It is due time for another How Did That Happen? post. This one is How I Survive Breaking Bad News. Not how to break bad news. That gets covered all over the place. I’m talking about the facing people later, living the rest of your life kind of survival.
This one is a result of my week of breaking bad news. I know, I am an oncology resident. More days than not, I break bad news. I tell people about pathology reports they don’t want to hear about. I tell them they have cancer (not always for the first time, but sometimes for the first time they really process it). I tell them their cancer is back. That it isn’t curable. That they need treatments they didn’t want. That they are going to die… Soon.
Breaking bad news is tough. So tough it is its own section in many med school communication classes. So tough most people do a crappy job of it because they are scared.
I’m a weirdo. I don’t love breaking bad news, but I like to do it. Because I believe people have the right to know the truth. And to hear it in such a way it is understood and compassionate.
This week has been especially bad newsy. From clinic to call to pediatric brain tumor clinic, I have delivered or been in on delivering all kinds of crumminess. It wears on a person.
- It is okay to cry. Seriously. Sometimes, stuff is really tough and you just have to let it out. I’m not saying sob on the shoulder of the person you are talking to, but it is okay to shed some tears then or later.
- It is okay to be angry or disappointed or relieved. Emotions are good.
- I’m going to sound cliché, but reflect on it. Sometimes, you say stuff that is stupid or comes off the wrong way and other times it goes well. Actually think back on it, even if it is tough and then learn from it and move on. I tend to really stew on things, so this is something I’m working on.
- Find the rays of hope. This is also helpful when delivering and discussing the news, but I really mean it is important for me too. Sometimes, I start to feel like I am the grim reaper or that life is a miserable existence. It is good to find the bright sides, like how fortunate I am, how that person will have a good outcome or good days or whatever. Just something positive.
- Count your own blessings. If I get really discouraged, I find it helpful to think of how fortunate I am despite the bad in the world.
- Talk about it. Confidentiality is important to maintain, but there is nothing wrong with discussing it with co-workers involved in the case, or even just your thoughts around it without disclosing details with a friend or family member.
- Have an outlet. I sing and dance like a fool. Or exercise. Or write. Just something not work that helps get some of that badness out.
- Do something happy. I like ice cream. Or spending time with friends. Or music. Or books.
- Mix it up. This isn’t always an option. But, I love that my job involves lots of time on the computer doing technical stuff or research, not just difficult conversations. I also love that there are really good positive things mixed with the difficult in clinics.
- My faith is super helpful to me at those times too.
What are your bad news survival tips?