BAD NEWS BEARERS: HOW TO TELL SOMEONE THE WORST

January 29, 2005

 

As a physician, I have years of experience in delivering bad news.

 

When I sit down with a patient in the office to deliver bad news, I usually welcome another set of ears or a note-taker or a tape recorder because I know my patient will hear only a small fraction of what is said. One of my patients told me long afterward that all she remembered as I talked was writing her own eulogy in her mind.

 

I told another patient that she had breast cancer. It was a grim prognosis, but even as we discussed the surgery and subsequent chemotherapy, and even after she had actually finished her treatment, it didn't really hit her until she read about herself in one of my columns. "It was a shock, seeing it in print," she commented when I next sat down with her.

 

Now, I protect their privacy, of course, but patients often recognize themselves here. Some even think I'm writing about them when I'm not. And there are some stories that thousands of you can read yourselves into.

 

For example, one of my patients is middle-aged and went home for the holidays last month to put her mother in a home.

She and her siblings decided that, if they presented a united front to their mother, it would be easier on everyone.

 

But when they all met, mom naturally viewed the move as an assault and prepared to do battle. She responded to the "let's sit down and talk" session by promptly putting it out of her head. This deliberate forgetting was made easier by the fact that her memory was failing. What's more, they had asked the family physician to revoke her driver's licence since they considered her a hazard on the road. So she was suddenly homebound, and ready for what her wicked children might attempt next.

 

But whether it was failing memory or canny strategy, she did leave the house willingly one day with her daughter -- whose job it was to keep her occupied for five or six hours while the rest of her children moved her belongings into the nursing home.

 

And the daughter actually did it, creating a mother-daughter day filled with hair appointments, a long lunch out, a visit to the new grandchild.

 

But later in the afternoon, when they drove into the driveway of a strange new building, mom knew something was amiss and she dug in. "I'm not going in there and you can't make me. I won't leave this car. Take me home."

 

Over and over, she reiterated her stance. But my patient is an old-hand schoolteacher, and as she thought about it after, she said she had delivered so much bad news over the years that she did the two things that mattered most. First, she said: "I know you are upset," and she kept on saying it, over and over.

 

Then she said: "We are going to get out of the car and we're going in," and this she said kindly, firmly and repeatedly until she knew it was the right moment to get out of her side of the car and offer to take her mother's hand.

 

The family who had spent the day setting up her belongings in the brand-new "memory unit" of the nursing home were waiting apprehensively inside as the scene played out in the car.

 

Mom didn't take her son's outstretched hand at the entrance to the home, and she was bitter in her accusations of the betrayal wrought by her children. In the end, they beat a hasty retreat, leaving my patient and her husband to take her mother to dinner in the new digs. They, too, soon left.

 

The home has asked the family not to have much contact in the early days and they are complying, though understandably my patient misses her daily phone contact with this irascible old lady. But most of all, like all children grown and small, she is ever hopeful that old hurts can be resolved and tenderness sparked anew with a parent.

 

Another of my patients endured a similar experience. But she lacked the years of training in delivering bad news. In many ways, the task was the same -- keep Mary entertained so that the band of buddies could accomplish the move without protest and combativeness. At least that's what they were prepared for, but what they got instead was shocking terror and wrenching pleas from Mary not to abandon her.

 

Mary was just 60, but growing increasingly demented and unable to care for herself. "It broke my heart to hear her," my patient said. In the night, she was called by the home and asked if she would come in and help to settle Mary.

 

She went and sat with the weeping woman through the night, holding her, rocking her, calming her. Eventually, she was able to leave and after a while Mary settled in. Now, her friends are able to collect her and take her out to lunch and bring her back without grief.

 

She continues to deteriorate mentally and the staff wonder how much longer they will be able to manage her in that facility. What helps, though, is that she is so pleasant and so well liked by the staff. My patient knows they will go out of their way to sustain this arrangement, and this gives her comfort too.

 

Two very "bad news" stories that show we take in only what we can manage, whether we have heard it, felt it, ranted or wept. We take it in as we are able -- and only when we are ready.

 

In turn, those who are stuck delivering bad news should take some comfort in knowing that the protective coverings we muster do defend, do cushion and do delay despair, and in doing so allow for resilience and, finally, for hope.

Dr. Jean

Marmoreo

 

Doctor. Writer. Athlete.

Advocate. Adventurer.