Here’s the story of how I learned the profound honor and responsibility of giving bad news to loved ones. The fire doors to the stairwells are fairly thick in the hospital. Still, when I opened the door to the stairs on the 3rd level, I could hear a distinct sound coming from the ground floor hallway. It was something like an animal howl, loud and uninhibited but also vaguely familiar. I couldn’t make out any words or clear emotions due to the muzzle of the two-inch-thick metal fire doors. However, I knew that I did not need to walk into whatever situation was sparking this noise. The ground floor hallway contains the trauma waiting room. That’s where friends and family of those unlucky patients did all that they could do. Wait. The trauma waiting room Whenever the doors are closed to the MedStar Trauma waiting room, someone is receiving bad news. Doctors and nurses are telling patients’ families that “we did everything we could” and “I am sorry for your loss.” It is difficult news to give. And, it’s even harder for loved ones to hear. I remember that when I passed by the waiting room earlier that morning, the door was open. I saw a middle-aged woman sitting alone. The Code Yellow alert, an alert to an incoming major trauma that I had come down to investigate, was not going to be one of mine. A teenage girl had been brought in with a gunshot wound to the head. It was a Wednesday. She should have been in school. But none of this mattered to me or my job. I only enroll patients into our traumatic brain injury research who have blunt head injuries. We are not interested in penetrating head injuries. When I left the unit to go see my other patients, the commotion in Trauma Bay 1 seemed to be winding down. I didn’t think she made it. The next time I passed by the trauma waiting room that day, the door was open, but no one was inside. The chairs had been rearranged so that two chairs faced one as if three people were having a close conversation. It clicked in my head that the sound I had heard earlier was the howl of that girl’s mother after receiving the news that her child had been killed. There was a reason that sound was familiar. I had heard it before. The visit “Hey, Bethie, I’m on campus for a meeting and want to take you out to lunch. When are you free, and where should I meet you?” “Hey, Pam! I have class until 11:30 and then a meeting at 1 for a project. Can we meet at The Golden Bear Café? It’s on Sproul. Food isn’t bad, and that’s where I always go for lunch!” “That works. I’ll see you there at noon.” I slid my phone back into my backpack. Dr. Fish was very clear on the first day of PolSci2: if he caught you with your phone out during the lecture, you would receive an automatic fail in the class. I knew I shouldn’t have even checked my phone, but I was a popular girl! I needed to make sure I kept up with my texts. Honestly, I didn’t want to go to lunch with Pam. Sure, she was the closest thing I had to the family at Berkeley. Further, rarely did she make the half-hour trip over the Bay to campus. But I was less than two weeks away from my first set of college finals. I was stressed. I did not have time to waste on trivial matters like eating or relationships. Then again, Pam and Dennis were basically my aunt and uncle, and I was thousands of miles from home in Chevy Chase, MD. It was not like I had many family commitments out at Cal. I guess I could spare time for lunch. Waiting for Pam I walked from Wheeler Hall to The Golden Bear Café (GBC for short). The sky was brightly overcast that Tuesday, just like always. It was in the 50s and foggy, and some leaves were still on the trees. Rotund squirrels were digging through the trash cans. In my opinion, everything was pretty damn near perfect. I was wearing my usual uniform of jeans, scuffed Frye boots, a white V-neck, and an effortlessly cool thrifted cardigan. In reality, I put a lot of effort into looking so effortless, but this is one of the accomplishments of a freshman college girl. I was starting to get annoyed. It was already 12:30 with no sign of Pam. I needed to get moving if I was going to make it on time for my Chemistry research project meeting. I was just about to text that I was leaving GBC when I saw her walking through Sather Gate with Dennis. Huh, she didn’t mention that Dennis was coming too. Dennis is my mom’s cousin, and Pam was my mom’s best friend in college. I guess it worked out pretty well when they got married. I was also close to their daughter, Sandra. She was the same year as me in school. At the beginning of the year, we joked that Sandra and I switched families for college since she was only a 20-minute drive from my parents at Georgetown University. My mom also said many times that if I was going to be so far from home, it made her feel better knowing I had family nearby in case of emergencies. Giving bad news I waved them over and gave both of them a hug. Dennis took one look at my outfit and said, “you’ve turned into such a hippie.” This made me smile even bigger. Hippies are cool! That means I’m cool! Look out world, new and improved Beth was making her way onto the scene. But it was then that I noticed something was a little bit off. I had tried to make eye contact with Pam, but she shifted her eyes behind her sunglasses and wouldn’t look at me. It was also definitely not sunny out. Why was she wearing sunglasses? I turned to Dennis about to ask what was up when he put his hands on my shoulders. “Beth, Charlie had an overdose.” Ok, this is ok, I thought in the ensuing two-second pause. He’s probably in a coma or in the hospital, but he’s ok. I’ll just go home for a week and be back in time for finals—nothing to freak out about. “And he died.” What? No, he didn’t. He’s 21. Or wait, he’s 20. His birthday is next week. I haven’t bought his present yet, but I swear I was going to get him something this week. They’re wrong. This isn’t right. My brother isn’t dead. You are wrong. He’s not dead I looked at Pam again and realized that she was crying. Dennis was crying too. I felt a slight sting in the corners of my eyes. “You’re wrong. He’s not dead.” They needed to know this. This was not possible. Dennis tried to hug me, but I pushed him away. I didn’t need a hug right now, especially not from him. Why would he joke about this? This wasn’t a funny joke. He could stop now. “I’m so sorry, honey,” Pam choked. She looked like she couldn’t stand without holding onto Dennis. My eyes were getting blurry. I wasn’t one to cry that often, especially not in public. I wasn’t even sure why I was crying because I knew this wasn’t true. Why are they saying this? My wrist reflexively went to my face as I felt the tears run from my eyes. My sweater sleeve came away damp. He can’t be dead “He can’t be dead,” I kept arguing. My breath started to shorten as the sobs swelled. I focused on my tuna melt and saw that I had only eaten a few bites. When I swallowed now, it felt like my throat had narrowed to half its size. “Let’s call your mom,” Dennis said. I could call my mom? That was allowed? Dennis handed me the phone, and all I heard was my mother howling. I had never heard a sound like that before. It was guttural. I don’t know what I did with the phone. It was then that I broke. People sometimes use the term “broke down” to describe their reaction to events like this, but I just broke. I was both totally inside myself and unable to think; I just kept wiping my face because the tears kept coming. Somehow, I wound up on the ground, sobbing. I was in the middle of the busiest part of campus right as classes were changing. I only saw one person looking at me before I went back into myself. And, then, I was in the back of Pam and Dennis’ car. I could call a friend? Pam asked me which friend I wanted to call. I could call my friends? I mean, I get that I could call my mom, but isn’t this a family thing? Don’t we keep things like this to ourselves? We never told anyone when George or Charlie were in rehab. Isn’t this the same thing? Pam told me I could call my friends, so I looked at my most recent calls. There was the call to Mom, and then the next call was from Alexis Newman the day before. Right, Alexis is my best friend. I called her. “Hey! What’s up?” Alexis said. “My brother died,” I wept. “Where are you. I’m on my way,” she said immediately. I think I said something about being in a car with my aunt and uncle. And then, I just cried. She kept asking me what had happened, but I didn’t know. What did happen? Dennis said it was an overdose, right? I don’t know if I told her that. I think I just cried. Giving bad news: My mom’s story My final memory of that extended day was seeing my family at Dulles baggage claim. Pam told me that they were coming to pick me up, but I didn’t know what to expect. I mean, it wasn’t my whole family picking me up. But I guess it would never be my whole family again. We were officially broken. When I saw my mom, it didn’t look like my mom. Yes, I recognized her. Of course, I did. But when did she get so small? She saw me and made that sound again. As I hugged her, I could feel that she had shrunk to the size of a child. I actually felt like I might break her if I hugged her too hard. Her frailty shocked me more than the gaunt look on my dad’s face or the anger shown on my brother, George’s. As we all walked down the corridor to leave the airport, my mother turned to the wall and wretched. Vomit sprayed all over the floor, but she just wiped her mouth and kept walking. We would never be the same. The present-day – medical school “I just don’t get what they won’t understand. If you walk them through and clearly explain everything that happened to the patient and why they’re not going to recover, how would the patient’s family not understand that?” Edward [1] made that comment in our class on the ethics of end-of-life care. It was part of a broader discussion on how to talk to our future patients and their families about the end of life. It also included an exploration of what our role should be as their doctor at this painful time. We had veered a bit off topic from discussing the readings. But this was always when the more interesting discussions happened in these groups. Besides, our ethics facilitator, one of the lead medical ethicists at Georgetown, did not seem to mind the direction we were heading. I replied, “I don’t think you get that logic might not work in this situation. There are so many emotions involved for the family members, and they might not even want to listen to you.” I was starting to get fired up. We were discussing how to break bad news to a patient’s family about the brain death of their loved one. As first year medical students, we had the luxury of having these theoretical discussions with our classmates and professors long before we would ever be expected to have them with patients. Try as I might, I sometimes got heated in these small group discussions. I probably came across as a little intense. However, I was starting to realize that not many of my classmates had encountered death or dying as I had. Maybe I could use the shock and grief I went through to help educate my peers. Final thoughts I thought about a surreal story my mother relayed from that day years later. She was alone in my childhood home when the police knocked on the door. They asked her “are you the mother of Charlie Glowacki”? After confirmation, they said, “I am sorry ma’am, but your son has passed.” “Passed what?” my mother asked in confusion. I think about that whenever I am told to “avoid euphemisms” when communicating with a patient. I remember that day in chunks and swathes. Little stitches of human interactions come through and stick in my mind to this day. There was Alexis’s concerned voice, the look of abject horror on my dad’s face, and the flight attendant’s offer of an extra blanket when she saw the tears in my eyes. There was also the sound my mother made. I have only heard it once since then. It was the same sound the mother at MedStar trauma made. It hollowed my bones and carelessly sliced through my chest. I hope never to elicit a howl like that. However, I know that sound will haunt me again sometime in the future, given my chosen career. I also know that it is a great responsibility and privilege to interact with someone on the worst day of their life. I will show the utmost compassion and humanity that people showed me that day. [1] Name changed for anonymity Source
