Receiving ‘bad news’

I have already made reference in a blog posted on this website to my recent volume written, hopefully, for the benefit of patients and their carers. From time to time throughout the course of these postings I may elect to quote from that work over the course of these blogs. The following account of a patient once known to me is one such case in point.

“I have your results and…well…its where to begin”. These were the introductory words allegedly heard and later recalled in conversation with a patient from his first post-diagnostic clinical interview with his consultant. Some months later he had been referred to my clinic by that same consultant because in the latter’s opinion, the man was making “heavy weather” (as he put it to me over the telephone) of his treatment and prognosis. The patient concerned was a refreshingly open and matter-of-fact kind of man. From the outset he also came across as a clear and decisive thinker He certainly was not, in my opinion, the kind of man who might prevaricate in face of a perceived need to seek advice or counsel where appropriate and – as he would himself have put it – “to revise and update the battle plan”. As a retired officer of fairly senior rank in what is now known as the SAS, I will leave you to imagine the kind of ‘tight and hairy’ situations that he must have encountered in his service days. However – and even allowing for the fact that I came to know him very well for a time – he never referred in any detail to that period of his life to me. Nor, I have to say, would I have expected him to. (Incidentally, I used the word “allegedly” at the commencement of this paragraph because I have long since learned the necessity of distinguishing between what is said and what is actually ‘heard’).

It was several months into our knowledge of one another before one day, and of his own volition, my patient referred back to that very first clinical interview. He told me, “I am a great believer in looking people in the eye to reinforce meaning and my consultant seemed to look everywhere else in the room but at me. Everything I learned in that interview seemed to be tainted by his furtive behaviour and quite frankly, on that day at least, any meaningful relationship between us seemed quite out of the question”. He added, “I couldn’t exactly say to him, “Look man, pull yourself together; just look me in the eye and ‘spit it out’. After all – and as my consultant – he held senior rank”.

There was a long pause, in fact of around half a minute (and that in any conversation is a long break), which I resolutely refrained from seeking either to break or to fill. His response at length was so very well worth the wait. Speaking as I recall, in more of an undertone which was so clearly directed at his present response to the memory of that day rather than to me, he mused “Do you know, this is really the first time it has struck me in this way…”:(another lengthy pause before adding) “I’ve never ever admitted it to myself or to anyone…”(a further pause) “…Why?” “Why should I experience…?” A further lengthy pause ensued before, this time, I gently prompted, “Would it help to share your thoughts about it…with me?”  How richly, looking back, was that tentative enquiry rewarded! My patient went on to describe the memory that had now surfaced about the afternoon in question.

“I knew it was bad news just from the man’s demeanour”, he told me. “I don’t know how long he spoke for but somehow it seemed as if I were becoming smaller and smaller and his voice more and more distant and faint”. “Up to that moment” he continued, “a diagnosis had not been confirmed and I had remained confident that all would be well. My wife, who was outside in the waiting area, had pleaded with me that we might go in together but somehow I believed that I should protect her and had insisted on going in alone. How I longed for her now!” He paused again but at this juncture, more to swallow and ‘gather’ himself before continuing; “Anyway, the long and the short of it was that I seemed to go partially deaf”. “When I rejoined my wife, I asked the nurse (who had been present throughout the interview) to summarize the main points about immediate treatment, on the pretext that it would be useful for my wife to be independently briefed”.

My patient continued, “As we walked away from the hospital that winter’s afternoon, things were decidedly different. The noise of the traffic seemed distorted and muffled in some way. Although I could feel my wife’s arm linked to mine, it seemed and felt as though we were twenty yards apart, she on one side of the street and me on the other. I remember thinking, how could our arms stretch so far”. “Well”, he concluded, “not to put too fine a point on it, I decided to put it all on the ‘back burner’ and I suppose the ‘gas’ just went out…until now”.

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