby!