While on my surgery clerkship during third year, my colleague decided to break some bad news to a patient. The day before, we had performed a hemi-colectomy plus extensive lymph node dissection, which was found to be stage III colon cancer, which was a recurrence (she was "in remission" for several years prior to this surgery). She was a fairly young woman as far as colon cancer goes, in her 50-60s, and she had a very admirable performance status. Being that we had become aware of her poor diagnosis during a frozen section during her surgery, my colleague, "Breanna", decided that she would inform the patient of her diagnosis.
It was about 5:30 in the morning when Breanna decided to enter Ms. Hemi-Colectomy's room. After waking Ms. H-C, Breanna proceeded to ask her many questions regarding her recovery from surgery and her previous experience with cancer. Breanna then decided to divulge the diagnosis to Ms. H-C, while mentioning the fact that it is "not curable" and that "hospice might be able to help you stay comfortable". As you can imagine, tired and lonely Ms H-C did not take to this diagnosis and prognosis well - she began sobbing uncontrollably at her "hopeless" situation. That's when Breanna decided to leave Ms H-C to herself. Breanna came over to me and started complaining about "how hysterical my patient was in there; all I did was tell her the diagnosis. I explained to her that we can get hospice involved - I don't know why she's so upset".
About a half hour later, after Breanna had left the floor, I was rounding on a few other patients when I heard a nurse complaining about something... "My poor patient! A damn medical student woke her up to break the news to her that she has terminal cancer at 6 o'clock this morning, and now she can't stop crying! So I've been in there for the past 45 minutes, trying to talk with her...What the h*** was that stupid student thinking!? It's 6 in the morning and she's all alone!!!"
I was in complete shock - this story is so distressing to me that sometimes I think I must have only imagined it. But this true - this poor woman learned her diagnosis from a brand-new, third year medical student who could barely string a sentence together in normal conversation (she was as close to Asperger's as I've seen outside of my psych rotation), who had no idea what the patient's true prognosis was, and did not even explore the possibility of further treatment. Also, this student also knew full-well that we were NEVER to discuss the diagnosis before the attending had time to break the news to the patient first. I honestly don't know what came over her and made her decide to break the news to this poor, unfortunate woman.
This is one of the most difficult conversations a physician can have with his/her patient, one which requires a lot of experience, tact, and respect in order to be done properly. It's a conversation that patient will never, ever forget - so it's unbelievably important to do it right.
But the worst part of this story is the fact that Stage III Colon Cancer can be amendable to treatment. This diagnosis was not implicitly terminal; we do have treatment options available which may offer a significant prolongation of good-quality life with the possibility of a cure.
As a student, I've seen a few things happen that I don't quite agree with, but this was definitely the worst. I can't even imagine how furious the surgeon was when he discovered what had happened - luckily we moved on to the next service before he found out. I don't want to know what he would have done to Breanna...
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