The Difficult Balance of Giving Bad News

The medical logic is perfect: the patient has suffered a catastrophic brain injury, and it is unlikely that she will ever wake up again; my other patient will likely need the ventilator for many more days and will need a surgery to connect the airway to his neck, called a tracheostomy. To me, as an ICU doctor, it is completely logical and rational.

To a loved one, however, those words are absolutely devastating. Telling a daughter that her mother will never wake up is just as catastrophic as the initial brain injury. Telling a mother and father that their son will need to live on a ventilator for weeks, if not months, is equally catastrophic. As the clinician giving this news, it is sometimes hard to see how catastrophic those words truly are.

On the one hand, I need to be objective and rational, not taken in by the emotion of the moment, so I can explain the medicine as cogently and completely as I can. It is important that I give my patients’ families accurate facts and data, so we can all make the most informed medical decision possible.

On the other hand, when I am totally enveloped in the medicine and its logic, it can be hard to see why what I am saying is causing so much distress on the part of the family. “What is so hard to understand or accept?” I may ask myself. “The medical logic is absolutely concrete and…