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No gentle way to answer the question. - Nobody wears a white coat any more...
...a tribute to becoming a doctor.
ayradyss
ayradyss
No gentle way to answer the question.
Message in my box: please call $patient re: lab results.

I had the lab results in my other box, beta-HcG, positive, means pregnant. I called. She was surprised; she was supposed to have a quantitative - she'd been seen in ED for bleeding, likely miscarriage, follow-up HCG in two days to see if it's dropping. I had a new OB intake scheduled with her on Thursday. She was concerned, she's still got a little bleeding. This was an unexpected pregnancy that she was just starting to like the idea of, just starting to want. And she doesn't want to miscarry. Nobody does.

I called the lab. They had a stored tube. They reran the test. They said they would page me results, but when I got back from seeing a well-child check the results were in my mailbox, faxed. Numbers going down. I'd expected that; I'd seen the ED reports - 1 week 1 day-sized baby at 9 weeks on ultrasound, but a heart beat. I had hoped. She was going out. "Have the clinic page me when you get back," I said. "I should have them by then."
I'm on ER this month. After getting 5 hours of sleep at the Chicago hotel, coming in at 9:45 AM, showering and running to the hospital, getting my TB test placed then noon conference then looking for someone to take my clinic then patient calls, I worked until midnight (I will tell you some of those stories later), got to bed around 1, and woke up again around six. And I've got post-travel fatigue. I went home after morning clinic today and slept. My pager woke me up.

How do you call someone and tell them that their fears are true? She wanted to know, she'd had some preparation in the ED, but still I was handing her confirmation. I called. I got her on her cell phone, the number she'd left me. "It's Dr. B. I talked to the lab." Pause. Okay? "The numbers are going down." Going down...what does that mean? I could hear in her voice that edge that means 'tell me that word doesn't mean what I think it means' and I didn't drag it out. "It means you likely are having a miscarriage. I'm so sorry." Pause. It's never a great connection when there's bad news. The silence holds pops and clicks of static; interruptions in my thought. I gave it a moment or two, but silence is a double-edged sword, when you are not face to face. "You have an appointment on Thursday. I know it was supposed to be a new OB appointment, but I still want to see you. I want to talk about how you're doing, what to expect, next steps. I know this is hard." This woman does not know me; she has never met me. The first time I talk to her I tell her she is losing her baby. What is she supposed to say? Yeah, she says. It is. Thursday. I'll be there. "I'm sorry. Hang in there, I'll see you Thursday?" Okay. Beat. Long beat. And goodbyes. I hung up trembling.

I forgot things about phones. I forgot to make sure she was at a good point to talk, not driving, things like that. I am always a little awkward on the telephone, and I am afraid of how that came across. I am consumed with me now, that strange introversion that comes with a new and uncomfortable experience, putting it on, testing the fit. I have decided already that I do not like being the deliverer of bad news; I like it even less over the telephone. I doubt I will ever be comfortable with it, and I don't think I should be. But at the least I can do it well, I can maybe ease the sting as much as possible, and I do not think that today I did it as well as I could have.
What say you?

now feeling:: thoughtful thoughtful

5 whispers echo . o O ( ... ) O o . whisper a word
Comments
pwwka From: pwwka Date: August 2nd, 2005 10:48 pm (UTC) (etched in stone)
You may have wished someone to tell you such horrible news in another way-- but she may have been the sort who'd have wanted to know right away rather than face-to-face, or the sort who'd dislike a doctor staring at her as she got visibly upset. Trust that you do all you can, and God works with the rest.

I'm sure she felt the heart in your voice.
trinapink From: trinapink Date: August 3rd, 2005 01:29 am (UTC) (etched in stone)

You did fine.

The minute you called, she'd have had a pit in her stomach. Leaving an ambiguous message or setting up a time to talk later would have just prolonged it. What you did was exactly what I would hope my doctor would do for me.

And you did say you were sorry. :-)
missysedai From: missysedai Date: August 3rd, 2005 01:46 am (UTC) (etched in stone)
I think you did the right and merciful thing. It's much easier to cope with bad news when the person delivering it is forthright and sympathetic.

When I was pregnant with Ernie, my AFP test came back elevated. I barely heard my OB as he explained what it could mean...trisomy 21...possible birth defects...could be nothing, but shouldn't take chances...suggest amniocentesis...uncomfortable...9 weeks for results...

...and as I sat there, holding my barely bulging belly and shaking in terror, he put his arm around me, told me it was OK to cry...and let me do just that while he gently reassured me that everything would be OK. It helped so much and made the wait much less stressful. (Ernie, as it happens, was just fine. Relief!)
turnberryknkn From: turnberryknkn Date: August 3rd, 2005 06:20 am (UTC) (etched in stone)
(nods nods) What missysedai said.

One of the major reasons I wanted to spend a year on Peds Heme/Onc during my HHMI year was to find out about myself if I could deal, emotionally, with the relentless toll of bad news it is a Peds Heme/Onc doc's duty to deliver. Deal with one case after another where you pull up a lab result that then requires you to explain to a twelve year old child and his parents that the child has already seen his last Christmas, and will see no more. Especially at a place like Michigan, where they send all the kids they can't cure elsewhere, sometimes because there *is* no cure. It was just as hard for me as it was for you the first time that year, and it was just as hard the upteenth time at the end of that year. My faculty mentors had been doing that for decades. And it never got easier for them, either. Then again, I don't think losing a patient -- a kid -- is *ever* supposed to be easy. And I'm not sure I ever want to work with a physican for whom it is.

Thanks again for sharing.

From: dr_bobbie Date: August 6th, 2005 12:49 am (UTC) (etched in stone)
I completely understand. The desire to pull it off well...I don't think that will ever be met, simply because you are the bearer of bad news, unwanted news, and the end result is that someone, somewhere, is hurting.

You did your best to be as compassionate as you should be. It's what I would have done, and what I would have wanted my doctor to have done.

Like you, I feel the same about bad news. It's one thing about this job lifestyle that will never, ever get easier.
5 whispers echo . o O ( ... ) O o . whisper a word