Why I deliver bad news myself

June 17, 2005

Patients are often deaf to the truth if their own doctor doesn't deliver it, the author says.

Thinking back on more than 20 years as an ob/gyn, I recall one experience that easily taught me the most important lesson I've learned to date. Ironically, this experience didn't take place while I was functioning as a doctor but as someone's close friend. Let me explain.

I met Mary, an artist with infectious energy, when she came to me for prenatal care for her first baby. Another baby followed, and, over time, she and I became close friends, sharing many interests and hobbies and socializing often.

When Mary's 37-year-old husband, Eric, was admitted to our hospital for chronic back pain, dyspnea, and weight loss, I offered to look in on him as I made my rounds.

The next day, I was on my way to Eric's room when I saw Dr. Jones in the hallway. Sharing the diagnosis with me, he appeared distressed that a young man could have such a horrible disease and dismal prognosis.

But when we entered Eric's room and saw Mary standing by the bedside, the couple seemed less sad than I would have expected. Then, an intern arrived, and gave what was, in fact, an excellent grand rounds synopsis, including symptoms, staging, the limited range of therapies available, and prognosis. Surely, I thought, my friends will understand the seriousness of the situation now.

But they didn't appear very upset.

"If it was really serious, Roger would have told us," Mary said. "But he didn't mention any of the stuff that the intern said at all. We'll have the treatments, and everything will be fine."

Filling the void, I tell my friend the bad news About 12 hours later, Dr. Jones called in a hematologist/oncologist, who described to the couple the "promising results" that doctors had been having with chemotherapy. Eric and Mary agreed to start the treatment immediately.

But that evening, Eric's respiratory distress and pain increased, and he was transferred to the ICU, where he was put on oxygen and IV morphine. It was there that I asked the couple what their plans were. Together, they insisted that no treatment should be withheld. As I looked into Mary's face, I knew she had no idea how ill her husband was-or of the nonexistent options available to them.

The following morning, I arrived to find Eric intubated. "He coded during the night, but the machine's helping now," Mary explained to me.

During the next two days, Eric's condition continued to deteriorate. Meanwhile, Mary, with her two young children, sat with Eric, oblivious to how bad her husband's condition had become.

Suddenly, I couldn't wait any longer for Dr. Jones to do his job-to alert his patient and his patient's wife to the gravity of the situation.

Escorting Mary out of the room to a quiet waiting area, I asked, "Has anyone explained to you what's really going on?"

"No," Mary said, her voice a bit tremulous. She probably suspects the truth, I thought to myself, but, as long as no one verbalizes it to her, it would remain just that, an unconfirmed suspicion.

"I pray I'm wrong about this, Mary," I said. "But Eric is probably going to die, and fairly soon. It might be best if we ask him what he wants, these last few weeks."