So today was not the best of days. One of the least favourite parts of my job is breaking bad news. It's one thing to do it in English and I don't even mind speaking in layman's terms, but breaking bad news to a patient when you don't speak his/her language and have to use a translator is something else. And, unfortunately that is the case in 90% of the patients I work with.
Anyway, my two years of internship gave me plenty of practice but. I still get awfully nervous right before doing it. Today, my patient with CML, the one I have mentioned before who came with a grossly distended abdomen, ascites and a pancytopaenia had her abdominal sonar. It showed gross ascites with multiple masses within the abdomen. None of which could be readily identified and a CT scan was therefore suggested. But, knowing her previous diagnosis, the masses are most likely metasteses, which puts her at Stage 4 disease and unfortunately incurable. She also deteriorated over night, and this morning she was in quite severe respiratory distress. On the grand ward round, the seniors decided that she'd be for palliative care and we should make her comfortable as she probably wouldn't make it through the weekend.
I knew this deep down, but really thought my consultant would come up with a brilliant plan. It was then, I realized I would need to break the news to her and I wasn't sure if I was ready. But, quite frankly is anyone ever ready to tell someone that they are dying and have hours, days, weeks or months left to live? I told her , even though it was accompanied by getting a lump in my throat, tears in my eyes, and shivers down my spine, but I was honest with her. Even though she looked shocked by the news, I really think that it was the right thing to do. At least now she has the time to contact her family to let them know, say goodbye to loved ones and get her affairs in order before she dies. The nursing sister even thanked me for taking the time to explain what was happening with her.
So, all in all I think breaking bad news is part of being a doctor but, I will get used to it and it never gets easier with time.
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