If there is one thing that I have learnt in my 24 years upon this Earth, it is this: Never trivialize another’s pain. Never act like it is less than it is, never dismiss it, and never ignore it. Pain can be crippling, life-destroying, and can suck the joy out of life.
Despite this, sometimes doctors (and medical students, and members of the healthcare team) have no choice but to inflict pain upon those we’re supposed to be healing and helping. Vaccinations require the pain of the needle to protect from future illness. Painkillers may be withheld if the risk of addiction is too high. And sometimes, bad news must be shared.
The other day, I had to hurt somebody. I had to give them some bad news. And to be completely honest, (language warning) I feel like I fucked up.
It had already been a long day. A number of complicated patients had already come through, with numerous problems, presentations, and plans made for them. My mental feet were beginning to drag. Worse, my emotional feet were getting tired. A new patient was sent to my room. I introduced myself as usual, explaining that I was a medical student, that my preceptor would come in to talk to them after, and what could I help them with today? They were in to get some test results. And well… the test results weren’t good.
If I could have re-done this, the major change would have been right here. If I could re-do this (as I have 100 times in my head since), I would have left to get my preceptor. To this patient, I was a stranger. I did not have the same bond of trust that he had with my preceptor. But at the time, they wanted to know their results, which I had in front of me. I tried to prepare them, I tried to ready them for the bad news as I had been taught to in a class.
And then I dropped a bomb in their life. I told them. I hurt them. I caused them pain. At the same time, I could feel my own heart ripping from it.
Devastation. Have you ever seen true devastation upon another’s face? The type of devastation that causes a person to immediately deny what they were just told? I have, and it is not something that I can forget. What do you say in the face of something like that? What can you say?
All of my so-called training in ‘giving bad news’ was forgotten. Human to human, I tried to console them. I tried to apologize that they were put into the situation that they were. I tried my best to just be there for them. But I was a stranger, who had just given them bad news.
Finally, finally, I realized what I should have done from the start. I went to go and get their doctor. Together, the doctor and I went back in. Thankfully, I think that my preceptor was able to give back some hope to this patient. The doctor was able to come up with a plan to investigate and to help however we could. Some of the damage from the bad news was treated.
I think that my preceptor noticed that the encounter had left me exhausted and drained. They gave me a break, told me to go get some food and come back. I never told them how much that last encounter hurt, and they never told me that they could tell. And yet, somehow, I know that they knew. And I know that that is why they gave me that half hour.
So I went home. I thought about the encounter. I screamed into a pillow for a little while. I tried to take what lessons I could from it. I acknowledged the pain and sadness I was feeling, and that helped me. Not to overcome it, but to incorporate it.
I decided, then and there, that I want to do everything I can to minimize pain for patients who need to receive this bad news. I want to do everything I can to be there for them, and to try to help them retain hope.
I went back to the office after that break, and I saw more patients. I tried to help them with their problems. I tried to reduce their pain.
I tried, and am still trying, to learn what it is to be a doctor.