As medical students and again as trainees, a lot of time is spent perfecting the art of breaking bad news. Many of us will have seen it done badly and as uncomfortable and horrible as those situations are, we remember them. Why? Because we absolutely swear never to do it like that.
Over the years, I have gained confidence in my communication skills. I know I can lead these difficult and distressing conversations but despite the experience, it never, ever, gets easier.
For each family, that moment is life-changing. The way in which you deliver that information has repercussions for the rest of their life: the words you choose, your tone of voice, the way you sit, your facial expressions… You slow down, you give them time, you listen, you offer them a shoulder, a tissue, a cup of tea… you do whatever you can to make a seriously shit experience just that tiny bit better.
So why is it that we don’t do this for each other?
A while ago, I looked after a child who was normally fit and well. He had become ill very quickly. The team had worked hard, doing our best to keep him alive. By the time I went home that evening, the boy was doing better. I was exhausted and thankfully had a few days off after this. When I was next on the ward, I heard a couple of nurses talking as I wandered through. In and amongst what they were saying they seemed to be referring to a recent death. I enquired who they were talking about.
“Oh haven’t you heard, (….) died a couple of nights ago.” They were talking about the boy I had looked after; the one I thought had pulled through; the one who seemed stable… They went on to tell me the clinical ins and outs of the situation. I stood there feeling overwhelmed: deep sadness for him and his family, guilt, uncertainty, what if I had missed something. I started running things over, should I have done something different? And before I had time to begin to process this the ward round commenced.
This is not the first time that I have found out about the death of one of my patients like this: a passing conversation on the ward, finding a bed space unexpectedly empty, a conversation at handover in front of 15 other doctors etc. Finding out like this really disconcerts and destabilises me.
Why is it that we spend years learning to break bad news to our patients in a sensitive and empathic way, yet when it comes to ourselves and our colleagues, there is very little thought put into how we discuss it. Losing a patient is challenging, no matter where you are in your career. It highlights our personal vulnerability: the sadness of losing of someone we knew well, a reminder of struggles in our own life, self-doubt and questioning of our practice, guilt, a trigger for mental health difficulties. All of this is completely normal, yet somehow it is overlooked when we talk to each other.
Looking out for each other
A few years ago, I looked after a little boy with a long term condition. He frequently attended the paediatric ward and the staff had all got to know him well: hilarious, witty, cheeky, brave and truly inspiring. He was my favourite. A few months into my maternity leave I received a call from one of my fellow registrars. She thought I should know that this little boy had died a few days earlier. I remember holding my trolley tighter, tears rolling down my cheeks in the supermarket car park.
I look back and realise how much that phone call meant to me. I was able to grieve at the same time as everyone else rather than having to wait until I returned to work to find out. That colleague gave me permission to feel. We are humans after all. It is OK to feel.
So, maybe next time you lose a patient, think of a colleague who deserves to find out in a more sensitive way than overhearing something on the ward or realising there is a missing name on the handover sheet. Give them a ring, check they are OK. Allow yourselves to grieve the loss of a patient. #ItsOKtoTalk