I was on my 5th day of my 5 days long, 10 hours shift in the emergency department. I was already tired at the beginning of my shift. It was 2330 hours. Just 30 minutes before my shift’s over. I was waiting for a CT abdomen pelvis scan result on one of my patient. I clicked on the investigation tab to see if the reports were back. Yes! there it was. I clicked on it. I read the result and I bleeped the Medicine duty on call doctor. I read the result to him and I said that my patient will likely need to come for her further management. He agreed. Just before we hung up, he said, “Does the patient know about the scan results?”. I said, “No, not yet, I will let her know”. He said, “thanks”. We both hung up. I took a deep sigh.
Out of all the task I do as a doctor, one of the most difficult task is to “break bad news” to patients, which I was about to do in a while. I was about to see her for the first time as I was handed over her care to me by one of the doctor who finished at 2200 hours. She was in cubicle 6. As I approached to the cubicle, I saw her. She was laying on her right side, wearing a lovely pink night gown. She was small in built and a bit thin as well. She was 75. I went close to her, I called her name. She was probably taking a nap, she opened her eyes. She looked at me. I smiled at her and I introduced myself. I began to ask if she knew what was happening with her? She said, “well I had a scan of my tummy and I am waiting for the results”. I said, “that’s true, but do you know why are you here today? In the A/E department?” She paused a bit, felt a bit confused. I came to her rescue and said the reason why she was there. She remembered. She was diagnosed with lung cancer recently. She was under treatment for it but she had some side effects to the treatment and had to stop the treatment since past few weeks. Since then she has been feeling unwell. Her appetite has been decreasing, she is not eating and drinking well, been feeling lethargic, has been vomiting and unable to cope at home. She lived alone and had her daughter come in to her home to help her with groceries and other bits and bobs. Her daughter called the ambulance today as she thought her mum was not coping well at home. She was hypotensive with the ambulance crew and a bit tachycardic as well. She was mildly dehydrated. It was evident that she had something going on, something both medical and/or a surgical problem. Thus, we decided to do bloods and scan her abdomen and pelvis as she had a huge ascites (abnormal fluid accumulation in the abdomen).
Her scan results showed that her lung cancer had spread to the abdomen, to her liver, to her adrenal gland on right side and also to her bones. I was about to shock her and probably rip her off any hopes she might have been cherishing to survive out of this cancer. I pulled the curtains around the cubicle. I lowered my self to her face. My voice slowly turning low. I grabbed her right hand. I began to utter slowly, “I am here to discuss about your scan result. If it is all right with you?” And at that point she must have realized that something is bad. I could see it in her eyes. Her pupils dilated, she tried to make herself comfortable in the bed and she faced straight at my face. She said, “yes”. I began to tell her the horrible news, that her cancer has now spread to multiple sites. I took as much pause as possible and I tried to be as clear as possible. It is one of the hardest task, where I need to step in my patient’s shoe and try to make them feel comfortable and cared and supported while I bombard them with the worst possible news in the most polite and graceful way as possible. As I said to her, “unfortunately, it seems that the cancer in your lung has spread to your abdomen”, she stopped me and said, “so is there no hope then?” This was the tough part, where as a doctor you want to show hope to your patient and at the same time show the realities of the bitter world. To tell them that they got cheated by life.
I said, “as with any cancer, Love, once it spreads to other part of the body, it is very hard to contain it and to eradicate it. Unfortunately, it will spread and progress with time”. She blinked slowly and looked away from me. I was still holding her hand and gently stroking it. I can now see tears in her eyes as if I am able to see my own reflection on her eyes filled with tear. I placed my hand over her forehead and I said, “I am sorry, I had to tell you this terrible news”. I further added, “I know it is hard, but you will not be alone, we will help you and support you in all and every possible way we can”. She blinked again. Blinked again as if she did not want the tears to roll down over her face.
There was a brief moment of pause. I asked if there is anything she wants. She grabbed my hand and squeezed it tightly and said, “do not worry about me doctor, I lived a happy life. But I do not like pain, can you make me comfortable, with no pain?” I said, “absolutely, we will support you in every way possible, you do not need to worry about it. We will involve all your doctors and we will come up with a plan. You are not alone, we are here for you”. It nearly broke me in tears when she said to not to worry about her because I was genuinely worrying about her. I saw her and I saw my grandmother, my mother. I have no words to describe the sadness I was going through. I nearly had a 10-15 min conversation with her. Just before I left her, she grabbed my face and gently caressed me like my mother and my grandmother. She said, “thank you doctor, you have been so kind, thank you for all the things you have done, thank you”.
It is like this events that you realize that you are so privileged to be a doctor, to come close to someone’s heart and emotion that you forget and later realize that you overstayed your duty hours, just to be with the patient you love and care so much. Just to provide them the tender loving care you would to your loved ones.
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