The art of giving bad news when you’re not as deep as you thought you were

One summer, I took a course called “Death and Dying”. Why? Well, I was a newbie in medicine. I was watching Woody Allen movies. And I was reading French existentialist novels. All in all, I was into thinking that I was deep. So very deep that I was nearly drowning – in all that self-importance.

As medical students, then as GP registrars, we learn how to give bad news.

As it turns out, what I should have been reading was the course description. The course did not teach any great epiphanies about death and mortality. Rather, it was mainly about how different cultures dealt with death, their different rituals and traditions. This made sense since the paper was called Anthropology 207.

Needless to say, I don’t remember much of the course, other than the lecturer saying in the last class: “I have planned out my death.”

Fortunately, he wasn’t crying out for help. He was just telling us that he had planned his funeral and how he would farewell his family and friends. I thought it rather morbid at the time. Understandable, sure. The guy was teaching a course on death and dying, it would have been weird if he hadn’t planned his own death. But it was morbid, nonetheless.

Little did I know that, nearly two decades later, I would be asking my patients to do the same.

“I am not a sick person; this isn’t me,” Sue tells me, not for the first time. This year hasn’t been kind to Sue. A lot has happened. And I don’t think she’s quite in the acceptance phase of grief about her illness. But there’s an elephant in the room and I know it’s time to address it. I just don’t know how to point to that elephant without depressing Sue even more.

“So, um, Sue…harrumph.”

I fidget and clear my throat several more times before I hand it over.

“It” is a piece of paper entitled “Advance Care Planning”.

“What’s this?” Sue asks.

I explain this is a questionnaire asking what the patient wants in the event they are dying. It asks whether they want resuscitation, whether they want to die at home or somewhere else, whether they have appointed an enduring power of attorney who can make their decisions on their behalf in case they can’t (for example, if they are in a coma or delirious), and whether they have made a will and planned their funeral.

Needless to say, as far as questionnaires go, there are more fun ones around.

“So, you want me to fill this out?” Sue asks me.

“Um…yeah. It’s just a chance for us to think about some things given…your health issues recently…sometimes it’s good to think about…”

As medical students, then as GP registrars, we learn how to give bad news.

Obviously, I excelled at it. Evidenced by my stop-start speech and the sweat running down my back.

Though, in all fairness, does this count as bad news? Sure, Sue’s health is deteriorating, but she’s not actively dying. Then again, as the protagonist in the movie Fight Club puts it: “In the Tibetan philosophy, Sylvia Plath sense of the word, we’re all dying.” That movie wasn’t known for its cheery tones, I remind myself.

Semantics aside, it seems to me that asking a patient to fill out a questionnaire to plan their end, feels the same as asking them to face their mortality. And that seems equivalent to giving bad news.

In that moment, I notice Sue’s hands on the paper next to my hands rested on the desk. And the optics of the situation do not escape me. A young doctor giving advice about mortality, to an elderly patient who is living it.

Sure, I am older than back in the day when I viewed mortality as big, uncharted territory, as a sliver of horizon over yonder. Not my problem; I was just a bystander, a tourist. It’s probably why I did that anthropology course, why I read all those books and listened to Woody Allen anxiously pontificating about it.

Then I got older. And that sliver of horizon I saw over yonder was, I realised, actually a tide. And it’s slowly creeping in. Lapping at my toes. One day, soon, I will be knee deep in it…

“Old age isn’t for cissies.”

“What?” I blink, coming up for air from nearly drowning in my own water metaphors.

“‘Old age isn’t for cissies.’ Do you know who said that?”

I shake my head. “No. Who?”

“Bette Davis. You know who Bette Davis is?”

I blank for a second, then say, “The actor?”

Ding, ding! I got it right. Sue nods with approval. “Yes.”

“Oh.” I shake my head again. My face falls. “That’s not good.”

“Why?” Sue asks.

I tell her, “Because I’m a huge cissy.”

That gets a smile from Sue. I smile too.

Somehow, I pull myself out of the morose funk. It’s all thanks to Sue. Surprisingly, she takes it in her stride. The consultation goes on, and we talk about other things we can try, to help with her pain and vertigo. Sue leaves, and I wonder what my 20-year-old self might think of that consultation. Probably would have made a big deal out of it, dramatised it out of proportion, and philosophised the situation.

Maybe I would have thought I attained some kind of great epiphany from it. Man, I’m so much older and wiser now – I would never waste my time with all that. And so much more self-aware too…

Somewhere the tide still laps at my toes, but I barely notice it.

Narae Song is a GP at Paraparaumu Medical Centre on the Kapiti Coast. None of the patients discussed in her columns are real patients, although the scenarios are inspired by real events