I rarely sit down for good news. There is no perceived air of indifference if I am standing at the bedside and relate that a CT scan shows improvement, or if I poke my head in to notify that bloodwork is stable, or stop by in passing to relate negative biopsy results. The delivery isn't as important as the content since the receiver is usually reassured and relieved by the information.
When I ensure that I am sitting down, it often heralds bad news. The more effort to set the stage usually corresponds with the gravity of the conversation. Because it's not solely about the information - it's about how you communicate it and deal with the outcome. There's a reason that there are sessions in school devoted to teaching these skills. They don't really prepare you for real life, though. Unfortunately that skill is refined through experience.
I was glad your wife was there. I pulled a chair up so I was at eye level with you both. I swallowed the lump in my throat that had formed there when I read through the CT results. They were far worse than I imagined. It was late in the afternoon and I could have gone home and discussed the results with you the following day, but I felt obligated to disclose them then. I had a special affinity for yourself and your family - you were always incredibly pleasant and lovely to deal with.
Before I began, I think you knew something up due to the difference in my demeanour. I remember how your face changed, smiling optimism to shocked disbelief, as I explained the scan results to you. Your wife's face furrowed with worry and tears formed in her eyes. I wished that I could have had different information for you, but unfortunately, the imaging demonstrated progression of the disease and new spread to your brain. I didn't expect that, Mr. H. The latter part worried you the most. "I don't want to lose my mind", you said before you dissolved into tears. I vividly remember how the sobs wracked your frail body as your wife clung to each other; I quietly left the room to give you both privacy to process the bombshell that had just been dropped.
The lump in my throat returned and I brushed tears away as I looked at the results again. I knew what this meant, and I felt helpless in my impotence. I was surprised to see B come in - I was there much later than I should have been and expected him to have gone home a long time ago. "Why are you crying?" "Mr. H is dying and there is nothing I can do about it."
"Is he less of a man because he's dying? Is there nothing you can do because he is dying?"
I didn't have much of an answer for that. I think I made a dry remark about B being more of a father figure to me than my own, with all of the deep questions and life lessons he discussed with me. For some reason, it was always him around when I cried. I acknowledged he was right and we discussed some of the finer points of palliative care. I think that is one of the pivotal points that helped me understand the importance of the philosophy of palliation. Cure was not an option but, as B explained, there was a whole lot that we could still do for you and your family.
Treatments were initiated. Your radiation mask was decorated with emblems of your favourite hockey team. You became more frail than you already were. Weakness and fatigue prevented you from getting up. You were plagued by pain and nausea. Medications were started, stopped, adjusted; true to your wishes, we endeavoured to help you keep your mind clear as well as we could. But you faded.
You had told me several times about your home in the country. That was your ultimate goal; to die at home in your comfortable, familiar environment surrounded by your family. You went home. I said goodbye knowing that this would be the last time I would see you again.
Thank you, Mr. H, for teaching me about the opportunities we have to care for someone at every step of the way. You died at home, just as you wanted. It was bittersweet as I was sad about the outcome, but at the same time, happy that we were able to help you accomplish your final goal. Rest in peace.
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