Every boy, girl and grown-up knows very well the sparks of gratitude upon receiving a gift on the Christmas festival. When we make a wrong choice of "gift", the resulting ripple can be far-reaching, though.
On the Christmas Eve, I made a phone call to my patient, a young lady who recovered from a stormy hospital course with a disease called systemic lupus erythematosus, after receiving her magnetic resonance images (MRI). "Good afternoon, Ms L, this is Dr. KM Chow who saw you last Tuesday and requested a MRI of your painful left hip. Should I go on?" With that, I then said, frankly, "The films did show a lot of destruction at your hip joint. Yes, quite badly damaged. Simply put, the previous steroid drug treatment led to permanent loss of blood supply to the bones. Without blood, the bone tissue dies and the bone at your hip collapses. Do you follow me?"
Before I had any chance to go on telling her the joint replacement for the injured bone, Ms L broke into tears.
I have since come to realize that breaking bad news on the Christmas eve is one of the stupidest things a doctor want to do. The Herculean task of giving her words of comfort was never easy after the stupid conversation on the Christmas eve.
"Silent Night..." the music goes on around me and seems to remind me the holy grail of keeping silent.
Lesson learned.
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- KM Chow is a young chap who is learning to show respect for the other person's opinion.
2 comments:
Thanks for your sharing!
Your words reminded me of my 1st Christmas Eve as a pathologist, which was a "sinful" day. I had 6 coroner's interview with the relatives of the deceased, and asked for 3 autopsies on that single day. I wasn't doing well on the first interview; I told the relatives that "After reviewing Mr L's case, I would recommend autopsy. Do you have any questions on that?" And there was complete silence for some 15 seconds.
Luckily, in the 3rd case, my empathy came back. This is a case with unknown cause of death, and autopsy is "inevitable". I was trying to persuade the son of the deceased to agree for autopsy, who did not want his father's body to be disturbed; I knew it is a painful decision for him, but I really cannot grant a waiver for autopsy. I spent 45 minutes with him, trying my best to explain the reasons for autopsy and how it'll help to solve my question and his question on the death of his father; I told him that if I were him, I would find it difficult to accept too (I nearly cried as I said those words). Finally, he broke into tears, and agreed for his father's autopsy.
This was the first time that I had a feel of helping people as a pathologist. I could have asked this gentlemen to apply for waiver right away, and let the coroner "order" an autopsy, without spending 45 mins talking to him. But this simply isn't my character.
(I guess my seniors would recommend me to ask this gentlemen to meet the coroner in order to play safe. But I'll never know the answer cos my senior was on leave on that day.)
Dear KM,
Merry Christmas!
After 3 months in palliative ward, I am not sure that there is ever a good time for bad news...I guess we can only do what we can in letting it out in a better way.
Sometimes, I think that as a doctor, I hope that we can try to give better news (of treatment) in the inevitable event of illness. I am sure that in that sense, you're better than most of us!
Happy New Year too!
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