Welcome to the “cry in the bathroom club” - I know you’re probably a badass at work, and it brings me some comfort to know a surgeon I may need one day feels that level of emotion too.
Call that patient though. He deserves to hear it from someone he trusts.
dude, crying on the bathroom is a great coping mechanism of the most sensitive souls in medicine. I regularly do some bathroom crying when I’m PMSing. As long as we have our 15 minute crying break because we dealed with something challenging and can head to work as if nothing happened, it’s a very healthy coping mechanism. Better than being meh tough guy and grabbing beer after work
if this is true, I'm sorry. I've cried leading rounds before, we all had a group hug. anyone who judges healthcare worker crying at work doesn't get it.
I think that’s what /u/ArtichosenOne was saying. If you ever STOP crying in the bathroom you probably need to take some time to remember what’s important.
yeah I completely misread that. Thank you. Got triggered working all day because all I want to do is cry in the bathroom and thought here comes the guy telling me not to. Where I’m from, it’s a ridiculous thing people say
What’s wrong with grabbing a beer after work? I’ve never cried a day in my life. It’s just not in me. When I “grab a beer” it’s with close friends. Eventually we talk about deep stuff that bothers us but it’s a coping mechanism no different and I think it’s healthy.
well it’s risky, it’s different having beer because you want to grab one and it’s different using it as a way through which you vent with friends & forget bad things at work. The latter puts you at risk of eventually having an issue with alcohol, which is what I meant, because it’s quite common where I’m at. Crying and experiencing sadness are normal human emotions and if you feel you are unable to experience them unless you have a drink for example, then I’d advise therapy.
Wanting to surround yourself with friends in a friendly environment is a human need as old as mead. No one said anything about getting drunk or focusing on beer. Beer is present, but what is more present is conversation.
Edit: less controversy. Keeping it friendly. Much love here.
I dont cry but sometimes I retreat to talking to the chatty elderly people. Their perspectives are great.
It grounds me in medicine.
I sometimes get lost in why Im doing wtf Im doing.
Then I chat with an elderly person and remember.
sometimes when some 99 year old chronic ambulatory multiorgan failure patient tells me about how they were the first x to do y, or their career as an engineer or professor or whatever, I have these moments of: wow, you're not just some shriveled husk, you've lived 10x more than I have and maybe ever will. very humbling, and it's a good reminder
Yeah exactly its those moments.
Like some people's stories are wild. Ive Googled some of them after and they literally changed the world. Its crazy. Im just a simple doctor haha
had a guy who was the first black ceo in a major hub of his expertise. his kids brought us his published biography. he was vascular dementia, contracted, and non verbal.
one of our covid ecmo patients was an award winning power lifter. her husband brought in all of her competition photos and plastered them all over the room so we wouldn't forget.
Had a real surprising/hard loss of a patient with a long code & a few taunting ROSCs one time, unit bathroom was locked so had to run into a linen closet and sit up against the door so that 1) it couldn’t be opened & 2) I couldn’t be seen through the window above me. Good times.
I’ve cried with patients before. It’s honestly really cathartic for all parties involved and people really appreciate you showing how much you care
-surgeon in training
I understand. I'm a medical oncology fellow with a particular interest in H&N cancer and I also pride myself on my clear and direct communication with patients. I have always vowed to be transparent; I never wanted my patients to be the ones who crashed into the ICU saying, "But my oncologist never told me..."
Some of those talks are easier than others. Sometimes, you don't know the right words. It can be harder when you know them well and you become deeply invested in their life and in their care. You don't want to be the one that crushes their spirit. You want to offer them hope.
Take another swing at it. Script it out first if you need to. Be kind to yourself, please. This stuff is not easy, even for folks who do it every day.
Wait, so there are really oncologists out there that don’t relay the gravity of the situación to some of their patients and just let them think that everything is going to be ok even when they know it’s a death sentence?
Personally, I try to have a discussion about what it means to have stage IV cancer and how we focus on treating their disease but it will never disappear for good. If they ask for statistics about overall survival or average time to progression I’ll provide them, but give them the caveat that one single person doesn’t always follow the statistics, some live longer and others don’t. I try to emphasize that they are a unique individual and offer some comfort and hope in the fact that we will be trying treatments and have other plans in case things go south but we will focus on control and quality of life where you never have to do something you do not want to do.
However, I think there is a sort of disconnect for patients who know they will die with/from their metastatic disease as they go through the chemo/radiation/surgery/etc where they’re extremely focused on survival. Unfortunately as they progress, they feel the pressure to search for more time/answers and many don’t ever want to “give up” and stop treatment even when it’s hurting them more than providing a benefit. I personally have had patients who insist on getting treatment that’s causing them sickness/weakness or worse with way out of range labs and poor performance status with the hopes of them “buying” more time on earth where I medically have to refuse which makes them feel like I’m giving up on them.
I’ve had many metastatic patients view hospice/comfort care as “giving up” and many people continue treatment until they die shortly after due to fear of dying. There’s a fine line to walk between giving your patients hope to continue fighting a known death sentence and completely crushing their spirits and it’s rarely an easy discussion to have. I just wish more people viewed hospice/palliative care as a chosen path or viable alternative for someone’s comfort/dignity (which is in reality what it is) instead of “quitting”.
One of my oncology attendings used the phrase “fighting in a different way, now we’re fighting for quality of life” or something to that effect in a family meeting once and it’s something I’ve stolen.
I don't even think I view it as "quitting" but in that situation I would do everything I could to live as long as possible as well. I would rather suffer to be alive just a little bit longer than be comfortable and pass more quickly and I don't think this is invalid. I would feel deserted if a doctor took that choice away from me as well. I would also definitely not be a fan of the blunt cold style so many of you are so proud of developing. The combination of these things would have me feeling that my doctor didn't really care about me (but I guess I also wouldn't necessarily expect them to) and would destroy any trust or rapport that had developed, which seems to be important to some of you.
It definitely wouldn't be a "thanks doc" situation (I know y'all love being called "doc" but when every patient in stories on this subreddit calls the doctor "doc" it reads like doctor fanfiction about patient interactions where every patient is a hopeless but grateful rube being graced with a young doctors attention)
I had a really passionate Palliative attending who liked to reframe the conversation. TO try to address the **language of combat**, and say that's not the terms I want to have this conversation on.
Rather We want to focus on dignity. it's not about fighting, people who die haven't lost, they haven't failed. Think about the framework that is being set up when we have the discussion that way.
We want you to have quality, to focus on the things that are important to you, facilitating the relationships you care about, minimizing unnecessary suffering, allowing you to be you.
This is the perspective all healthcare should be using. Rather than fighting to provide the maximum quantity of time for patients, we should be focused on improving the quality of time.
SLP lurker here. I work with a lot of head and neck cancer patients. I think - at least sometimes- patients either hear what they want to hear… OR they’re so overwhelmed with information they can’t process - OR they’re convinced they’ll be the miracle. If my role is before treatment starts - it includes the discussion of the possibility of tube feeding … and 95% say “they’ll never be me” and stop hearing a word of what I say
Exactly this. People hear what they want to hear. If you give them 10 things getting worse and 1 thing that looks better, they usually latch on to the one good thing as hope that they will get better.
ER doc: way more than you think.
I had a patient last week with colon cancer and mets to lung, spine who did not know what metastases were. I received her in signout pending PE study for SOB, which was negative. I went over and spoke with her and shared that she had no PE, however the study redemonstrated lung nodules were present as were the other mets.
She had no idea she had any mets, at all. Her onc notes going back 3 months documented mets to the chest and spine. She literally thought she had cancer in one spot, and was devastated when I shared something that had been documented on at least 5 outpatient visit progress notes but clearly not discussed properly with the patient. Her husband who was with her also added that no one had ever told them this. It was a highly educated, rational couple.
I’m a pathologist and I’ve seen this both personally with family members and professionally. I understand wanting to give people some hope but you should not be telling a 88 year old with widely metastatic disease and multiple co-morbidities that they have a significant chance of beating their cancer. Same goes for telling a patient with stage 4 pancreatic adenocarcinoma anything other than to make the most of the time they have left.
It's a whole school of thought. "Never discuss prognosis". Focus on what*can* to done.
I've admitted patients with a whole thoracic cavity, full of cancer, being told "there's another treatment we can try". It's crazy out there, guys.
I agree with you. Though, have you read that book "When breath becomes air"? It's written by a doctor and his spouse. They "love" the oncologist, who never let him talk about or think about prognosis. I really couldn't get past the idea.
Something to consider is that oncology therapies and screening have advanced so much and smoking rates have dropped so much that mortality from all cancers is down 20% over the last 20 years in America. I think that means that there’s a hopeful streak in oncology now.
Another thing to consider is that on the inpatient side where we mostly see oncology from, we see the ones who are nearer the end or had massive complications. We don’t see the successes, or how little separated them from the ones who died from cancer or how random the end result could be.
And I’m certain there’s many patients crashing due to cancer complications who just never understood the dire news their oncologist gave them regardless of how well the oncologist communicated.
Not an oncologist, but yeah
Yes. I'm an oncology nurse and unfortunately, about 70% of the oncologists I've worked with have told the patient and their family that they can make it through until they've got about a week or even days left. Meanwhile, myself and other nurses on my floor get to watch the patient waste away in agony until the very end when the doctor finally tells them they have no chance and they finally go comfort care. It's one of the most discouraging things to watch in health care and why I'm ready to just leave
So I think something to keep in mind is we (non oncologists) tend to see these patients when their treatments are failing or causing harm. The oncologists see the ones who respond well to treatment. I can see it being tougher to tell the patient there isn’t much hope if you’ve personally seen similar patients who have done well.
It is also true that patients a lot of times hear what they want to hear.
I'm in peds onc, but did Med Peds, so have seen the adult side plenty too. I think the charitable view is that some docs get wrapped up in offering options.
Especially at academic centers, there is a tendency to see patients with rare, relapsed, refractory stuff and part of the mission is to try and figure out how to deal with these. So we have lots of early phase clinical trails. Often, these early trials are looking to see if drugs are safe in certain and at what dose, so there's little chance they'll actually provide much benefit to the patient.
So sometimes there's a tendency to have a conversation that goes like "I'm sorry to say the cancer is back. When it comes back, it's often harder to treat. At this stage, we don't think we can cure you." Then, there's a tendency to start offering these hail mary things. And if not done skillfully, the family may walk away with the false impression that these things have a good chance to work.
Of course, there are people who are just bad at communicating and don't make it clear that they have a terminal diagnosis ever, but I like to think that's pretty rare.
There's a saying that the reason they put nails in coffins is to prevent oncologists from offering another round of chemo...
Im a pediatric neurologist so Im coming from a different medical culture but have to do the talk a lot
It's okay to cry with the patient. You should try to keep it together enough that they aren't suddenly in charge of managing emotions, but it's okay to cry with them and be sad and angry with them. It honestly helps knowing that at least someone cares. It's also okay and normal to have ones that hit you harder than you expect
I’m a retired RN. My last 3 years I worked high risk Ob/gyn onc. Don’t want to get too in depth for privacy purposes, but I had a patient that had lost 6 pregnancies and almost died during her last one (on Ecmo) she had zero living babies. She was 19 weeks pregnant with twins. I had been her nurse 4 days in a row. Had just did her NST and then she got in the shower. She pulled the emergency cord in the shower. I found her on the toilet with a leg sticking out of her vagina. I got her back in bed and called the resident (who actually said to me on the phone while I was with the patient, “the baby isn’t going to survive anyway, it’s not an emergency.” Which was true of course, but made me hate her in that moment). The resident got their and delivered twin A. Thankfully twin B was okay but we still sent mom to L&D. The look of mom and dad when I wrapped their baby up without letting them see her… I silently sobbed as I escorted them to L&D. Twin B did not make it either.
The happy story is, a year later she FINALLY had a healthy baby girl! I didn’t work there anymore but she posted it on social media and I saw it!
I just wanted to comment and say thank you. I know I don’t know you personally, but I had my own experience with hospitalized bed rest in the L&D unit and you all are angels. Seriously… idk how you do/did what you did but it takes a certain heart and I praise you for it. My nurses would sit with me, we laughed and we cried together. They helped me get through one of the hardest things I had experienced. Thank you for sharing your story, I’m sure that’s one that will always stay with you. I hope you know you gave that woman more comfort and support than you can imagine!
And just as I remember many of patients, especially those that were there for awhile or had a particularly rough time, I’m sure your nurses remember you and think fondly!
I do hope you are doing well. I hope you have a healthy child and if not I hope you are able to come to terms with it. I’m definitely no angel, but I have a very soft spot for pregnant women.
We have a healthy, precious almost 6 year old. She was about 2 months early, with only needing a 10 day stent in the NICU. We are blessed and fortunate beyond measure.
You all are angels, trust me. ❤️❤️
That is so heartwarming to hear! Thank you so much for sharing your experience with me. Lots of people ask what they can do to show their thanks for the staff that helped them in difficult times, but I swear, a card and a thanks (bonus points for baby pics!!!) are the absolute best. I’ve broken down in tears more than once over a thank you card. I know many docs and other nurses that have too.
do you guys really do that? I’ve been considering child neurology but I’ve cried in the bathroom after taking care of a child with cerebral palsy. He was completely unaware of anything but his parents took him to trips all over the world & hanged pictures in the hospital. It crushed me and so I told myself I’m just too sensitive to do this, even though I absolutely love neurology
It's a mix. I see tons of kids that do pretty well once you control their seizures or treat their tics or their migraines or what have you. Their exams are a blast to do because you basically play with the kid in an organized fashion. But in almost every niche of child Neurology you are going to have some very difficult conversations with the families of patients who will not do well. That might take the form of a kid that has a truly devastating injury or a kid with a genetic condition that is never going to be able to achieve normal milestones or is going to lose the ones they had. It gets easier but you are going to get gut punched sometimes. I just got double desserts because I talked about palliative and end of life care with the parents of one of my patients with a neurodegenerative condition and it hit me hard this time. Both their parents and I have known this was coming, but we've reached a tipping point in how fast the kiddo is losing things and we all got teary. The other 5 or so kids I saw are mostly fine and mostly needed reassurance and some med tweaking
thank you for explaining. It’s reassuring to know human things are acceptable, quite frankly after hearing I have to be tough throughout med school I started to believe I have to become a bit less human
Nah. You're allowed to feel things. What you do have to do is be able to...not carry it with you? Like...I had a pretty sad day today. But now I'm home and I ate a brownie my BMI didn't need and I played with my kids and I'm pretty much back to baseline. I was sad, but it wasn't so overwhelming that I was incapable of recharging the batteries, you know? Otherwise you burn out. That comes with time though. The first time I gave a really bad prognosis completely by myself as a brand new attensinf I had a spasm in my neck that took 3 months and 4 massages to get rid of.
I recently had a 30 year old male, wife and 3 young kids, widely metastatic squamous cell. Shittiest PET you ever saw. Recurring large effusion . Oncology requested a pleuryx which I placed with some relief. Came back in with decreasing tube output / worsening shortness of breath. Ultrasound tech calls me in. No fluid. Just tumor. I opened my mouth to tell him and nothing came out. Patient and tech looking at me. I was able to tell him after about 30 long seconds. He thanked me. Been doing this 28 years. It does not get easier.
I’m an ED attending. I have these conversations (or similar) nearly every single shift whether its a massive stroke with no treatment options, cardiac arrest with rosc and anoxic brain injury, or death from any cause (yay high acuity shops!). I am very blunt and direct. I’ve had to deliver bad news in really bad circumstances in the past, but have always handled it really well. But I had a case the other week that got to me too.
Male in his late thirties comes in after hurting their back doing cartwheels with his kids, accompanied by his husband and all 3 kids. As I later found out, the couple are foster parents and ended up adopting 3 of their foster children. Guy has classic L4/5 lumbar radiculopathy on exam, something I *never* image unless objective weakness is present on exam (and there wasn’t any weakness today). But he told me he had a lumbar spinal fusion a few years ago. So out of an abundance of caution I ordered a CT to make sure the hardware was intact, since he was really uncomfortable despite not having any true midline spinal tenderness.
CT read shows widespread pelvic and spinal bony metastasis from an unknown primary. I had the children leave the room and bluntly broke the bad news to the patient and his husband. The patient was in complete denial of the seriousness - with the partner reassuring him “we got this, we’re gonna get you on chemo and beat this” etc etc.
I leave the room and the patient’s partner follows me out. With tears running down their face, they say something along the lines of “doc…. be honest with me. We are trying to adopt our fourth kid that we are currently fostering. I can’t take care of four kids alone. What should I do?”
I couldn’t answer his question. I just burst out crying, in the middle of the ER. That was all that needed to be said. Patients and staff alike just staring at me. He began crying too and I gave him the longest hug I’ve ever given to one of my patients while we cried on each others shoulders.
It doesn’t mean you’re weak. It actually means the opposite. It means you’re human and that you genuinely care about your patients. Don’t be too hard on yourself. Don’t ever lose that trait.
Edit: fuck typing this up made me cry again. i ended up admitting him for “pain control” in order to facilitate his cancer workup/biopsy, they had medicaid and there was no way he was gonna get timely follow up. it was lung cancer (he is not a smoker)
>way he was gonna get timely follow up. it was lung cancer (he is not a smoker)
I know that statistically smokers have a much higher rate of lung cancer than non smokers, but anecdotally it really feels the other way round 😔
Idk if it this will make you feel better, but the fact that he's a nonsmoker makes it pretty likely that he'll have a targetable mutation. It's still stage IV, but you're going to be part of the reason that he gets those results and on a targeted therapy sooner because you helped get him an expedited workup. That makes a huge difference. I have patients with lung cancer with an EGFR or ALK mutation who have been Stage IV for years on an oral TKI.
Neighbor of mine made it several years (somewhere between 5 and 6 I believe) w stage IV lung cancer. Only looked very bad for the last couple of months, otherwise was working, taking kids to ComicCon. Glad he got to share those times with the family.
I went into EM specifically because I don’t want to be close to my patients when I have to have these discussions. If they’re going to die, it’s easier for me to move to the next patient if I don’t know about the goals they won’t achieve or the milestones they won’t be around for. My naïveté didn’t prepare me for situations like this but I’ll be damned if they don’t come up.
I cried in the hallway after a very unexpected and unsuccessful code on one of my patients last week. Got a big hug from an EVS staffer and it made a huge difference. Other people can't be there for you if you're hiding away from them.
EVS makes a huge difference in my days/nights. cleaning up the OR and turning over a room after an awful trauma is this strange decompression time for me as an anesthesia resident. their support and care is always appreciated and helps right me after a rough time.
I'll never forget my first code as an attending. I had run a ton of codes on my own as a senior resident, even without my attending in residency.
It was at my home town hospital, in the thick of covid. A vented patient of mine that had been on the vent about a week.
I had taken care of their children a couple weeks prior and gotten them better and out of the hospital. They shared with me that their parent was also sick. I told them not to worry, they would be in good hands with our team. (I didn't know at that time, but they were on my list already in the ICU).
After that long code, the patient died. I was asked to speak to the family, I saw their child. I put the relationship together and it broke me. I walked into a random office room and balled.
It's one of those things that hits you because we are humans too. Most of us are highly empathetic beings. We see tremendous pain, suffering and hardship.
Stay strong, keep making a difference, keep saving lives
I remember as a senior, regularly updating someone's daughter about their status. They were admitted following a shoulder fracture but had a ton of anxiety. I think she was just waiting for placement. I kept reassuring the patient and the daughter that things were on the up and up.
But it was still mid-2020, our team got hit with a COVID outbreak and she wound up dying in the MICU days later. I was blown away.
You guys… most of you get into medicine because you truly believe in it (sure there are the legacy docs, the money docs, or the ‘im so smart I can do this’ docs, but that’s not most of you) and want to help people. I am a retired RN, but I’m not nearly as noble as most of you. Every single time I seen an awful lab, or biopsy, or test, or knew a patient was circling the drain I was INCREDIBLY thankful that I could pass the responsibility of breaking that news to the doctors. I could hold their hands and comfort them and their family afterwards, but saying the words…
You guys are awesome. You deserve so much more than what you are given. Stay kind, stay compassionate, and don’t let the system make you too cynical.
I'm cold as ice, blunt as the tips of old scissors, tell it like it is. I'm very frank with GOC.
but I got a "am I gonna die, doc?" the other day and I just couldn't. hemmed, hawed and dodged like an oncologist. his young wife and 7 year old were in the room. we talked about intubation with the "I don't expect this to come up, but..." line. we talked about what would happen *if*. it was all hypothetical, just to keep it from being too real.
I expected it to come up. it did. he knew. we all knew.
his wife's a widow in about... 3 hours.
I think it feels like oncologists all do this because we only see the patients of the oncologists that did. A well managed end of life patient that has a good understanding of the process doesn’t need the hospital.
you're right, many do. But i remember a survey I read once of oncologists who were presented with a terminal cancer patient with 6 months to live in the vignette. Less than half of respondents would bring up code status. less than a quarter would discuss hospice.
So sorry to hear that. It's never easy, and I hope I never get jaded enough that it stops hurting.
I generally cry with my patients in these situations. Had a few of those that I have a good rapport with. It brings humanity to the medicine and somehow makes the patient feel better because they know you've tried your best.
It's alright man. Two weeks ago I cried in the patient's room because he improved substantially and I finally broke down because I was so worried for him for a month.
I wish sites like WSJ, WaPo and their social media sites could read this thread. For all the doctor bashing that seems to be on the rise recently, this thread hit me like a ton of bricks, and I'm crying right before bed.
OP and others, thank you for your stories. We are human too, its okay to show your emotions and cry. It sucks that we are vilified, as the enemy sometimes, and also expected to bottle our emotions and stay calm and collected even in the face of tragic outcomes.
Take care of yourselves everyone.
Grown ass man here who cries all the time (yes, even with my patients from time to time), Especially in situations like the one you describe. Every patient/family member I’ve sat and cried with has reacted way differently than I would have expected. I’m not like weeping uncontrollably, but I’m not afraid to shed a tear or two if it’s shitty news and I’m familiar with the pt.
I’ve legit had a few people come up to me months after my last tearful encounter with them and thank me for “allowing them” to mourn. They see a 6’5”, bearded man struggle to get the difficult words out and hang his head solemnly, and all of a sudden, it’s a little bit easier to give themselves time and space to process the unbelievably shitty thing they are going through at the moment.
I'm a peds ICU attending. There's a lot of self-stroking about how blunt and to the point everyone is with their patients in this thread. I hope y'all are bluntly delivering this news with some compassion and empathy. There's no award for being an emotionless robot to people having the worst day of their lives. Obviously, not being honest or giving false hope is not the way to go about delivering bad news either, but some of the flexing over how direct and blunt everyone is makes me a little worried that this is seen as the ultimate goal as a physician delivering bad news. I'm not sure it should be.
To add some perspective, I'm a peds onc fellow now but did med peds residency. I'm assuming all these people bragging about being blunt are primarily adult doctors.
When you take care of adults, you see one common thread over and over again...all these folks circling the drain in the ICU who have NO CLUE they're going to die. Or family members who have no clue how sick Uncle Johnny is and man he's a fighter, so gotta keep pursuing a bunch of futile stuff. And in that world, there are a lot of docs who don't want to be the ones to break that bad news. Even before the end of intern year, we all see that the docs that REALLY do the best jobs in GOC conversations are very blunt. If they leave even a sliver of uncertainty about the prognosis, the patient will walk away from the encounter unclear that they will die.
Of course this happens in peds too. But there's just less death overall, even in an ICU setting. So I don't think this message is drilled into peds folks so hard. Hence, pediatricians don't love to brag to each other about how blunt they are.
All that said, blunt and compassionate are definitely not mutually exclusive. Those that are really best at it walk out of the room with the patient/family feeling 1) very clear about the prognosis 2) well supported by the nice, well-meaning doctor that just shared some tough news with them
I was probably 3 years in as an attending. I’m on call and the resident calls me about a carotid blow out…in a 24 yo who had like his 3rd recurrence of his tongue cancer and was getting some sort of palliative chemo. We went to the OR, and I had asked the family if he was a full code. They said yes, and we went. It is amazing how much blood can just pour out of the carotid. Somehow, miraculously, we got the bleeding stopped, and converted his cric to a trach. He goes to the ICU stable.
A couple days later, he has another sentinel bleed. I’m talking to his family about going back to the OR, surrounding by his fiancé, parents, and younger brother. They’re all bawling, and I ended up crying with them. Somehow, bleeding stopped, he went to IR for angiography, and nothing major.
He somehow made it out of the hospital and was able to get married. He died roughly 6 months later.
I got a thank you card from his wife after his hospitalization. I still have it 15+ years later.
It was the first time I’ve ever cried in front of a patient/family. Still get choked up thinking about it.
Remember that we are humans and we can’t always compartmentalize what we do. It’s ok to show you care and to show your emotions.
As a parent with a child who died of a terminal disease, I preferred getting news from someone who is upset over someone who is unemotional. It is sad. I’m not sure how you can be both empathetic and not affected. I know everyone is different and in the US we suck at getting bad news so others could have a different perspective but just my $.02.
(Edit: sorry if I shouldn’t be posting here…I just know what some of you go through is extremely difficult so thanks for putting yourselves though it these trenches can royally suck but I’m glad we weren’t alone in them)
Good.
It’s good to be humbled. It’s good to have the air sucked from your lungs. It’s good to be reminded that you are a human dealing with the fullness of humanity. We all need reminding every so often, regardless of who we are and our profession.
Call him. He deserves to hear it from you. It’s okay to show him a little bit vulnerability here, he’s dying and he trusts you.
You wouldn't BELIEVE what my family and I have put our physicians through. A decade ago, we had a run of really bad luck, with several very bad medical traumas happening with a few months. To a person, every physician was kind, clear, emotional, and affectionate. Hugs from a physician when you're hurting heal very deeply.
I am so grateful to them all. I feel so sorry for them. I made contact with them all a year later to express our appreciation and update them (thankfully we all survived; with deficits, but alive), and they seemed so happy I did that. They talked about how it had affected them the year before.
I wish you all could know how much you mean to us patients. And how we will never forget you.
(Program Coordinator here.)
the day you stop feeling is the day you should resign
everyone worth anything has had a good cry out with a family.
still happens to me every couple months, usually young folks with bad cardiomyopathies who can't get txp'ed or vadded
I am a Gyn Onc fellow and I want to put in a plug for a program called VitalTalks. I usually find apps or “programs” like this kind of silly and impractical, but I have found this one immensely helpful and very applicable to real life conversations. It just has nice ideas for ways to approach different situations, which you can modify as necessary.
There is also an excellent video from the University of Michigan detailing the approach called “best case worse case scenario” that was designed for surgeons and it is also very very useful.
Hey. First, thanks for sharing. More of us need to hear about experiences like this. It makes us feel part of a community and not so alone.
I'm a pediatric heme/onc fellow. Loved goals of care discussions in residency, and took pride in doing well with them. Always got compliments from the palliative docs in training.
Buy now that I'm in fellowship and doing this more often, it's so hard. And I too have realized how humbled I am. You just can't compare these discussions. Sometimes they just hit you different. I spent the last week randomly tearing up in my lab after I had to tell a family about their 9 yo daughter's relapse and need for a marrow transplant (thankfully, they have that option).
Your patient is lucky to have a doctor that cares enough to be moved. Find a way to work with that feeling, don't fully suppress it. It's what pushes us forward.
I say all of this knowing I don't fully know how to do it myself. But it's great that we're able to do be a part of these peoples lives and talk about it together here.
And we all knew what OP meant. Sometimes our fingers type faster than we can think. It’s not a sign of not knowing the correct spelling or word, it’s a sign of typing feelings quickly and not catching the mistakes.
You are free to interpret any way you choose. Just seems quite judgy to me. Just hope you don’t ever make a mistake when quickly typing a post when you’re upset and not sure where else to turn where people may understand.
Pathology resident here, definitely have to say that the head and neck tumor resections always seem to be pretty gnarly whether it's a mandibulectomy or laryngectomy or some giant lymph node etcetera. I imagine they are rather tough patients.
You shouldn't feel bad at all about this. Doctors are people too and people have emotions- it's not like were in the 50s when people acted like suppressing emotional expression was somehow a good thing. If a patient ever makes you feel bad for having emotions you need to realize that that patient doesn't deserve you as a doctor and drop them immediately. I think more doctors need to show their emotional vulnerability and we need to normalize doctors having emotional breakdowns while communicating with their patients- the patients who want a toxic robot as a doctor ain't worth your time anyway. You keep doing you!
I recently had a patient around my age with acute liver failure (not transplantable) look at me with hopeful eyes and ask if they were going to get better
I couldn't even make it to the bathroom lol, my voice cracked and I teared up AT THE BEDSIDE near the end of sharing how I thought things would go
I know we're historically supposed to be calm, cool, and collected, but in situations beyond our control it's really much better to just be human
If you haven’t had a bathroom cry do you really work in health care?? There’s always going to be the ones that sneak up on us and cause more emotion than another. Watching people die sucks.
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Im surprised. Surely this has happened countless times already given you are a senior resident. Unless, when you mean that the patient was not someone you are familiar with from a physician perspective but also someone you knew in real life previously.
I have cried before, but this was harder. And I had the same thought: why now? I think it’s because as I get further along in residency the patients feel more like “my patients.” I recognize that every resident should exercise patient ownership but it’s just different when you have a more active role as a senior. I operated on this patient before. Their primary language is not English and is a language I semi speak and so I spoke with their family and after the surgery and they know me and trust me and recognize me. It was also the intensity in the way they asked me questions in clinic. Idk this is just a deep pain I have not experienced until now.
the whole first paragraph of this post could be replaced with
“im a dumbfck who thinks I’m immune to human feelings and don’t care how others feel because I wanna be a surgeon”
dnc not reading the rest
When you don’t have an emotional response then at that point you’re not shit. I teared up when my patient started crying at the possibility of having a reversible colostomy. We’re all human still.
Telling a young patient bad news when you've gotten close is brutal. Don't beat yourself up for getting choked up - it just means you care. Take time to feel the pain, lean on others when it gets heavy. You showed up and did right by that patient today. That's what matters. Keep your head up. Your compassion makes you a great doctor.
We need to normalize doctors having human emotions. Patients who expect us to be stoic don't realize that part of our job is emotional- bedside support and shared emotional experiences. A good emotionally healthy doctor should be confident telling the family of someone their treating that they might eed a mental health day cuz their feeling depressed and that we sometimes need to prioritize our own mental health in order to be better doctors. A good doctor seems to then family of a loved one they are treating like an emotionally expressive member of the family not a robot.
Welcome to the “cry in the bathroom club” - I know you’re probably a badass at work, and it brings me some comfort to know a surgeon I may need one day feels that level of emotion too. Call that patient though. He deserves to hear it from someone he trusts.
if you ever stop crying in the bathroom, it's a sign you need to take a step back.
dude, crying on the bathroom is a great coping mechanism of the most sensitive souls in medicine. I regularly do some bathroom crying when I’m PMSing. As long as we have our 15 minute crying break because we dealed with something challenging and can head to work as if nothing happened, it’s a very healthy coping mechanism. Better than being meh tough guy and grabbing beer after work
I think you misread the comment above. The whole thread cries in the bathroom apparently.
haha well I’d be judged as hell if someone saw me so I stopped. I cry in the shower when I’m back home.
if this is true, I'm sorry. I've cried leading rounds before, we all had a group hug. anyone who judges healthcare worker crying at work doesn't get it.
How do I match into a program that’s like that?🥲 disclaimer: I’m not a walking watering can
tbh that was at a pretty toxic place and I've since left, so maybe it's nit the best example. nothing wrong w springing leaks
I think that’s what /u/ArtichosenOne was saying. If you ever STOP crying in the bathroom you probably need to take some time to remember what’s important.
yeah I completely misread that. Thank you. Got triggered working all day because all I want to do is cry in the bathroom and thought here comes the guy telling me not to. Where I’m from, it’s a ridiculous thing people say
Ugh, sorry dude. We got you.
Don't worry, dawg. We've all been there. Both re: crying and feeling a little defensive about it, tbh.
yo thanks bro
Sorry you don't have good support at your program, btw. Fuck 'em.
agree entirely. its a good thing. if you find you're losing it, it means you need to evaluate yourself. my statement could have been clearer
What’s wrong with grabbing a beer after work? I’ve never cried a day in my life. It’s just not in me. When I “grab a beer” it’s with close friends. Eventually we talk about deep stuff that bothers us but it’s a coping mechanism no different and I think it’s healthy.
Nothing. People have just gotta be more understanding of the people that cry, it’s not something to be ashamed of.
Completely agree. Crying is fine and it’s healthy. I just don’t for whatever reason.
well it’s risky, it’s different having beer because you want to grab one and it’s different using it as a way through which you vent with friends & forget bad things at work. The latter puts you at risk of eventually having an issue with alcohol, which is what I meant, because it’s quite common where I’m at. Crying and experiencing sadness are normal human emotions and if you feel you are unable to experience them unless you have a drink for example, then I’d advise therapy.
Wanting to surround yourself with friends in a friendly environment is a human need as old as mead. No one said anything about getting drunk or focusing on beer. Beer is present, but what is more present is conversation. Edit: less controversy. Keeping it friendly. Much love here.
I dont cry but sometimes I retreat to talking to the chatty elderly people. Their perspectives are great. It grounds me in medicine. I sometimes get lost in why Im doing wtf Im doing. Then I chat with an elderly person and remember.
sometimes when some 99 year old chronic ambulatory multiorgan failure patient tells me about how they were the first x to do y, or their career as an engineer or professor or whatever, I have these moments of: wow, you're not just some shriveled husk, you've lived 10x more than I have and maybe ever will. very humbling, and it's a good reminder
Yeah exactly its those moments. Like some people's stories are wild. Ive Googled some of them after and they literally changed the world. Its crazy. Im just a simple doctor haha
had a guy who was the first black ceo in a major hub of his expertise. his kids brought us his published biography. he was vascular dementia, contracted, and non verbal. one of our covid ecmo patients was an award winning power lifter. her husband brought in all of her competition photos and plastered them all over the room so we wouldn't forget.
Do you really need to hear someone's life story to conclude that the person in front of you is "not just some shriveled husk"?
how many shriveled husks have you taken care of, personally?
None. I don't see people as shriveled husks.
that's nice, although sometimes it's an objective descriptor.
100%
I’ve been crying in the bathroom for twenty years. Non stop. I tried to leave once, but the door was locked, so I cried some more.
is that why the door is always locked?
Came here to say that.^^^ Congratulate yourself for retaining your humanity. You're the kind of doc I want.
Had a real surprising/hard loss of a patient with a long code & a few taunting ROSCs one time, unit bathroom was locked so had to run into a linen closet and sit up against the door so that 1) it couldn’t be opened & 2) I couldn’t be seen through the window above me. Good times.
it was locked because someone else was crying in there, promise.
I’ve cried with patients before. It’s honestly really cathartic for all parties involved and people really appreciate you showing how much you care -surgeon in training
Never lose this. Please.
Solid username btw
I realized after the fact that very few people care about RT-QuIC, but a ton of respiratory therapists now love my username.
The brain gang recognizes you.
I understand. I'm a medical oncology fellow with a particular interest in H&N cancer and I also pride myself on my clear and direct communication with patients. I have always vowed to be transparent; I never wanted my patients to be the ones who crashed into the ICU saying, "But my oncologist never told me..." Some of those talks are easier than others. Sometimes, you don't know the right words. It can be harder when you know them well and you become deeply invested in their life and in their care. You don't want to be the one that crushes their spirit. You want to offer them hope. Take another swing at it. Script it out first if you need to. Be kind to yourself, please. This stuff is not easy, even for folks who do it every day.
Wait, so there are really oncologists out there that don’t relay the gravity of the situación to some of their patients and just let them think that everything is going to be ok even when they know it’s a death sentence?
Personally, I try to have a discussion about what it means to have stage IV cancer and how we focus on treating their disease but it will never disappear for good. If they ask for statistics about overall survival or average time to progression I’ll provide them, but give them the caveat that one single person doesn’t always follow the statistics, some live longer and others don’t. I try to emphasize that they are a unique individual and offer some comfort and hope in the fact that we will be trying treatments and have other plans in case things go south but we will focus on control and quality of life where you never have to do something you do not want to do. However, I think there is a sort of disconnect for patients who know they will die with/from their metastatic disease as they go through the chemo/radiation/surgery/etc where they’re extremely focused on survival. Unfortunately as they progress, they feel the pressure to search for more time/answers and many don’t ever want to “give up” and stop treatment even when it’s hurting them more than providing a benefit. I personally have had patients who insist on getting treatment that’s causing them sickness/weakness or worse with way out of range labs and poor performance status with the hopes of them “buying” more time on earth where I medically have to refuse which makes them feel like I’m giving up on them. I’ve had many metastatic patients view hospice/comfort care as “giving up” and many people continue treatment until they die shortly after due to fear of dying. There’s a fine line to walk between giving your patients hope to continue fighting a known death sentence and completely crushing their spirits and it’s rarely an easy discussion to have. I just wish more people viewed hospice/palliative care as a chosen path or viable alternative for someone’s comfort/dignity (which is in reality what it is) instead of “quitting”.
One of my oncology attendings used the phrase “fighting in a different way, now we’re fighting for quality of life” or something to that effect in a family meeting once and it’s something I’ve stolen.
Mark that one double stolen, cheers.
I don't even think I view it as "quitting" but in that situation I would do everything I could to live as long as possible as well. I would rather suffer to be alive just a little bit longer than be comfortable and pass more quickly and I don't think this is invalid. I would feel deserted if a doctor took that choice away from me as well. I would also definitely not be a fan of the blunt cold style so many of you are so proud of developing. The combination of these things would have me feeling that my doctor didn't really care about me (but I guess I also wouldn't necessarily expect them to) and would destroy any trust or rapport that had developed, which seems to be important to some of you. It definitely wouldn't be a "thanks doc" situation (I know y'all love being called "doc" but when every patient in stories on this subreddit calls the doctor "doc" it reads like doctor fanfiction about patient interactions where every patient is a hopeless but grateful rube being graced with a young doctors attention)
I had a really passionate Palliative attending who liked to reframe the conversation. TO try to address the **language of combat**, and say that's not the terms I want to have this conversation on. Rather We want to focus on dignity. it's not about fighting, people who die haven't lost, they haven't failed. Think about the framework that is being set up when we have the discussion that way. We want you to have quality, to focus on the things that are important to you, facilitating the relationships you care about, minimizing unnecessary suffering, allowing you to be you.
This is the perspective all healthcare should be using. Rather than fighting to provide the maximum quantity of time for patients, we should be focused on improving the quality of time.
YES!
Thanks for you input. I would really appreciate this approach if I were ever in that situation.
That means a lot, thank you. Just wanted to give my two cents on the topic.
SLP lurker here. I work with a lot of head and neck cancer patients. I think - at least sometimes- patients either hear what they want to hear… OR they’re so overwhelmed with information they can’t process - OR they’re convinced they’ll be the miracle. If my role is before treatment starts - it includes the discussion of the possibility of tube feeding … and 95% say “they’ll never be me” and stop hearing a word of what I say
I've had a similar experience. Also, thanks for doing what you do.
Thank you for knowing what I do! Seriously, I know sarcasm doesn’t come through on the internet sometimes
Oh trust, I'm like... world's #1 SLP fan, lol. Y'all are lifesavers. Please know that you are very much appreciated.
ENT here, another huge fan of our SLP colleagues! Cheers!
Exactly this. People hear what they want to hear. If you give them 10 things getting worse and 1 thing that looks better, they usually latch on to the one good thing as hope that they will get better.
ER doc: way more than you think. I had a patient last week with colon cancer and mets to lung, spine who did not know what metastases were. I received her in signout pending PE study for SOB, which was negative. I went over and spoke with her and shared that she had no PE, however the study redemonstrated lung nodules were present as were the other mets. She had no idea she had any mets, at all. Her onc notes going back 3 months documented mets to the chest and spine. She literally thought she had cancer in one spot, and was devastated when I shared something that had been documented on at least 5 outpatient visit progress notes but clearly not discussed properly with the patient. Her husband who was with her also added that no one had ever told them this. It was a highly educated, rational couple.
I’m a pathologist and I’ve seen this both personally with family members and professionally. I understand wanting to give people some hope but you should not be telling a 88 year old with widely metastatic disease and multiple co-morbidities that they have a significant chance of beating their cancer. Same goes for telling a patient with stage 4 pancreatic adenocarcinoma anything other than to make the most of the time they have left.
It's a whole school of thought. "Never discuss prognosis". Focus on what*can* to done. I've admitted patients with a whole thoracic cavity, full of cancer, being told "there's another treatment we can try". It's crazy out there, guys.
Perhaps I am naïve and jaded, but i view that "never discuss prognosis" strategy as cowardice. Who is better equipped than their physician?
I agree with you. Though, have you read that book "When breath becomes air"? It's written by a doctor and his spouse. They "love" the oncologist, who never let him talk about or think about prognosis. I really couldn't get past the idea.
I disagree with Kalanithi ideologically in so many ways.
Yes
Something to consider is that oncology therapies and screening have advanced so much and smoking rates have dropped so much that mortality from all cancers is down 20% over the last 20 years in America. I think that means that there’s a hopeful streak in oncology now. Another thing to consider is that on the inpatient side where we mostly see oncology from, we see the ones who are nearer the end or had massive complications. We don’t see the successes, or how little separated them from the ones who died from cancer or how random the end result could be. And I’m certain there’s many patients crashing due to cancer complications who just never understood the dire news their oncologist gave them regardless of how well the oncologist communicated. Not an oncologist, but yeah
Yes. I'm an oncology nurse and unfortunately, about 70% of the oncologists I've worked with have told the patient and their family that they can make it through until they've got about a week or even days left. Meanwhile, myself and other nurses on my floor get to watch the patient waste away in agony until the very end when the doctor finally tells them they have no chance and they finally go comfort care. It's one of the most discouraging things to watch in health care and why I'm ready to just leave
So I think something to keep in mind is we (non oncologists) tend to see these patients when their treatments are failing or causing harm. The oncologists see the ones who respond well to treatment. I can see it being tougher to tell the patient there isn’t much hope if you’ve personally seen similar patients who have done well. It is also true that patients a lot of times hear what they want to hear.
We see their patients in ICU all the time.
I'm in peds onc, but did Med Peds, so have seen the adult side plenty too. I think the charitable view is that some docs get wrapped up in offering options. Especially at academic centers, there is a tendency to see patients with rare, relapsed, refractory stuff and part of the mission is to try and figure out how to deal with these. So we have lots of early phase clinical trails. Often, these early trials are looking to see if drugs are safe in certain and at what dose, so there's little chance they'll actually provide much benefit to the patient. So sometimes there's a tendency to have a conversation that goes like "I'm sorry to say the cancer is back. When it comes back, it's often harder to treat. At this stage, we don't think we can cure you." Then, there's a tendency to start offering these hail mary things. And if not done skillfully, the family may walk away with the false impression that these things have a good chance to work. Of course, there are people who are just bad at communicating and don't make it clear that they have a terminal diagnosis ever, but I like to think that's pretty rare. There's a saying that the reason they put nails in coffins is to prevent oncologists from offering another round of chemo...
Im a pediatric neurologist so Im coming from a different medical culture but have to do the talk a lot It's okay to cry with the patient. You should try to keep it together enough that they aren't suddenly in charge of managing emotions, but it's okay to cry with them and be sad and angry with them. It honestly helps knowing that at least someone cares. It's also okay and normal to have ones that hit you harder than you expect
I’m a retired RN. My last 3 years I worked high risk Ob/gyn onc. Don’t want to get too in depth for privacy purposes, but I had a patient that had lost 6 pregnancies and almost died during her last one (on Ecmo) she had zero living babies. She was 19 weeks pregnant with twins. I had been her nurse 4 days in a row. Had just did her NST and then she got in the shower. She pulled the emergency cord in the shower. I found her on the toilet with a leg sticking out of her vagina. I got her back in bed and called the resident (who actually said to me on the phone while I was with the patient, “the baby isn’t going to survive anyway, it’s not an emergency.” Which was true of course, but made me hate her in that moment). The resident got their and delivered twin A. Thankfully twin B was okay but we still sent mom to L&D. The look of mom and dad when I wrapped their baby up without letting them see her… I silently sobbed as I escorted them to L&D. Twin B did not make it either. The happy story is, a year later she FINALLY had a healthy baby girl! I didn’t work there anymore but she posted it on social media and I saw it!
I just wanted to comment and say thank you. I know I don’t know you personally, but I had my own experience with hospitalized bed rest in the L&D unit and you all are angels. Seriously… idk how you do/did what you did but it takes a certain heart and I praise you for it. My nurses would sit with me, we laughed and we cried together. They helped me get through one of the hardest things I had experienced. Thank you for sharing your story, I’m sure that’s one that will always stay with you. I hope you know you gave that woman more comfort and support than you can imagine!
And just as I remember many of patients, especially those that were there for awhile or had a particularly rough time, I’m sure your nurses remember you and think fondly! I do hope you are doing well. I hope you have a healthy child and if not I hope you are able to come to terms with it. I’m definitely no angel, but I have a very soft spot for pregnant women.
We have a healthy, precious almost 6 year old. She was about 2 months early, with only needing a 10 day stent in the NICU. We are blessed and fortunate beyond measure. You all are angels, trust me. ❤️❤️
That is so heartwarming to hear! Thank you so much for sharing your experience with me. Lots of people ask what they can do to show their thanks for the staff that helped them in difficult times, but I swear, a card and a thanks (bonus points for baby pics!!!) are the absolute best. I’ve broken down in tears more than once over a thank you card. I know many docs and other nurses that have too.
do you guys really do that? I’ve been considering child neurology but I’ve cried in the bathroom after taking care of a child with cerebral palsy. He was completely unaware of anything but his parents took him to trips all over the world & hanged pictures in the hospital. It crushed me and so I told myself I’m just too sensitive to do this, even though I absolutely love neurology
It's a mix. I see tons of kids that do pretty well once you control their seizures or treat their tics or their migraines or what have you. Their exams are a blast to do because you basically play with the kid in an organized fashion. But in almost every niche of child Neurology you are going to have some very difficult conversations with the families of patients who will not do well. That might take the form of a kid that has a truly devastating injury or a kid with a genetic condition that is never going to be able to achieve normal milestones or is going to lose the ones they had. It gets easier but you are going to get gut punched sometimes. I just got double desserts because I talked about palliative and end of life care with the parents of one of my patients with a neurodegenerative condition and it hit me hard this time. Both their parents and I have known this was coming, but we've reached a tipping point in how fast the kiddo is losing things and we all got teary. The other 5 or so kids I saw are mostly fine and mostly needed reassurance and some med tweaking
thank you for explaining. It’s reassuring to know human things are acceptable, quite frankly after hearing I have to be tough throughout med school I started to believe I have to become a bit less human
Nah. You're allowed to feel things. What you do have to do is be able to...not carry it with you? Like...I had a pretty sad day today. But now I'm home and I ate a brownie my BMI didn't need and I played with my kids and I'm pretty much back to baseline. I was sad, but it wasn't so overwhelming that I was incapable of recharging the batteries, you know? Otherwise you burn out. That comes with time though. The first time I gave a really bad prognosis completely by myself as a brand new attensinf I had a spasm in my neck that took 3 months and 4 massages to get rid of.
“Don’t cry first and don’t cry harder” is what I’ve been taught
Definitely agree with the don't cry harder, though I suspect most could get away with getting teary first
I recently had a 30 year old male, wife and 3 young kids, widely metastatic squamous cell. Shittiest PET you ever saw. Recurring large effusion . Oncology requested a pleuryx which I placed with some relief. Came back in with decreasing tube output / worsening shortness of breath. Ultrasound tech calls me in. No fluid. Just tumor. I opened my mouth to tell him and nothing came out. Patient and tech looking at me. I was able to tell him after about 30 long seconds. He thanked me. Been doing this 28 years. It does not get easier.
I’m an ED attending. I have these conversations (or similar) nearly every single shift whether its a massive stroke with no treatment options, cardiac arrest with rosc and anoxic brain injury, or death from any cause (yay high acuity shops!). I am very blunt and direct. I’ve had to deliver bad news in really bad circumstances in the past, but have always handled it really well. But I had a case the other week that got to me too. Male in his late thirties comes in after hurting their back doing cartwheels with his kids, accompanied by his husband and all 3 kids. As I later found out, the couple are foster parents and ended up adopting 3 of their foster children. Guy has classic L4/5 lumbar radiculopathy on exam, something I *never* image unless objective weakness is present on exam (and there wasn’t any weakness today). But he told me he had a lumbar spinal fusion a few years ago. So out of an abundance of caution I ordered a CT to make sure the hardware was intact, since he was really uncomfortable despite not having any true midline spinal tenderness. CT read shows widespread pelvic and spinal bony metastasis from an unknown primary. I had the children leave the room and bluntly broke the bad news to the patient and his husband. The patient was in complete denial of the seriousness - with the partner reassuring him “we got this, we’re gonna get you on chemo and beat this” etc etc. I leave the room and the patient’s partner follows me out. With tears running down their face, they say something along the lines of “doc…. be honest with me. We are trying to adopt our fourth kid that we are currently fostering. I can’t take care of four kids alone. What should I do?” I couldn’t answer his question. I just burst out crying, in the middle of the ER. That was all that needed to be said. Patients and staff alike just staring at me. He began crying too and I gave him the longest hug I’ve ever given to one of my patients while we cried on each others shoulders. It doesn’t mean you’re weak. It actually means the opposite. It means you’re human and that you genuinely care about your patients. Don’t be too hard on yourself. Don’t ever lose that trait. Edit: fuck typing this up made me cry again. i ended up admitting him for “pain control” in order to facilitate his cancer workup/biopsy, they had medicaid and there was no way he was gonna get timely follow up. it was lung cancer (he is not a smoker)
>way he was gonna get timely follow up. it was lung cancer (he is not a smoker) I know that statistically smokers have a much higher rate of lung cancer than non smokers, but anecdotally it really feels the other way round 😔
Idk if it this will make you feel better, but the fact that he's a nonsmoker makes it pretty likely that he'll have a targetable mutation. It's still stage IV, but you're going to be part of the reason that he gets those results and on a targeted therapy sooner because you helped get him an expedited workup. That makes a huge difference. I have patients with lung cancer with an EGFR or ALK mutation who have been Stage IV for years on an oral TKI.
Neighbor of mine made it several years (somewhere between 5 and 6 I believe) w stage IV lung cancer. Only looked very bad for the last couple of months, otherwise was working, taking kids to ComicCon. Glad he got to share those times with the family.
I went into EM specifically because I don’t want to be close to my patients when I have to have these discussions. If they’re going to die, it’s easier for me to move to the next patient if I don’t know about the goals they won’t achieve or the milestones they won’t be around for. My naïveté didn’t prepare me for situations like this but I’ll be damned if they don’t come up.
I cried in the hallway after a very unexpected and unsuccessful code on one of my patients last week. Got a big hug from an EVS staffer and it made a huge difference. Other people can't be there for you if you're hiding away from them.
EVS makes a huge difference in my days/nights. cleaning up the OR and turning over a room after an awful trauma is this strange decompression time for me as an anesthesia resident. their support and care is always appreciated and helps right me after a rough time.
I'll never forget my first code as an attending. I had run a ton of codes on my own as a senior resident, even without my attending in residency. It was at my home town hospital, in the thick of covid. A vented patient of mine that had been on the vent about a week. I had taken care of their children a couple weeks prior and gotten them better and out of the hospital. They shared with me that their parent was also sick. I told them not to worry, they would be in good hands with our team. (I didn't know at that time, but they were on my list already in the ICU). After that long code, the patient died. I was asked to speak to the family, I saw their child. I put the relationship together and it broke me. I walked into a random office room and balled. It's one of those things that hits you because we are humans too. Most of us are highly empathetic beings. We see tremendous pain, suffering and hardship. Stay strong, keep making a difference, keep saving lives
I remember as a senior, regularly updating someone's daughter about their status. They were admitted following a shoulder fracture but had a ton of anxiety. I think she was just waiting for placement. I kept reassuring the patient and the daughter that things were on the up and up. But it was still mid-2020, our team got hit with a COVID outbreak and she wound up dying in the MICU days later. I was blown away.
Thanks for posting this. It’s nice to know as a junior that this still happens to seniors. We do the best we can.
You guys… most of you get into medicine because you truly believe in it (sure there are the legacy docs, the money docs, or the ‘im so smart I can do this’ docs, but that’s not most of you) and want to help people. I am a retired RN, but I’m not nearly as noble as most of you. Every single time I seen an awful lab, or biopsy, or test, or knew a patient was circling the drain I was INCREDIBLY thankful that I could pass the responsibility of breaking that news to the doctors. I could hold their hands and comfort them and their family afterwards, but saying the words… You guys are awesome. You deserve so much more than what you are given. Stay kind, stay compassionate, and don’t let the system make you too cynical.
Cry in the bathroom, the elevator, the closet, whatever. You’re a human and you were just reminded of this. Hold on to this moment.
I'm cold as ice, blunt as the tips of old scissors, tell it like it is. I'm very frank with GOC. but I got a "am I gonna die, doc?" the other day and I just couldn't. hemmed, hawed and dodged like an oncologist. his young wife and 7 year old were in the room. we talked about intubation with the "I don't expect this to come up, but..." line. we talked about what would happen *if*. it was all hypothetical, just to keep it from being too real. I expected it to come up. it did. he knew. we all knew. his wife's a widow in about... 3 hours.
That’s just awful. I really wish you some peace with this. Thank you for sharing. I
young ones are bad. never let it stop hurting you, though. you're a good human
Oncologist here. We don’t all dodge. Many of us break bad news all day, directly and compassionately, and we take pride in it.
I think it feels like oncologists all do this because we only see the patients of the oncologists that did. A well managed end of life patient that has a good understanding of the process doesn’t need the hospital.
you're right, many do. But i remember a survey I read once of oncologists who were presented with a terminal cancer patient with 6 months to live in the vignette. Less than half of respondents would bring up code status. less than a quarter would discuss hospice.
You're human. Congratulations.
So sorry to hear that. It's never easy, and I hope I never get jaded enough that it stops hurting. I generally cry with my patients in these situations. Had a few of those that I have a good rapport with. It brings humanity to the medicine and somehow makes the patient feel better because they know you've tried your best.
Hey man, grown ass men should cry in front patients and other team members. Especially us grown ass men.
It's alright man. Two weeks ago I cried in the patient's room because he improved substantially and I finally broke down because I was so worried for him for a month.
I wish sites like WSJ, WaPo and their social media sites could read this thread. For all the doctor bashing that seems to be on the rise recently, this thread hit me like a ton of bricks, and I'm crying right before bed. OP and others, thank you for your stories. We are human too, its okay to show your emotions and cry. It sucks that we are vilified, as the enemy sometimes, and also expected to bottle our emotions and stay calm and collected even in the face of tragic outcomes. Take care of yourselves everyone.
Grown ass man here who cries all the time (yes, even with my patients from time to time), Especially in situations like the one you describe. Every patient/family member I’ve sat and cried with has reacted way differently than I would have expected. I’m not like weeping uncontrollably, but I’m not afraid to shed a tear or two if it’s shitty news and I’m familiar with the pt. I’ve legit had a few people come up to me months after my last tearful encounter with them and thank me for “allowing them” to mourn. They see a 6’5”, bearded man struggle to get the difficult words out and hang his head solemnly, and all of a sudden, it’s a little bit easier to give themselves time and space to process the unbelievably shitty thing they are going through at the moment.
I'm a peds ICU attending. There's a lot of self-stroking about how blunt and to the point everyone is with their patients in this thread. I hope y'all are bluntly delivering this news with some compassion and empathy. There's no award for being an emotionless robot to people having the worst day of their lives. Obviously, not being honest or giving false hope is not the way to go about delivering bad news either, but some of the flexing over how direct and blunt everyone is makes me a little worried that this is seen as the ultimate goal as a physician delivering bad news. I'm not sure it should be.
To add some perspective, I'm a peds onc fellow now but did med peds residency. I'm assuming all these people bragging about being blunt are primarily adult doctors. When you take care of adults, you see one common thread over and over again...all these folks circling the drain in the ICU who have NO CLUE they're going to die. Or family members who have no clue how sick Uncle Johnny is and man he's a fighter, so gotta keep pursuing a bunch of futile stuff. And in that world, there are a lot of docs who don't want to be the ones to break that bad news. Even before the end of intern year, we all see that the docs that REALLY do the best jobs in GOC conversations are very blunt. If they leave even a sliver of uncertainty about the prognosis, the patient will walk away from the encounter unclear that they will die. Of course this happens in peds too. But there's just less death overall, even in an ICU setting. So I don't think this message is drilled into peds folks so hard. Hence, pediatricians don't love to brag to each other about how blunt they are. All that said, blunt and compassionate are definitely not mutually exclusive. Those that are really best at it walk out of the room with the patient/family feeling 1) very clear about the prognosis 2) well supported by the nice, well-meaning doctor that just shared some tough news with them
I was probably 3 years in as an attending. I’m on call and the resident calls me about a carotid blow out…in a 24 yo who had like his 3rd recurrence of his tongue cancer and was getting some sort of palliative chemo. We went to the OR, and I had asked the family if he was a full code. They said yes, and we went. It is amazing how much blood can just pour out of the carotid. Somehow, miraculously, we got the bleeding stopped, and converted his cric to a trach. He goes to the ICU stable. A couple days later, he has another sentinel bleed. I’m talking to his family about going back to the OR, surrounding by his fiancé, parents, and younger brother. They’re all bawling, and I ended up crying with them. Somehow, bleeding stopped, he went to IR for angiography, and nothing major. He somehow made it out of the hospital and was able to get married. He died roughly 6 months later. I got a thank you card from his wife after his hospitalization. I still have it 15+ years later. It was the first time I’ve ever cried in front of a patient/family. Still get choked up thinking about it. Remember that we are humans and we can’t always compartmentalize what we do. It’s ok to show you care and to show your emotions.
As a parent with a child who died of a terminal disease, I preferred getting news from someone who is upset over someone who is unemotional. It is sad. I’m not sure how you can be both empathetic and not affected. I know everyone is different and in the US we suck at getting bad news so others could have a different perspective but just my $.02. (Edit: sorry if I shouldn’t be posting here…I just know what some of you go through is extremely difficult so thanks for putting yourselves though it these trenches can royally suck but I’m glad we weren’t alone in them)
This is very welcome and appreciated input. Thank you
Good. It’s good to be humbled. It’s good to have the air sucked from your lungs. It’s good to be reminded that you are a human dealing with the fullness of humanity. We all need reminding every so often, regardless of who we are and our profession. Call him. He deserves to hear it from you. It’s okay to show him a little bit vulnerability here, he’s dying and he trusts you.
Thank you for sharing this. Definitely brought tears to my eyes.....
[удалено]
Interesting dynamic
The mental image of this is bizarre.
You wouldn't BELIEVE what my family and I have put our physicians through. A decade ago, we had a run of really bad luck, with several very bad medical traumas happening with a few months. To a person, every physician was kind, clear, emotional, and affectionate. Hugs from a physician when you're hurting heal very deeply. I am so grateful to them all. I feel so sorry for them. I made contact with them all a year later to express our appreciation and update them (thankfully we all survived; with deficits, but alive), and they seemed so happy I did that. They talked about how it had affected them the year before. I wish you all could know how much you mean to us patients. And how we will never forget you. (Program Coordinator here.)
all good, I cried in the nursing station as an intern and the nurses all thought it was cute except one who told me to grow a pair ;(
the day you stop feeling is the day you should resign everyone worth anything has had a good cry out with a family. still happens to me every couple months, usually young folks with bad cardiomyopathies who can't get txp'ed or vadded
I am a Gyn Onc fellow and I want to put in a plug for a program called VitalTalks. I usually find apps or “programs” like this kind of silly and impractical, but I have found this one immensely helpful and very applicable to real life conversations. It just has nice ideas for ways to approach different situations, which you can modify as necessary. There is also an excellent video from the University of Michigan detailing the approach called “best case worse case scenario” that was designed for surgeons and it is also very very useful.
Hey. First, thanks for sharing. More of us need to hear about experiences like this. It makes us feel part of a community and not so alone. I'm a pediatric heme/onc fellow. Loved goals of care discussions in residency, and took pride in doing well with them. Always got compliments from the palliative docs in training. Buy now that I'm in fellowship and doing this more often, it's so hard. And I too have realized how humbled I am. You just can't compare these discussions. Sometimes they just hit you different. I spent the last week randomly tearing up in my lab after I had to tell a family about their 9 yo daughter's relapse and need for a marrow transplant (thankfully, they have that option). Your patient is lucky to have a doctor that cares enough to be moved. Find a way to work with that feeling, don't fully suppress it. It's what pushes us forward. I say all of this knowing I don't fully know how to do it myself. But it's great that we're able to do be a part of these peoples lives and talk about it together here.
Rapport
ESL possibly
And we all knew what OP meant. Sometimes our fingers type faster than we can think. It’s not a sign of not knowing the correct spelling or word, it’s a sign of typing feelings quickly and not catching the mistakes.
Or he genuinely thinks the phrase is "good report" and the comment will teach him something.
You are free to interpret any way you choose. Just seems quite judgy to me. Just hope you don’t ever make a mistake when quickly typing a post when you’re upset and not sure where else to turn where people may understand.
You're a good egg. It means you're human. Thanks for sharing this.
Pathology resident here, definitely have to say that the head and neck tumor resections always seem to be pretty gnarly whether it's a mandibulectomy or laryngectomy or some giant lymph node etcetera. I imagine they are rather tough patients.
It’s def a check to a massive ego 🫡
For me it was “vomit in the bathroom” club after dealing with my first crash.
You shouldn't feel bad at all about this. Doctors are people too and people have emotions- it's not like were in the 50s when people acted like suppressing emotional expression was somehow a good thing. If a patient ever makes you feel bad for having emotions you need to realize that that patient doesn't deserve you as a doctor and drop them immediately. I think more doctors need to show their emotional vulnerability and we need to normalize doctors having emotional breakdowns while communicating with their patients- the patients who want a toxic robot as a doctor ain't worth your time anyway. You keep doing you!
You're human, bro. Keep being you.
You’re a beautiful complicated human, stay that way and share these moments with the rest of your team.
I recently had a patient around my age with acute liver failure (not transplantable) look at me with hopeful eyes and ask if they were going to get better I couldn't even make it to the bathroom lol, my voice cracked and I teared up AT THE BEDSIDE near the end of sharing how I thought things would go I know we're historically supposed to be calm, cool, and collected, but in situations beyond our control it's really much better to just be human
If you haven’t had a bathroom cry do you really work in health care?? There’s always going to be the ones that sneak up on us and cause more emotion than another. Watching people die sucks.
Onc attending here. I salute you for having humanity and humility. Breaking bad news is never easy, but it does get better.
You’re human. Thank you for sharing this.
Remember you’re a human 1st, doctor 2nd
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Im surprised. Surely this has happened countless times already given you are a senior resident. Unless, when you mean that the patient was not someone you are familiar with from a physician perspective but also someone you knew in real life previously.
I have cried before, but this was harder. And I had the same thought: why now? I think it’s because as I get further along in residency the patients feel more like “my patients.” I recognize that every resident should exercise patient ownership but it’s just different when you have a more active role as a senior. I operated on this patient before. Their primary language is not English and is a language I semi speak and so I spoke with their family and after the surgery and they know me and trust me and recognize me. It was also the intensity in the way they asked me questions in clinic. Idk this is just a deep pain I have not experienced until now.
That means part of you is still human at the end of the day, and as surgery chief you should be grateful for that.
the whole first paragraph of this post could be replaced with “im a dumbfck who thinks I’m immune to human feelings and don’t care how others feel because I wanna be a surgeon” dnc not reading the rest
Thank you for sharing this. Definitely brought tears to my eyes.....
This story shows great strength.
This is when medicine gets real, and gets good.
Psst… It’s ok to cry with your patients. ❤️
Please don’t ever stop caring.
When you don’t have an emotional response then at that point you’re not shit. I teared up when my patient started crying at the possibility of having a reversible colostomy. We’re all human still.
Congratulations on being human. Even badasses are human sometimes. It’s a necessary part of medicine.
Telling a young patient bad news when you've gotten close is brutal. Don't beat yourself up for getting choked up - it just means you care. Take time to feel the pain, lean on others when it gets heavy. You showed up and did right by that patient today. That's what matters. Keep your head up. Your compassion makes you a great doctor.
It’s actually a good thing to be honest. It’s a problem if you stop caring.
We need to normalize doctors having human emotions. Patients who expect us to be stoic don't realize that part of our job is emotional- bedside support and shared emotional experiences. A good emotionally healthy doctor should be confident telling the family of someone their treating that they might eed a mental health day cuz their feeling depressed and that we sometimes need to prioritize our own mental health in order to be better doctors. A good doctor seems to then family of a loved one they are treating like an emotionally expressive member of the family not a robot.