A difficult conversation
Investigation results are a false crutch for breaking bad news to patients
Several years out of medical school, I was working my first general medical registrar job as the night cover in a rural hospital. An elderly gentleman, unconscious and intubated, was brought in by ambulance to our emergency department. A computed tomography (CT) scan of his brain showed massive bilateral haemorrhages. I phoned my consultant, discussed the case, and agreed that a “not for resuscitation” order was appropriate.
None of them knew that this man, so special to them, was now lying unconscious in the next room, breathing through a tube, irreversibly damaged. I introduced myself, and thanked them for coming. I looked at the expectant faces. They already knew of the unconscious collapse. What “warning shot” could I give, to help steel them for the bad news? I thought about the only new information I had: the cerebral CT results. These were so clearly bad; surely they’d…