Difficult Conversations

28 Mar 2018

I’m a trauma and critical care surgeon. I deliver bad news. It’s not one of the perks of the job, but it’s one of the very important parts of my job. I have seen it all. The full spectrum of emotions: shock, sadness, terror, fear, rage. You name it, I’ve seen it. I say this because I thought I understood it….the emotions, the feelings my patients’ family members have when I deliver bad news. I’ve been less than gracious in my mind when I see families “falling out” at the shock and horror of losing a loved one. Everything changed September 2, 2011.

I will never forget the phone call from my brother-in-law. As I raced to the hospital across town from mine, I cried. Something was seriously wrong with my sister. My car literally ran out of gas before I could park in the emergency lot (yes, I’m one of those people who drives a day or two with the gas light on if I’m going short distances). I ran inside to find her intubated, hypotensive, pupils fixed and dilated. At that point I knew, but my parents didn’t, and they had a 6 hour drive to get here. Her team worked tirelessly to keep her with us until our family could arrive. I was with her when she died. I was alone with her and I became that family member, the one who was falling out. Nothing prepares you for that intense grief. I knew it was coming, yet I couldn’t handle the reality of it.

That experience, while grueling, made me a better doctor. I am able to relate to patients and their families on a different level than before. I am able to have those tough conversations with a new perspective. The point of this is: end of life situations are hard. They are even harder when the situation happens suddenly and unexpectedly. Many families have not had the discussion to know what their loved ones would want. As surgeons, we have unique perspectives and should be having these conversations with patients and their families.

My perspective clearly comes from one of trauma and critical care, but many surgeons are caring for patients that may benefit from discussions regarding serious illness planning. We know that 55% of first time end-of-life discussions in a large group of cancer patients happened while the patients were in the hospital and many of these conversations happened in the last 33 days of life.1 We owe it to our patients to be honest and to have conversations beyond the mortality risk from the operation. We owe it to them to discuss their overall prognosis and how what we are doing fits into that prognosis. We need to focus not only on diagnosis and treatment, but the human concerns associated with end-of-life discussions as well. For those of us who feel untrained or uncomfortable with these conversations, there are checklists and resources available to help guide our discussions, as listed here:2,3

At the end of the day, we all want the best for our patients and there is good evidence that suggests open, honest communication about end-of-life scenarios, even in the surgical population, is beneficial.

The American College of Surgeons has published the document Surgical Palliative Care: A Resident’s Guide available at: https://www.facs.org/~/media/files/education/palliativecare/surgicalpalliativecareresidents.ashx

  1. Mack JW, Cronin a, Keating NL, et al. Associations between end-of-life discussion charcteristics and care received near death: a prospective cohort study. J Clin Oncol. 2012; 30(35):4387-4395.
  2. Bernacki RE and Block SD. Communication About Serious Illness Care Goals: A Review of Synthesis and Best Practices. JAMA Intern Med. 2014; 174(12): 1994-2003.
  3. http://www.talkaboutwhatmatters.org/documents/Providers/Serious-Illness-Guide.pdf

Stepheny Berry, MD is an Assistant Professor of Surgery at The University of Kansas Health System. She completed her general surgery residency at Henry Ford Hospital in Detroit, Michigan and her surgical critical care fellowship at The University of Tennessee-Memphis. When she’s not taking care of patients, Dr. Berry is passionate about animal rescue, family and KU basketball (not necessarily in that order). You can tweet her @Dr_Stepheny.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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