How to deliver bad news about a very sick child
No one wants to do this.
OK, you have seen it done badly. Maybe there’s no other way. Maybe there is no good option.
But here you are, and maybe you didn’t step forward to volunteer. Could be that everyone else took a step back. Yeah. That’s it.
Well, get on with it.
Step one. Make sure it is bad news. Because there is bad news. And then there’s bad news. So sort that out and get it clear. Hold a dress rehearsal in your head. And your heart.
Two: reconfirm that this is bad and see if anyone has some spare magic pixie dust.
3 — talk to a colleague to see if they agree
4) Have someone else set up a meeting in a good place. Bedside can work; sometimes that is the best. Or a private room with a couch, so parents can sit next to each other, in hugging distance.
5) Be 2 minutes late.
6) Prepare to take the stage. This is Performance Art. But certainly not artifice. Improvisational? Yes.
6.5) These people should know you, or maybe not. If there is any doubt, introduce yourself – slowly. Full name, title, how you know their child, what your role is in the terrifying world that is now upside the head down, on the worst day of their life. They are utterly exhausted in every facet of their beings – physically drained, thirsty but not hungry for the last three days, faint, short of breath, unshaven, unwashed, emotionally clabbered and spiritually clotted. They suddenly remember that they can’t remember where they parked the car, and it’s almost out of gas. Then give them your business card.
7) Remember, Ars longa, vitae brevis.
8) Make eye contact with each person there.
9) Shake hands, eldest first. Sometime this can be tricky, like if you are a man and the woman is Muslim, wearing a hijab, do you offer your hand? No? Yes? What if it’s a burka? What about Quakers, or Pennsylvania Dutch. Or just Dutch. Do your best. At least shake hands with your eyes and your voice – not soft, not unsure, firm and in control but still as vulnerable as the stars.
10. Sit down
11. Choose a chair that allows you to keep your eyes at the level of their eyes. A little lower would bring you a little more grace.
11.5 Tell them you have some news to share with them.
11.75 Ask them if they have any questions.
12. Tell the whole story of the child’s life that brought you all to this room on this day at this hour with this fear. This may take a few minutes. You have now become the story teller, the historian and the prophet.
12.5 Ask if they have any questions.
13. Then the news. Be clear and short. I’ll smack you if you use big words, especially medical ones. They can handle complex ideas and emotions, but your natural vernacular will throw them off a cliff. Don’t. Do. That.
14. Silence at this time is a good thing.
15. They have questions now. If you answer them, they will remember neither their questions not your answers.
16. Kleenex is good. Please offer to parents before you take some for yourself.
17. Silence at this time is a good thing.
18. A simple handout that explains the badness of the bad news would be eminently appropriate to hand to them. Your business card should be stapled to the front. If they call the phone number, you should be answering on the second ring. Within 48 hours they will lose this.
19. Let them know that someone will contact them to set up another meeting in 1, 2, 3, 4 days. Or years.
20. Ask if they have questions.
21. Point out positives. There are always positives. They will not hear this. You will, and you will deliver a subtext to your subconscious along the lines of “Really!! My God!!! How dare you insult the humanity of the moment?”
21.5) Don’t go there. Believe in positives. There is always hope, and there is always an option to find research, to look at the odds, to pray, to fight, to take a stand, dig in, get another opinion, challenge the status quo, ask more questions, eat more vegetables, try keto, and just say no, not today, we are going to breathe and we are going to find a way.
21.6) Tell them you will be with them on that road.
22) Hope that they will look at you tenderly and ask you if you have any questions.
23) You will have questions.
24) They will have answers.
Scott McLean, a physician/writer living in San Antonio, TX, is working on chapbooks of poetry, short fiction, and a book of prescriptive/practical nonfiction – First Steps to Improve Your Genetic Health. He and his wife, Paula, are upfitting a Ford Transit Trail – a Class B Camper/RV – to discover wild America.