Selection from Hanging on for Your Life
Curled up and bruised, Carter sleeps uncovered on his bed, his sheet rumpled at his feet. Perhaps he shoved it off during a bout of sweats. He has the appearance of being trampled by a bronco. A rodeo rider, he grew up in Minford, a small Ohio farming community.
Carter shuts his eyes and rubs them. He clenches his jaw. “Can you give me something for pain? I hurt like hell.”
The next day I perform the bone marrow biopsy without problems and don’t engage in much additional conversation. Two days later, I muster the courage to enter Carter’s room in the late morning. I sit on the chair next to his bed. “Are you more comfortable?”
“Sometimes. The nurse said I was screamin’ last night.”
Get to the point I remind myself. “Carter, I have results from your tests.”
“Bad?” he asks.
“You have some serious health problems.”
He frowns at the pain of my words and closes his eyes.
I tell him that the bone marrow biopsy shows Hodgkin’s disease, a type of cancer in his lymph nodes and bone marrow.” He begins to cry. I rest my hand on his shoulder. I continue, “This type of cancer can be treated with chemotherapy. Sometimes the cancer disappears.”
“Sometimes.” I take in a deep breath, prepare myself for the next part. “But there’s another problem. You have AIDS.” I remain quiet but am unsatisfied that I’ve told him this without a family member or close friend in the room to comfort him after I leave. Carter turns away from me. I notice how thin his black hair is on the back of his head. In this moment, it’s not important how he got AIDS.
“Does Betsy know?” he asks.
“Not yet. Do you want to tell her or should I?”
“Ya tell her. God, I hope she’s okay.”
“She should be tested for AIDS.”
A slight nod and more silence. There are no right words to fill these spaces.
(Excerpted and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)
Giving bad news to a patient is never easy. It’s not easy for the person giving the news and it’s not easy for the receiver. The best advice is to share the bad news when you are not in a rush and can have a conversation with the patient and his/her family. In this story, the physician does not do the best job of sharing the diagnoses of cancer and AIDS with the patient. He seems distant and does not take the time to create an appropriate setting.
Sometimes we don’t have a lot of control over the situation in which we are asked to share bad news. Nevertheless, be prepared to return and answer questions. Patients and family members react in different ways and usually have additional questions after they’ve had some time to mull over what you’ve said.
For some tips on how to break bad news see this article in the American Family Physician. As you spend time in the clinic or hospital you will see clinicians who share bad news well and those who don’t do a very good job. Learn from all of these situations.
Watch Lorence read from his selection.