Your Wife Is Dying!
It’s said that if you have not made a serious mistake then you have not seen that many patients. It’s practically impossible not to make a mistake when all sort of really really sick people come through the door. I can live with knowing I made a mistake but I can not live with not knowing if I was right or wrong.
I was once asked to speak to someone to tell him his wife is dying. I looked at the file, yup the woman is dying. Everyone who has seen her today made that conclusion and the plan was to “keep comfortable” all over the notes. No one spoke to the husband yet at that point. Not really sure why. Possibly avoidance, possibly he was never there when the doctors were around. It’s now my responsibility to tell him the bad news. Or simply spell it out to him – surely even he can see it. I saw the patient quickly to make sure and then asked to speak to the husband.
SPIKES is a useful way of breaking bad news to people. You make sure the Setting is right, you check the person’s Perception of what has been happening, Invite them to the bad news with something like: “I’d like to share with you what we think” Give the Knowledge; show Empathy and Summarise at the end. Obviously no matter how hard you try, there is no nice way to tell someone their relative is dying. You develop phrases to use in such situations. You should be empathic but you should also shield yourself from being emotionally affected because if you do, you compromise your care to the next patient where you possibly can make a difference. This is a balance that I find extremely difficult to achieve. I tend to say something like: “I am genuinely sorry – but it’s important that we are honest and that you know what is happening – we are doing everything we can at the moment but things are taking a turn for the worse”
People react differently. From my relatively little experience there are three types:
- 1.Those who know that their relative is dying and has been dying for a year before they came to hospital. They tell you they know this is the end and that they are prepared for it, smile and thank you for what you are doing.
- 2.Those who know their relative is very very ill, and that ther’re hanging on to dear life with a thin thread. They tend to be the dramatic ones you see on TV looking at you with anticipation, extremely worried and as soon as you say “I am sorry.” They lean backwards, turn red and their eyes fill with tears.
- 3.Those who haven’t a clue. They wonder why you have asked to speak to them and come to the room chatting. And then when you break the bad news, they go into angry denial “But they told me he has a simple chest infection”. Well, unless “Aggressive colorectal carcinoma with brain and liver metastasis” somehow means: “simple chest infection” then no we did not tell you it’s a chest infection!
Now it is somewhat embarrassing when you tell a guy his wife is dying and then she recovers. Comfortably embarrassing I should say – we all want our patients to live. After being 2 cm away from her grave, this remarkable lady somehow turned around and came back. I saw her a week later sat up in bed talking to her family and two weeks later she was discharged from hospital. Needless to say, the husband was giving me weird you-know-nothing-all-you-useless-bastards-with-all-the-knowledge-you-claim looks. I am sorry; we do make mistakes!
June 24th, 2006 at 2:52 pm
lol !
wouldn’t it be easier if you could have said .. you can pray for her..
i know for sure its much easier in islamic culture where u’d say (ela3mar b2eed allah) .. and the arabic translation of prayin’ for her/him that allah may relieve their misery .. neways .. from semi-proffesional-semi-personal experience even if the relatives know for sure how bad is the situation of the patient they certainly would want you to say.. there’s a tiny piece of hope or else they’ll say he’s a baaad doctor .. he just want “the patient” dead so that he doesn’t work on that case.
June 25th, 2006 at 2:32 am
it is never easy to reveal the bad news…its just somthing that u can never go over it no matter how hard u tried..it is the human nature that controls our emotions in such situations…it wasnt a mistake that u made ..its ws somthing beyond ur ability and knowledge..the news were based entirly on scientific findings and case prognosis..the rest was left to god who decided in this case that the lady should move on with her life..n leave that little space for doctors to learn that no matter how much they know..n think that will happen…is god at the end who is in control….
June 26th, 2006 at 4:57 am
Hahahaha, funny…sorry you had to go though that…
Its been 3 yrs since I had to break such news…
June 26th, 2006 at 7:04 pm
poor thing!
June 29th, 2006 at 3:52 pm
yeah excatly u are not angels after all u do mistakes but patienst except the doc to be perefect and never make a mistake
allah aywfgkk
July 1st, 2006 at 5:51 pm
And they are probably thinking “ paki !! “
:P
July 2nd, 2006 at 8:02 pm
Al a3mar beyad Alah. I know from a medical point of view you are doing what you are supposed to do and I believe this is what happened in the situation you described. What happened could have happened with any other patient and doctor; I wonder what would have happened if you walked to the guy to tell him, congrats that his wife made it back :s My only comment would be, the formula would have been a bit different if this situation happened in a Muslim community. Saying something like “Sawana ale 3aliana, results are not good bs el bage 3al Alah” - would have a different impact I guess. I don’t know, what do you think from your experience?
July 3rd, 2006 at 11:51 am
lol u should have said woow that is a miracle !
God loves her
Good luck man ;)
July 4th, 2006 at 5:53 am
Sugar, the contrast of what people what to know and how they want to know it between our culture and the westren culture is an interesting one. I think i will find it difficult when i come back to work in UAE because I am used to patients wanting to know, and i am used to being legaly obliged to tell the patient first rather than ask for the family’s permission to tell the patients. And I am not so used to saying (sorry its God’s well, lets just pray now).
It will have to be a steep learning curve - and doubtless I will screw up and upset few people at first.
Reemany, breaking bad news is a very very difficult affair. It must be one of the hardest aspects of the job and not just at my level. Even very senior consultants find it difficult. Obviously surgeons (which are well known for their cut-and-put-be-together-and-the-rest-is-not-my-problem approach) might not find it as hard.
HLH:0
Flic, she was in septic shock and multi organ failure secondary to neurtopenic sepsis secondary to chemotherapy for breast carcinoma - that continued to deteriorate despite all appropriate treatment.
Alwaysgirl, you cant help but be embarrassed though. lol
lanieres.. me or the patient? lol
Reactive, I am not too big on saying things like that to be honest. Its part of my training and experience I guess. I dont recall any of the communication courses at uni mentioning anything about God and prayer when it comes to breaking bad news. Perhaps its a bad thing - Its such an easy thing to say to shift the blame from being directed towards us-the-doctors to God - persumably many doctors practicing in islamic countries like that
North Manchester, i bet you have alot of stories like this to tell.
UAEMAx, yeah that would have gone down REAAAL well. haha
July 7th, 2006 at 4:17 pm
Very interesting story. Of course, you are reporting the fact then and there. In life, split seconds could change things drastically. Obviously, in this case - it was for the better. The patients’ relatives should have the maturity to understand that; but obviously, emotionality kicks in and you’re supposed to be the pillow upon which they collapse.
Can you pls update more often? Your words are always gems that please readers who stumble into them.
July 12th, 2006 at 5:48 am
I haven’t got much to say, but you remind me of the series ‘Grey’s anatomy’.
If you have the time, you should watch a couple of episodes, although they are surgeons in training, i find that you will totally relate to them.
..and i agree with Amorelicious, you should definately update more often- when you can ofcourse.
Good luck.
July 18th, 2006 at 11:24 pm
loool…
It was funny because I didn’t expect the ending… But look to the +ve side, he’s going to be happy to have his wife living more =) this might ease the feeling after a mistake…
Liked the SPIKES =)
Allah yewaffegek bro.
July 25th, 2006 at 10:12 pm
yeah
sure its hard to say that someones is dying i tink that relegious people can handle the situation better
y36eeek alf 3afyah
August 1st, 2006 at 2:31 am
a doctor from the family used 2 say how hard her job during the ER time
especialy when she says the bad news for the family,,,,, but imagine how hard for her to say for her own family in the same hospital that her own father is dying …………… !!!!
regards to u Dr and for your nobel job
August 3rd, 2006 at 11:37 pm
at least you’ve learned how to break a bad news.
communication skills have been recently introduced to medicine and in membership exams, the must difficult part where i failed twice. it will improve your life skills, you will see how different you are in all aspect of your life.
regarding UAE people, from my experience, people behaviour towards knoledge highly influenced by doctors attitude towards them, encourage them to talk and you will discover whom is to blame. medicine is an art ! wish u a good luck
August 4th, 2006 at 1:17 pm
your work is really difficult.. it needs stronge heart
best of luck in your work ..
August 10th, 2006 at 10:37 pm
Its about time for another post doc…
August 11th, 2006 at 6:48 pm
i strongly agree with HLH
August 21st, 2006 at 12:08 pm
waiting for new post………………..
September 10th, 2006 at 12:31 pm
Salam Doc
Very nice and quite interesting update
The situation you went through is I guess one of those points you have to go through in your career. But what an interesting turn around. Sub7analla kil shai ib 2eed rabna
I guess its also normal for the guy to maybe respond that way. His emotions took over him. lol
May Alla bless you inshalla and wish you the best with you career
October 18th, 2006 at 9:36 pm
We are missing your updates Doc!
October 23rd, 2006 at 9:16 pm
happy eid :)
November 5th, 2006 at 11:58 pm
did you quit?
http://the-mind-spa.blogspot.com/
November 7th, 2006 at 6:24 am
thetubster.blogspot.com
OMG, that is exactly why i dont wanna study medecine >.
November 27th, 2006 at 2:30 pm
OK …was looking at your new years resoloution and I know that number 2 didn’t work out. Wonder what else in the list you didn’t follow through ;)
December 26th, 2006 at 1:45 pm
I had an accident last summer and my two brothers were dying in the operation room. I was in the ER and i was asking the Dr. about them and he lied to me. I slept that night peacefully thinking that they were OK, when actually the my whole life was collapsing outside my room, and because of the shock and pain I felt the next day for not even having a chance to say goodbye to them, I couldn’t cry or grieve for a month! I told the Dr. that i hated him for lying to me and i still resent him..
What am trying to say is that it’s always better to tell the truth.. I know it’s always hard to tell someone that their loved ones are dying, but it’s their right to know and they have a right to set their priorities and maybe say goodbye =)
May Allah Bless you in these holy days, and great blog u have here!
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