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is there a good way to deliver bad 世界杯决赛2022?
when we are facing our mortality, compassion and connection is what we need most.
oct 28 2020
8 minute read
are we doing the best job of supporting people when they get a devastating diagnosis ?getty
have you ever thought about what you would do in the moment you were told you are dying?
maybe you would jump out of your seat, fist raised, railing at the heavens at the unfairness of it all. maybe you would take a deep breath and find comfort and strength in the fact that you have lived a good enough life, that you had done enough and seen enough to be okay with an imminent end to it all. or maybe you would sit stunned, tears quietly rolling down your cheeks as your partner/sister/friend wordlessly held on tight to your trembling hand.
this is what’s been on my mind lately. partly because i have been following a thread on twitter from doctors about the best ways to break bad news to patients now that they can no longer see them in person because of covid-19. and partly because my brother got his own bad news this week.
months ago, the bmj posted a story on how doctors can share scary 世界杯决赛2022 from a distance. it was sort of an ode to empathy towards patients and their families during a time when face-to-face meetings are virtually impossible, and hugs forbidden. some of the advice included preparing a script, making sure the call can happen without interruption, ensuring the patient has a loved one join in on the call and using easy-to-understand terms with an empathetic tone.
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and while i am down with using the phone, screens and flowery voices to discuss skin rashes and vaginal odour, it seems to me that when it comes to the bigger stuff, we should think more about how we soften the blow of bad news. surely we can do better than a nice tone and pulling in a loved one who, while theoretically could serve as a valuable second set of ears, very likely is just as sad and scared as the patient.
six years ago, i was that loved one. i sat with my brother — he was just 40 — as we listened to a young resident with fancy brown alligator skin shoes describe the results of a recent mri. they weren’t good.
it wasn’t the first time he was told he was dying. in fact, that he has received this dire news more than once in his life and lives to tell the tale has become a bit of a dark joke between him and my mother.
when he was nine, after years of receiving blood transfusions for a clotting disorder he was born with, he was infected with hiv and hepatitis c through tainted blood. doctors sat my parents down and said he would live for maybe a year, if he was lucky. “don’t bother suing,” they said, referring to the thousands of other hemophiliacs and their families who were taking legal action against the red cross for screwing up catastrophically. “he’s not going to be around long enough to enjoy the money.” they sent my parents home to grieve alone.
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he was “lucky.” he did, in fact, live. he grew up, got a great job, had children and settled down with a significant other. by all accounts, he defied the odds.
fast forward to 2014. after months of abdominal pain that doctors sloughed off as side effects of the harsh cocktail of hiv meds he was taking or muscle strain from weightlifting or indigestion from the occasional spicy burritos that he loved, his bloated belly caught the eye of an emergency room doctor who ordered a scan of his right side, just above his liver.
that scan —which showed stage four liver cancer — landed us at the princess margaret cancer centre.
“you have about three months,” the resident said, his eyes shifting from his shiny shoes, to his clipboard, to my brother, to me and back to the shoes.
three months echoed in my head. “three months for what?” i asked, casually. three months to get medication? three months to see a specialist? ohhhh, you mean three months to make him better, right?
right?
and then that thing you hear about that happens when people get really bad news happened — the understanding part of my brain stopped working. it was as if anything of relevance in my head melted and became a vast, sloppy mess. like when your foot falls asleep — you know it’s there, but no matter how much your brain tells it to move, nothing happens. as much as i tried to be coherent, my words sounded slow and dragged out — i was very conscious of the fact that i was failing miserably at the job of the helpful loved one with thoughtful questions and optimistic observations.
even when i looked over at my brother and saw the tears in his eyes, and watched his lips say that he needed time to talk to his kids, i still really didn’t grasp what the doctor had said. or i maybe i did, but my brain had gone into some kind of preservation mode: must slow things down to avoid meltdown.
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i felt this way years earlier, when an equally shifty-eyed doctor in red converse high-tops told me i had blood cancer. he didn’t know how bad it was, he said, when i asked if i was going to die. the hospital sounds suddenly became deafening: the vent above my head, the whirring of carts being wheeled down the hallway just outside the door, the sudden smell of disinfectant and latex — it was all too much.
my brain went into meltdown avoidance mode. it took me away — made my body jump off of the examination table and throw open the door, despite the doctor’s stern instructions that i needed to be discharged. i walked in steps that felt big and long, like the movements of an awkward flamingo, out of the room, past the nursing station and through the crowded waiting room, as someone who sounded far away loudly called my name. it wasn’t until i was outside in the dark air that i was able to breathe.
years later, i have often considered how much better that experience would have been if, instead of standing alone in a cold parking lot searching for solace and relief from the fear in the darkness, there would have been someone else standing beside that awkward giver of bad news in the red shoes to wrap me in words of comfort and encouragement.
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maybe that person would take me from that sterile room to another with warm lighting, a comfy chair and round table with magazines on it — normalcy within my chaos. this person could be a social worker or a psychologist, or even a pastor — someone not afraid to look me in the eyes when i asked if i was going to die and leave my kids without a mother. they wouldn’t be devastated by my news, like someone who loved me would, so we could go down this road together — me sobbing, them, objectively dry-eyed — their lack of emotion helping me to focus and regain my footing. they would help me make a plan for survival — or death — with grace, skill and expertise. at the very least, they would dry my terrified tears.
but — sigh — this isn’t the way it is at many healthcare facilities. instead, doctors deliver bad news and we, along with our loved ones, are tasked with figuring it all out, when what we really want to do — and what we should be doing — is figuring out how to heal our broken hearts. and while covid-19 may have highlighted the necessity of extra compassion in our healthcare system, it has also underlined the fact that — when it comes to doling out scary news — we need to pull in expert support so patients and their families aren’t left alone holding a bag full of fear and grief and nowhere to put it.
in the spirit of going it alone, jessie gruman takes a look at what we can expect to feel in the midst of a gloomy health diagnosis in her book, aftershock: what to do when the doctor gives you — or someone you love — a devastating diagnosis. she describes the sense that we are out of control, ruminating over what-ifs and worst-case scenarios, feeling the need to make urgent decisions about treatments and dwelling on what we may have done to cause the diagnosis. her strategies to overcome these feelings include being aware that the intensity will lessen, taking time to get a second opinion or do research, seek comfort in the things you like to do — it’s not a time to forfeit pleasures, she says — and finding support in friends, but only those who can handle your news. a weepy friend who worries out loud is not helpful.
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what do you say — or do — when someone gets bad 世界杯决赛2022?
and speaking of weepy … are you wondering what to say to someone who has found out something bad about their health?
in the cancer support group that i lead, we advise families and friends not to ask how they can help, but rather, just do something — someone who is ill should never be made to worry about burdening someone else. instead be proactive and say something like, “i am dropping dinner off on friday. pizza or fish?” or leave a bag of groceries at their front door. other ideas include being careful not share your own worries and fear about your loved one’s illness — you don’t want them to feel responsible for making you feel better. instead, listen without adding commentary. maybe throw in a “man, this is really tough. i am here for you.” and never talk about the neighbour/letter carrier/uncle you know of who died of the same health issue.
my brother had been cancer-free for six years. but last week, after reading ominous scan results online, and having ample time to scour the internet for the worst-case scenario, his fears were confirmed by phone: four new tumours on what’s left of his liver. the phone conversation was brief. and while i am not certain that an in-person meeting would have changed much about how he heard the news, at the very least, it may have felt more humane and connected — the two things we need the most when we are facing our mortality.
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it’s just another way that covid-19 is hurting us.
this story previously appeared in the healthing weekender. subscribe for daily updates on the top 世界杯决赛2022 and a wrap-up of the latest stories delivered to your inbox on saturday.
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