Bad News is a Real Bitch

Bad news is a real bitch.

It's true. It really is. None of us like receiving it. Depending on the severity of it, it can ruin our day, our week, our month, or, in some extreme cases, the rest of our lives. And the worst part is, the news doesn't give a shit. It is what it is, will always be that and nothing more, and will potentially wreck us whether we are ready for it or not.

Most of the time, we aren't.

Even when, at least on some level, we are expecting bad news, it still catches us unprepared. It hits us, bowls us over, and has its way with us—some news we can never be fully prepared for.

We all have been there, to one degree or another. The news hits. Often, it is a wave of ice-cold water that pours over us. That icy chill runs over our entire body. Our hands become clammy. Our hearing begins to deaden, noise cancelling headphones, the modern version of the cotton balls in the ears. Our throat is suddenly dry sand, a hot desert wind blowing through, stealing every drop of moisture.

Our body responds to the news, perhaps violently. Often, though, our mind does not. It simply refuses. We enter the cycle. We deny, are angry, bargain, enter the depths of depression, and only after some time, hopefully, we emerge through it all to the other side and are able to accept.

As our body submits to that physiologic surge of endorphins and cortisol, our stress response bursting through our very skin, our mind enters that place of black denial.

I have seen it. I have watched the lights turn off in people's eyes as they enter that dark place. I have been there as the curtain of acceptance drops quickly and with certainty. I have felt their minds retreat and close off, and no further comprehension was to be had.

I have seen it because, on many occasions, I was the messenger of bad news. As physicians, we have a duty to care for those who trust us with their health. We have a duty to work to improve their health, and thereby their lives. But sometimes, lately it has been far too often, we also have the duty to be honest, forthright, and give people the bad news.

There has been a lot of that lately. Too many people with bad cancer. In more than one case, the diagnosis was evident before I became involved. Yet, I quickly realized that no one had already shared the diagnosis. Trust me, I hate giving bad news. I honestly do. It is the worst part of my job. But I also have an obligation to be honest about that bad news. Only once we reach the point of acceptance about the news can we begin, together, to work toward some solution. And acceptance can never happen until the news has been given.

I understand my colleagues not wanting to give bad news. It isn't easy. I think many of our medical schools do a piss-poor job of training us in how to be human with other humans. And due to the rigors of getting into medical school, too many of us have aspects of our humanity shredded and torn away as we progress along that path. In some cases, people never developed it fully.

Odd that. In a field that demands us to be humane with others, we often are bereft of those tenets of humanity that would allow us to most effectively be there for others.

I digress. The truth is, in my experience, too many health professionals shy away from honest, painful conversations. These conversations are miserable, so we avoid them. Perhaps we think we are being humane in our avoidance. Perhaps we are lying to ourselves that things aren't as bad as they are. Maybe we remember that one case where the diagnosis it wasn't as bad as it seemed.

Still, deflection and avoidance are damaging, and we must stop them. I come back to the idea that only once acceptance is reached can we truly begin to work on making things better, or at least as good as they can be. Acceptance is never genuine if we are unwilling to be honest with the humans who trust us to be just that.

That doesn't mean we abandon hope. We hold to hope. We fight for hope. We strive to keep that hope alive. But we must be honest. Only from that place of honesty can we reach some sense of healing, a place from which we can all move forward.

Ultimately, that is our obligation as doctors: to help those who come to us and trust us reach a place where healing can occur.

Even when healing doesn't mean being healed.