Bad news

As medical students in india, we were not taught the art of breaking bad news to patients/ families.

To say it as it is, without minimizing the severity of the illness , yet with compassion and realistic hope, is not easy.

Most of our Indian teachers were naturally good at it.

Not all.

In Trivandrum Medical College,I remember one day when I was rounding as an intern with the team. We had a patient, a head load worker, who had dry gangrene of both his legs almost to mid leg. I was incurious then, so didnt bother to find out exactly what happened. The story was that some people ( I’ m guessing it might have been an INTUC/ CITU fight) tied up his legs and electocuted him- it doesnt make perfect sense- why didnt he die with such a strong shock? I don’t know. Anyway, he did somehow end up with gangrenous legs.

Our Unit chief when presented the case quietly walked to the bedside.

Without speaking a word , with his right hand he made a chopping motion over both legs below the knees.

A graphic but harsh way of conveying the treatment.

The wife standing next to the patient fainted and would have fallen if the MS student hadn’t caught her.

The chief was otherwise a fine gentleman, so I wont name him.

Two glaring examples of Foreign Medical Graduates here who were “insensitive” – one resident was reprimanded for leaving news of a patients demise on the answering machine of their home phone !! Obviously, not an Indian doctor.

We were trained better, socially. Even after someone had died, the telgram would only say ” Serious. Start immediately”.

Another resident – an Indian doctor , competent but lacking in common sense, had to inform a patient who had left the hospital against med advice two days prior, that he had tested positive for HIV.

She gave the news over the phone !

The patient later told her ” Doc, you almost killed me. I was driving over a bridge when you called me. I was devastated and felt like driving my car off the bridge into the sea.

When we are the first to break the news to a pt of their cancer or HIV or some such serious disease( its getting easier to offer hope for both early cancer and all HIV now, thanks to medical progress in cancer and to HAART- ( highly active antiretroviral therapy for HIV ) it takes time from our busy schedule , answering their immediate questions , reassuring them etc before an Oncologist or an HIV specialist sees them.

It also takes something out of us.

We think we are somewhat immune, by now, to human suffering, pain and death. We are not- these things chip away at our hearts, mind thought we don’t realize it.

We are forced by the nature of our profession, to ourselves carry some of their pain and suffering , mentally.

In their helplessness against a terminal disease , we ourselves feel helpless when we have nothing to offer and often nothing comforting to say…..

The public doesn’t( we ourselves don’t) know the toll it takes on us.

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