Residency Diaries Series #12: Delivering Bad News

6/2/2020 Tuesday 11:53pm

 Today I had to tell one of the patients that she had a widespread lymphoma everywhere. She came in with 1 month of severe nausea and vomiting and also a giant lymph node on her left neck. She had a 30lb weight loss in a month that she attributed to not being able to tolerate any solids for the past several weeks. 

 I’ve had to do this a couple times in the past-- telling people that they have a serious cancer that they didn’t know about. I take my time and make sure there are no distractions. I pull up a chair and sit next to them if possible. I print out all the labs and CT scan results and go over it objectively and give my impression on what I think may be going on. Patients nod and ask questions and thank me for explaining it to them. Sometimes they cry, but not always. Often they take it very well. When patients take the news well, it always makes me wonder whether I accurately explained the situation.

Of course it’s not necessary to explain just how dangerous or life threatening their cancer is on the day they receive the diagnosis (also technically it is not a true diagnosis until you have the biopsy results). I leave that up to the oncologists. Most likely the diagnosis hasn’t sunk in enough for people to express grief or any other emotion. Anyway- today, the woman I spoke with about her lymphoma started crying but explained that they were tears of relief for finally having the answer to why she has been suffering all this time. 

 I think it’s important to make these ED visits as pleasant as possible. I mean, you probably remember the day you find out you have cancer for the rest of your life. So it probably matters that everyone treated you nicely and checked in on you and offered you food and all that. It’s weird to think that for the rest of her life, I will be remembered as the doctor who told her she had cancer.

Well, maybe the ED resident (me) will be forgettable. Maybe all her cancer-related memories will be replaced by other doctor’s appointments, medications, pain. But I hope that she at least remembers the feeling of being cared for in the emergency department. I hope she remembers that I, along with other providers, felt sad about her newfound diagnosis and that we cared about her and how she might feel. I hope that makes a small difference in her memory.