Breaking bad news to patients when they are alone

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Today, we got called on a patient in the ICU who recently had a new brain mass removed surgically. The specimen came back positive for an aggressive brain tumor known as glioblastoma multiforme. We discussed his diagnosis and prognosis with him at bedside alone, with his wife and daughter on speakerphone given visitor restrictions due to the current coronavirus pandemic.

Unfortunately, this type of situation is rather familiar to us. We are used to breaking bad news, comforting patients during their times of need, and then shifting to our usual survival tactic of orchestrating a treatment plan. While many aspects of this exchange were similar, there were unique variables that grabbed my attention, given our current circumstances.

Our patient was a charismatic yet stoic gentleman, who superficially did not appear phased by our news. He seemed to be fully digesting every word we said, repeating them back to us to demonstrate comprehension – all the textbook rules of proper patient understanding. The panic that others would feel when faced by this news was present in his daughter instead, who was audibly exasperated and concerned via speakerphone.

There are many patients who are alone in the hospital when they receive bad news. We often will speak to absent family members in a similar manner, forging through the poor connection, call waiting, and all. Today, there was a certain fear during this encounter that felt so much more palpable to me. While the daughter was only a few miles away, it felt as though she was across the country. After a series of repeated questions, back and forth processing between father and daughter, we were able to cover a great deal of ground. Even through discussing daily radiation therapy, chemotherapy side effects, and risk of cancer recurrence, our patient endured.

The patient’s wife was silently listening through the entire conversation. As we neared the conclusion of our treatment planning discussion, she began to speak. At first, he confused her with his daughter, given some static on our phone connection. She repeated a “hello” – and at that moment, we witnessed a complete transformation. We could see the color and fear rushing back into him. His wall of armor melted into worry. Not being able to see his family for the past seven days. The pain he had in his head at his surgical site. Lying in a hospital in a city that had more viral cases than his hometown. The uncertainty of our treatment plan and the fear of having to register this information with no one by his side. The feeling of being trapped. He told his wife he wished he had her hand to hold.

This isn’t a unique situation during this time. This isn’t even the worst-case scenario. Our patient was awake, comprehending our information, and still able to communicate to his loved ones. He was fortunately not hooked up to a ventilator or sedated, as so many currently are. But the fear there was real, and fear is always relative. The fear of a loved one with a serious diagnosis, compounded by the terror that has been brought on by this pandemic. I wish I knew exactly how to comfort him, but I am not exactly sure that anything I said could have. Every day, and every hour, we are collectively learning how to function within this new world that has been created. We aren’t perfect – but I know there are so many incredible minds putting their heads and hearts together to find a path through this and a path for our patients to get home.

Azam J. Farooqui is a hematology-oncology fellow.

Image credit: Shutterstock.com

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