Friday, September 14, 2007

Hanging Crepe'

Why can't the pathologists be the ones who have to tell people that they have cancer? I mean they could come in and tell them and then leave. After all, you really don't know that they have cancer until the pathologist tells you.

I think having to deliver bad news is the hardest part of the job. No matter how hard you hope and pray for better news, sometimes you have to tell people that they are going to die. Then it gets worse. You do everything that you can do to help ease their suffering and comfort their family as you watch them slowly die. As they die, a piece of you dies as well.

Today, I had to give someone bad news. The very next patient was irate because I took so long with the previous patient and that I would not sign disability papers for their non-existant injury. I smile and apologize for their wait and explain that I dont due disability forms but will be glad to help them with their medical problems.


SeaSpray said...

Hi Throckmorton - I'm sorry that you had to deliver bad news today. I can appreciate that doing that would be the hardest part of a physician's job.

Ugh! Having to tell them that must just rip your heart out. It is a huge responsibility and if your the type to "hope and pray" then no doubt you are filled with compassion for them and that will come through in your discussion.

It must be frustrating for doctors too in that you are trained to facilitate healing and while death is a part of life it's what you work so hard to hopefully prevent for a long time.

Dr Keagirl over at her Urostream blog's current post is about feeling the loss of a patient and how it affects her and her staff.

Having worked in ER registration for 20 years, I got to know generations of patients. I also worked out patients because we had to do both when it was the old ER. So,I saw many of the repeat OP's and ER pts and became familiar with their medical conditions, their families, etc.

I am thinking of one woman now who was so sweet. She suffered and eventually died from Crohn's disease. She seemed sad sometimes. She told me once that she had lost a little 3 year old boy when she lived down south, Arkansas I think. He had fallen in an open cesspool. She was a MDCD pt and a frequent flier to the ER and sometimes I know staff was sometimes impatient with her. She was a gentle soul and I always talked with her when I could. I also remember a sweet man that died of colon CA and I could go on about other pts. I would feel sad when I heard or worse if I was on and they passed away. I kept my emotions in check (most of the time but not always)when I worked because just in a different mode but then this stuff would hit me the next day and I would cry at home.

I only worked in registration. I can only imagine how much worse it is for a doctor who has gotten to know and care for their patients. Seeing them deteriorate and suffer before your eyes. I remember that particular pt with the colon CA had been morbidly obese and had gotten so gaunt looking. He always had a good attitude. He was always polite.

Your post tugged at my heart strings and I am thinking about some things I haven't thought of in awhile.

Speaking as a patient, your being there for them,listening to them so that they feel heard or understood can make all the difference. Even a hug at the right time is healing in itself, you don't even have to speak. I think a hug speaks volumes. What do they say? A picture is worth a thousand words? A hug is worth a thousand words too. Obviously your medical expertise is key in helping them but I think it is important to treat the whole person because mind, body and spirit are all connected.

"As they die, a piece of you dies as well." Awww...again..I am sorry Throckmorton. It sounds like this pt is special to you. I am sure they all matter but sometimes there are certain ones that we all just bond better with.

When these circumstances come up and they take their toll on you, I hope you have people and hobbies that help to renew your spirit, bringing joy and peace into your life.

Do you ever watch Scrubs? (love that show)Sometimes they portray the patients that die as disappearing from their beds as everything else continues on. It always seems like such a striking contrast to now...then they never existed..but they did and now they are left behind in the hearts and minds of those that knew them.

I can't imagine ever being irate with a doctor because he was hung up with another pt. YIKES! How selfish is that? Some people just don't have the ability to see the larger picture.

Don't you sometimes have to do disability forms for the post-op pts, etc?

SeaSpray said...

Throckmorton -I, oh gee ...Throckmorton
I am really trying get past your name, really I am. It just evokes this giggle within even if I don't let it out.(I actually mentioned your site on another blog (Medblog Addict)but I digress) Seriously- I have been pondering what you said,that a piece of you dies when they die.

Throckmorton- I ended up writing a long comment. Please feel free to delete if you wish. Sometimes I tend to write long comments in other blogs. I have yet to finesse the short ones. ;)

I believe that you were chosen to be the doctor in their lives for whatever reason. I don't think it is a mistake when people are brought together when the deeper issues come up.(Even chance meetings can have a purpose)Your patients will benefit from your skill,compassion and wisdom. You gain things from them as well. Since we are the accumulation of all past and present experiences and as you have indicated these pts touch your heart,you then go forward and bring an even deeper level of humanness complimenting your medical expertise to your other pts.

One thing reading these med blogs has done for me is that I have even more respect (already had a lot)for physicians because of all you have sacrificed to get to where you are, and the huge responsibilities you have in caring for all of your patients, along with the business savvy required to run your practices. And that's just work! You have family responsibilities like anyone else. (Hope you all know how to maximize your down time!) The burdens you must carry when things are going south with a patient. Oh and this really irks me that docs have to be squirrelly about lawsuits on top of it all.

So, where am I going with all of this. I guess I just want to say to you and any other physician who comes along and reads this is that we patients DO appreciate you. Maybe not every pt and every doctor isn't good either.

But take it from this pt, the good ones are gifts from God on earth. The good ones will ALWAYS be remembered by their patients, even after they part ways.

It warms my heart to know that doctors care so much about their patients and I can honestly tell you that if anything bad happened to a couple of doctors that I currently have...I would be devastated. (i miss my OBGYN-he died a few years ago)I don't know them at all personally but do have a strong doctor-pt bond. It is a good feeling to know a doctor knows about you,what you need,how you work, and understands you and is willing to work to the best of their ability for you. I am talking about my PCP and my uro Doc. They are AMAZING doctors! They have gone out of their way to help me at times and I will just never forget them. They have earned my implicit trust, particularly the uro doc because of the frequency of visits due to the chronic nature and subsequent treatments - he has been in the trenches with me. You just don't forget something like that.

Because of what I have read in the medblogs, I feel somewhat guilty because I have learned through various doctor posts what a cost effective patient is and I haven't been, especially last year. I am trying though.) (chatty and friendly) Ha,my PCP ALWAYS has extended visits with me no matter what I go in for but he chats with me too. He even prays for me if I ask (we share the same belief system)but he doesn't advertise that. This warms my heart. Once my PCP saw me walking near by at a local concert and I heard someone yell through the noise,"PAT!" and I turned around to see him waiving at me with a big smile on his face. I never would've known he was there and I thought that was so sweet of him.

O.k., I have certainly gone off topic a bit and admittedly, brevity with words is not my strong suit. ;)

One last thing. Dr Schwab from the surgeonsblog has turned me into a surgical groupie ever since I read his October 7th post called "Taking Trust" and of course now my own (minimal-thank God) experiences with OR and last but not least "Grey's Anatomy." Dr Schwab has said they don't hold the instruments right though - they hold them too far out?

I read your post on "Dumpling Toxicity" (like the title) and have some comments about that for sure but it's a fabulous fall day and time to go do some things.

Throckmorton said...

Thank you so much for your kind words, it really helps! I think some of the most unsung heroes of medicine are those who work in Hospice, I trully don't know how they do it.

I know exactly what you mean when you say "you work in a different mode" sometimes.

I hate to say that I haven't watched Scrubs. I have found that I really can't watch medical shows on television. I guess I watch TV to not think about medicine.

I have a little saying on a card I keep at the nursing station that says "may your fondest memories be stronger than your deepest sorrows".

SnowLite said...

Your very welcome Throckmorton.

I am SeaSpray but have a different icon because I was playing around last night/today with opening another blog. Not sure what I will do with it as my SeaSpray blog is my "real" blog - my toy. I might do something more personal with it or make this Chanson D'hiver blog more about deeper subjects or poetry etc., or close it-not sure.
** (Warning -another long comment and I am not going to continue doing this. After all,it's YOUR blog. I think I am perhaps a little more sensitive to the topic of death and dying, etc., because it is an issue not far from my heart right now. Memories are stirred up and the idea of losing people I love in the present.)

Yes,I agree with you and think the hospice people have a special calling as do those that work in oncology.

It is tougher on you though in that you have to be "the one" to break the bad news to your pt whereas by the time hospice comes in the pts have fought the fight and are at the point where they need assistance with comfort, both physically and emotionally and enabled to leave this world with as much peace and dignity as is possible. is hard to see the families and the pt suffer.

Years ago I volunteered for hospice, went through the training (learned under a dear friend who I lovingly and gratefully refer to as my mentor-for many reasons)but then I was pregnant and so last minute decided to just volunteer for the office, so I never did get out in the field. I attended the death and dying classes though and I have tapped into that knowledge (sadly) many times over the years. My friend was on the board for that hospice and did a lot of public speaking on death and dying before she ever met Julie and Joe Quinlan.

Do you remember that case? Their daughter Karen Ann had ingested both alcohol and drugs back in 1975 and also that case became the cornerstone for the legal "right to die" and that landmark decision is why we are able to have advanced directives today.

They were the loveliest sweetest couple (odd that I am discussing this now as I just ran into Julie Friday after not seeing her for a few years-life is weird sometimes)and God bless them for turning around and using their personal tragedy for the purpose of opening up The Karen Ann Quinlan Center Of Hope. They, in their beloved daughter's name have helped so many people, including members of my own family and friends.

Sadly, and I hate even saying it (because I do think there is power in our words)we have a close family member who is battling with breast CA which metastasized to her groin and neck last September. (She never had a female exam and she was 67 and she hoped it would go away. she didn't tell her sister (my m-i-l) who overcame breast CA with a radical mastectomy.) I honestly thought it was a death sentence last fall and amazingly she responded to a new cancer drug that is helping tens of thousands of people and they were able to do a mastectomy in the spring. So, she really rallied back prior to the surgery but since then it has hit her liver. More aggressive treatment and I don't think she is doing well. I have always heard that if it hits the liver that is it but I haven't even said that to my husband- she's his aunt. I DO believe in miracles but sometimes total healing happens after going home to be with God.

My mentor was told she had 3 weeks to live in July 2006 and entered a hospice program. She initially started with idiopathic cardiomyopathy (didn't check spelling), developed other co-morbidities, defying all odds that she would survive and confounded the doctors. By last summer she was in end stage renal failure, unable to care for her physical needs other than feeding herself and she is cognizant of her surroundings and still manages to counsel people (staff) from her bed. Being in her room is like a respite to them and I have witnessed it being like Grand Central Station-which isn't always a good thing. One thing I could not believe and am glad was able to help her with.

Prior to my visiting her I had been treated for a ureteral stricture which resulted in several stents to correct the problem and one of the meds I was taking was pyridium which helps greatly with the discomfort. She was so uncomfortable with the foley, etc., and weren't giving her that but after I told her about it, she was able to get it.

Maybe they weren't used to urological issues - should have known though.

They kicked her out of hospice in December, which devastated her but mercifully since she is friends with the administrator it was just a technicality and he worked it so she could keep her room.

It is a good place but she just called crying the other night because she feels they aren't listening to her. She is leaking around the foley and getting SOAKED through pads, etc. and staff keeps saying nothing can be done about it. One person said she should have a larger (now I forget) I am going to say foley, but I don't know if they come in different sizes. She doesn't have a urologist and I told her she should ask for a urology consult. Maybe I am wrong, but after what I have been through myself...I wouldn't even waste my time going to anyone but a urologist if I thought there was a urological issue.

Maybe it is different with her being on MDCR/MDCD- then again they didn't think to give her the pyridium either. I think her dx is now changed to chronic kidney disease along with the other co-morbidities. She basically has pulled an art Buchwald who also had end stage renal disease and had to leave hospice and has since passed on. She wants to. I want her to...but's going to hurt.

I think we all have key people that are in our lives for whatever reason, beyond our parents. Special people that impact us in life changing ways. The exciting thing is that we never know who or when it will be...but there they are..forever leaving an imprint on our soul. (think I am going to do a post on this)Teachers, doctors, clergy - people from all walks of life who sometimes become our friend and take us under their wing, mentoring us or it could be something as simple as encountering a stranger on the street, a divine coincidence of sorts that sets us on a better or more enriched path. Hopefully, we will also be that special person for others, effecting positive growth/changes in another, keeping the ripple of good moving forward.

I love the "It's a Wonderful Life" movie because it demonstrates the impact we can have on others and future generations. I think we would be amazed if God pulled back the veil and let us see how we have made a difference.

"may your fondest memories be stronger than your deepest sorrows". That is beautiful and may it be true for all of us. :)

Since I am already long with this I will just lighten it up a bit.

Have you heard of the Bordello vaccine? LOL!!

The receptionist at the vet was telling me that someone called to schedule their pet for a Bordello vaccine! I posted about it. I didn't know dogs frequented BORDELLOS! ;)

Chrysalis Angel said...

I wish after reading this we could walk and talk a while.

As a patient that sat across from her doctor and received the news. I remember thanking him at the end of the meeting. He said, "Thank you? How can you thank me for giving you the worst news?" I said, "Because of the way you gave me the news." He sat down, He looked me in the eyes, he had compassion for my plight and worried for me.

I wish we could talk a while. Dying is a part of our lives. It is part of the curse we are dealt. The separation is only temporary.

I really like your site. I'm going to put you on my blog roll. Best to you.

SeaSpray said...

Hi Throckmorton - I just have a slight correction on what I quoted Dr Schwab as saying.

I checked with him and he thinks he said something like "they hold their elbows out with their hands up in the air, like they're making stew. Real surgeons brace themselves to steady the instruments."

Interesting! I will have to look for that when the new Grey's Anatomy episode comes on Thursday nite. Although it still might get past these untrained eyes. :)