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
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.”

ADVERTISEMENT

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

ADVERTISEMENT

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

  • Complicity vs. protest: a doctor’s choice

    Patrick Hudson, MD
  • When cancer costs too much: Why financial toxicity deserves a place in clinical conversations

    Yousuf Zafar, MD
  • The hidden rewards of a primary care career

    Jerina Gani, MD, MPH
  • Why doctors regret specialty choices in their 30s

    Jeremiah J. Whittington, MD
  • 10 hard truths about practicing medicine they don’t teach in school

    Steven Goldsmith, MD
  • How I learned to love my unique name as a doctor

    Zoran Naumovski, MD
  • Most Popular

  • Past Week

    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • What is a varicocele and how does it affect fertility?

      Martina Ambardjieva, MD, PhD | Conditions
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • What is a varicocele and how does it affect fertility?

      Martina Ambardjieva, MD, PhD | Conditions
    • How profit-driven hospitals fail long-term patient care

      John Corsino, DPT | Conditions
    • Complicity vs. protest: a doctor’s choice

      Patrick Hudson, MD | Physician
    • How physician burnout and system reform are shaping the future of U.S. health care

      Irim Salik, MD | Policy
    • How nature is inspiring the future of pain medicine

      Varun Mangal | Conditions
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy

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

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • What is a varicocele and how does it affect fertility?

      Martina Ambardjieva, MD, PhD | Conditions
    • Why I left the clinic to lead health care from the inside

      Vandana Maurya, MHA | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • How a doctor defied a hurricane to save a life

      Dharam Persaud-Sharma, MD, PhD | Physician
    • What street medicine taught me about healing

      Alina Kang | Education
  • Recent Posts

    • What is a varicocele and how does it affect fertility?

      Martina Ambardjieva, MD, PhD | Conditions
    • How profit-driven hospitals fail long-term patient care

      John Corsino, DPT | Conditions
    • Complicity vs. protest: a doctor’s choice

      Patrick Hudson, MD | Physician
    • How physician burnout and system reform are shaping the future of U.S. health care

      Irim Salik, MD | Policy
    • How nature is inspiring the future of pain medicine

      Varun Mangal | Conditions
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • 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...