Breaking bad news is tough, but breaking good news sucks…

BMJ 31 October 2012    Cite this as: BMJ 2012;345:e7355

Figure1

“How long does granny have, doctor?”

“Only a few days,” I said. Granny was almost nearly dead, but I was young and beautiful and too green to know that the wise clinician always fudges the prognosis. We Irish love this kind of thing, and within minutes the message of doom was winging its way across the globe.

A few nights later and there were relatives tucked in every corner, swinging on the rafters, hanging from the roof, dangling from the curtains. Not that granny was an angel; as Jonathan Swift said, “True to her profit and her pride, she made them weep before she died. But as La Rochefoucauld observed, we are more often loved for our vices than our virtues, and the relatives had ridden in on the four winds, swum dangerous rivers, climbed huge mountains, endured biting insects and even Ryanair flights. They’d come from Boston, Singapore, Sydney, Vladivostok, all determined to be there at granny’s deathbed, to stand witness to the demise of the last of a generation, and to have a rake of beers and tell stories all night.

So I was disconcerted to find granny looking much better, quite perky even. Breaking bad news is all part of the job, but breaking good news was a novel challenge. I’d parked my car on a downhill slope, facing away from the cottage, and left the engine running, all to facilitate a quick getaway. If it proved a long pursuit, had I enough petrol, I wondered?

“I have good news,” I said, trying gamely to give it a positive spin, “Your granny’s not dying after all. She’s looking much better. Ain’t that great?”

There was an ominous silence, which, inexperienced as I was, I felt compelled to fill.

“Underneath it all, she has a great engine, heart like a lion, strong as a horse, and all,” I continued, starting to babble, hoping that this testament to the clan’s animal virility might soften the blow.

“We were told she was very ill,” accused Boston.

A rebellious muttering began. “It’s cost me a bloody fortune,” from the deserts of Sudan. “My return flight is next weekend,” from the gardens of Japan. “I’ve taken a week off work for this,” from Milan. “I knew there was bugger all wrong with her,” from Yucatan. The crowd shifted threateningly forward, as crowds do when someone has a rope, a nearby tree has a convenient low branch, and the gestalt has a lynching in mind.

“Don’t lose hope,” I said, “I’ve adopted the Liverpool care pathway.”

 

Footnote; this column, based almost nearly on a true story, received mixed responses, such as…..

 

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