I’ve been a doctor for three years. During that time, I’ve had the opportunity to be with people for their most ecstatic, ground-shaking, life affirming moments. I’ve also been there for the soul-destroying ones. Being there to support patients and families is an incredible privilege. It’s part of the reason I wanted to train in medicine and my biggest role models among consultants are those who do this well.
I recall one shift on a busy medical admissions unit. We were getting hammered on this particular winter afternoon, and were down one senior member of medical staff. Every bed was full and we were getting intermittent reports that A&E was now blocked. The hospital was well over full capacity.
A woman in her thirties had been brought in by her family. They were concerned she was acting strangely at home. Nothing major, but repeating herself, getting angry at insignificant things, forgetting where she was. Eyeballing the notes I was relieved as her early warning score (made up of baseline vital signs, and a predictor for how unwell someone is) was 0. This wasn’t someone who was rampantly septic. My immediate suspicions were either some kind of neuropsychiatric issue or something drug- or medication-related.
Talking to her, she did seem a bit emotionally blunt, which further raised suspicions of a mental health issue. She told me the only significant past medical history she had was an inconclusive result from a breast lump many years ago.
I discussed her with my consultant. We agreed the first thing to do was organise a CT scan of her head, as her blood tests hadn’t given us any clues.
I took 20 minutes to grab a sandwich with some colleagues from another ward I hadn’t seen for months. We swapped stories and laughed and joked. It was a welcome relief from the relentless, back-breaking work of the unit.
Back on my ward, I took some time to catch up with the investigations I’d ordered during the morning. A few abnormal blood results for various patients, but nothing too horrendous. I noticed that my lady’s CT scan was back, much quicker than I thought she’d get it. Unfortunately there was no radiologist report attached to it, but I thought I’d scan the pictures quickly.
The first image that loaded caught my breath. I stared at the screen aghast for minutes. Instead of the black and grey familiar walnut-shaped structures of the brain’s two hemispheres, was a large, irregular, white blob. It was massive, pushing the normal structures out of place. This could only be a very large brain tumour, possibly primary, or possibly malignant spread from an as yet undiagnosed breast cancer.
Given its size, I instinctively knew that this would not be survivable. This white blob would kill this woman.
I discussed the case with my consultant again. She suggested that we try to find a quiet room we could break the news to her. She also said that I should take the lead on this discussion – it would be a useful learning experience for me, and she would be there for support if I needed help. “Just sell the positives,” she said. Positives? What on earth could be positive about telling a young woman she has terminal cancer? “We can get rid of some of these symptoms by starting some steroids, and she can go home today.”
Unfortunately, given how busy the ward was, there was nowhere available other than the bedside. As I drew the curtains I felt a pit of dread in my stomach. This felt wrong, such a public place. There were various other friends and family members there but, full of nerves and inexperience, I just ploughed on: “Are you sure you don’t want your husband here?” This served as the warning shot she needed. She started crying and begged me to tell her what was wrong. “I’m afraid I have some bad news. There appears to be a shadow on your brain scan, and I think this is most likely a form of cancer.”
What happened next will haunt me for the rest of my life. A quiet high-pitched sound filled the intimate area by the bed. And then it progressed to a wail. The patient looked like I had just hit her in the face with a sledgehammer. She dissolved on to the floor, sobbing, screaming, telling me to stop. I couldn’t go on. Tears in my own eyes, I turned to my consultant who stepped forward, and expertly took over the situation, as she must have done hundreds of times before. She told her not to worry, and that we would take care of everything, and how sorry she was.
I felt like such a failure. I should have done better. I had underestimated how difficult delivering the worst news in the world to someone would be. My consultant reassured me that I was still new and learning, but that I should draw on this experience and use it positively. I do, but that woman’s screams will stay with me forever.