Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Cushioning the fall of bad news

Meghan Gaffney Liroff, MD
Physician
May 24, 2018
163 Shares
Share
Tweet
Share

Angela Harris has been here in the hospital for six hours, awaiting the results of her CT scan. I won’t take responsibility for all of that wait time: complicated CT scans and labs do take a significant amount of time to perform. But she didn’t need to wait the last hour.

She was waiting on me — her emergency physician — because I needed to confirm her cancer diagnosis with radiology, arrange some oncology follow-up … and find the most appropriate phraseology for: “You have stage IV cancer, but you don’t meet admission criteria.”

I’ve delivered this diagnosis five times this year — and, ironically, always in that room. The cold, narrow one that echoes.

I pause outside of room four and, unseen by anyone, quickly make the sign of the cross. I haven’t been to mass since Christmas, and my father is Jewish; but for some reason, when I feel overwhelmed, I return to some foundational beliefs to ask for help. I’m about to tell a patient something invasive, painful and traumatic, so I take a personal time out beforehand, as if I were about to place a chest tube.

In situations like this, I fall back on a script. Now, carefully following that script, I walk into the room and intentionally choose my seat. To my right, flush against the wall, sits the hospital gurney, a used gown folded neatly over its crumpled white sheets. To my left, in the chair closest to the door, sits Ms. Harris, already dressed.

I head for the empty chair wedged into the corner, murmuring “excuse me” as I brush past her in the cramped space. I sit down in the chair and angle it slightly toward her; our knees almost touch.

This is what I say:

“I have the results of the CT scan. Is it OK to discuss those results with you now?”

Ms. Harris nods.

“When we performed the scan,” I continue, “we saw something that we weren’t expecting to find.”

Her face changes completely. The standard pall of emergency-department anxiety disappears; her eyes widen slightly, and her posture becomes perfectly erect. This is what terror looks like.

“The scan showed a mass with a certain pattern,” I say. “I’m concerned that the symptoms that prompted you to come to the emergency department are due to this mass.”

“Is it cancer?” she asks blankly.

I hate the way I say the next part. I haven’t figured out how to be honest without, at the same time, seeming to deliver a death sentence.

“I’m concerned that this mass may be cancer. I can’t diagnose cancer until we have a sample of that tissue and look at it under a microscope. Still, the pattern that we see is a very high-risk pattern.”

Silence. An eternity of silence.

From the corner of my eye, I notice her left hand. It begins to tremble, and she covers it with her right.

It’s at this point, during this kind of conversation, that I become a bit depersonalized. The situation becomes a movie scene to me. It can’t be real: This is too much pain, and the rawness of the situation comes too close to dismantling my appropriate and necessary denial of mortality. It’s human pain, but, for today at least, not mine.

“What do we do now, doc?” she asks, holding onto her poise. She rapidly blinks her eyes, warding off the possibility of tears.

The conversation continues into territory that’s hard to discuss because of all of the unknowns. I always feel that I’m in way over my head.

“We’re so concerned about the pattern we see today that I’ve called the cancer specialist, who has reviewed the scans,” I say. “We’ve reserved an appointment for you tomorrow so that the next steps can be discussed. Your medical team will go over the tests and treatments with you.”

“So, I’m going home today?”

My inner self laments the system. For Ms. Harris, I know, these next days will be full of waiting for results — of having too much time between appointments, and no guarantees.

“You don’t need to stay in the hospital,” I say. “Do you have someone at home who can be a support to you? Your sister? I want you to talk this over with her. These next days will be hard, but you have many reasons to be hopeful. Take this one step at a time. Right now, I’ll give you a prescription for some anti-nausea medications and pain medications. Tomorrow, you’ll see the specialist.”

I make myself pause, then say, “You’ve taken in a lot of information. What questions do you have?”

“None right now.”

Feeling embarrassingly relieved, I stand up.

“All right, then; this is the start,” I say. “Please excuse me, I’ll go and get your discharge paperwork.”

She sits still, eyes downcast, waiting for privacy.

Trying not to race for the door, I take an awkward step. Only when I start to lose my balance do I realize that my foot has gotten wedged under the leg of my chair.

I fall forward, and behind me, the chair topples over and hits the floor with a metallic crash.

Ms. Harris laughs. I find myself on my hands and knees directly in front of her, bruised in body and ego.

Bending down from her chair, still smiling, she takes my elbow and scoops me up.

Meghan Gaffney Liroff is an emergency physician. This piece was originally published in Pulse — voices from the heart of medicine. 

Image credit: Shutterstock.com

Prev

The dangerous precedent of Alfie Evans

May 24, 2018 Kevin 11
…
Next

How to deal with devastating criticism

May 24, 2018 Kevin 5
…

Tagged as: Hospital-Based Medicine, Oncology/Hematology

Post navigation

< Previous Post
The dangerous precedent of Alfie Evans
Next Post >
How to deal with devastating criticism

More by Meghan Gaffney Liroff, MD

  • The calm before the hospital

    Meghan Gaffney Liroff, MD

Related Posts

  • Are negative news cycles and social media injurious to our health?

    Rabia Jalal, MD
  • KevinMD fall 2017 speaking preview

    Kevin Pho, MD
  • How online physician reviews can be fake news

    Deborah Burton, MD
  • A physician’s addiction to social media

    Amanda Xi, MD
  • Why medical students shouldn’t always fall in line

    Ton La, Jr., MD, JD
  • The story behind a cadaver: Fall down, get back up. Even after you’ve passed out

    Rachel Matar, PA-C

More in Physician

  • The harmful effects of shaming patients for self-education

    Maryanna Barrett, MD
  • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

    Wendy Schofer, MD
  • Skydiving and surgery: How one doctor translates high-stress training to saving lives

    Alexandra Kharazi, MD
  • Don’t be caught off guard: Read your malpractice policy today

    Aaron Morgenstein, MD & Laura Fortner, MD
  • The dark side of medicine: an urgent call to action against greed

    Don Gaede, MD
  • Dr. Glaucomflecken for president!

    Aaron Morgenstein, MD & Amy Bissada, DO & Corinne Sundar Rao, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
    • How this doctor found her passion in ballroom dancing [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Embryo Development Delayed in Pregnancies Ending in Miscarriage
  • No Survival Benefit With CRT Versus Chemo for Locally Advanced Endometrial Cancer
  • FDA Greenlights First Drug for Rare Immunodeficiency Disease
  • Ankle Sprain Physical Therapy Doesn't Shift the Pain Elsewhere
  • Use of EMR Directive Tied to Reduced Opioid Prescribing After Spine Surgery

Meeting Coverage

  • No Survival Benefit With CRT Versus Chemo for Locally Advanced Endometrial Cancer
  • Ankle Sprain Physical Therapy Doesn't Shift the Pain Elsewhere
  • Use of EMR Directive Tied to Reduced Opioid Prescribing After Spine Surgery
  • CRT Regimen Boosts Complete Response Rate in Unresectable Vulvar Cancer
  • CDK4/6 Inhibition Active in Recurrent Low-Grade Serous Ovarian Cancer
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The harmful effects of shaming patients for self-education

      Maryanna Barrett, MD | Physician
    • The power of self-appreciation: Why physicians need to start acknowledging their own contributions

      Wendy Schofer, MD | Physician
    • The endless waves of chronic illness

      Michele Luckenbaugh | Conditions
    • Skydiving and surgery: How one doctor translates high-stress training to saving lives

      Alexandra Kharazi, MD | Physician
    • Telemedicine in the opioid crisis: a game-changer threatened by DEA regulations

      Julie Craig, MD | Meds
    • How this doctor found her passion in ballroom dancing [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...