BMJ 01 September 2001 Cite this as: BMJ 2001;323:521


Breaking bad news is quite all right with me; as La Rochefoucald said, “We all have strength enough to bear the troubles of others.” However, I often try to soften the blow with the gift of music: “Your Auntie Rose is dead,” sung to the tune of “Happy Birthday”; or the gift of humour: “You have two months to live, gosh, but that was from last month, and this is February”; or the gift of charades, which is tricky, as medical terms don’t lend themselves to mime—once I had to abandon a consultation prematurely, as the patient was in pain and was nowhere near getting “You have a whopping big pilonidal sinus.”

But Joe was a tough call. We’d be gently caressing a slow air on the mandolin and whistle and then Joe would come busting in with the 12-string guitar, deafening everyone.

We’d tried many schemes. We’d file his strings so that they’d snap. We’d employ women to chat him up, but Joe was no beauty, Ireland is a small country, and we soon ran out of women. We tried fake phone messages that his granny was dead, which strangely worked the first three times. We suggested he try another instrument, which only led to the Great Accordion Disaster of 1998.

So the band decided Joe would have to be terminated. The band was being compromised, music and beauty were the real losers, and due to my medical training I was selected to break the bad news. Sticking my finger down my throat in the graceful Irish gesture of farewell, I left to do the terrible deed.

“Me and the boys were thinking,” I started, “that maybe you should …” But the words wouldn’t come out; I could see a mute appeal in his eyes. Had his senses, so useless when it came to anything musical, subliminally warned him that the knives were out? It felt like kicking a spaniel, of which I have had some experience. I scrutinised his dog-like face, the sagging skin under his eyes, the hairs growing out of his ears, the greying of his stubble; Joe was growing old and maybe beneath the bravado lay the fear of not belonging. Perhaps it was fear that made him play so loudly, just as primitive tribes bang drums to frighten away the demons of the night: deep down Joe was afraid that he was no good.

“Joe,” I tried again, “maybe you should …” and then I heard myself damn us to a dread musical Götterdämmerung, “maybe you should bring in the Accordion next week.”


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