One of the hardest things we do as physicians is breaking terrifying, devastating news to our patients and their loved ones. In my palliative care practice, I am honoured to care for patients with life-limiting diagnoses—whether it be cancer or not—over weeks, months, and sometimes even years, in the clinic, hospital, hospice, and community. This poem explores how the strong physician-patient relationship that continuity of care builds affects how we break bad news, and how this has never truly grown easier over time for me.
I consider turning away
In many years of medical training
I’ve given awful
terrible, life-altering news
in hallways and hospital rooms
emergency departments, clinics
over the phone
in the middle of the night.
It never gets easier.
Today
on an icy pit of winter Tuesday
I see your beaming
well-worn, familiar face
in clinic.
In that moment I consider turning away
from the computer
from the words
devastating the page:
widely metastatic disease.
Instead
I reach through the wall
shattering the emergency glass
and pull you through, from the before into the after.
Over time
my hands have developed thicker skin
calluses
that split, scar, and bleed.
On this Tuesday I am thankful
to still feel
the devastation my words can cause
no matter how gently delivered.
To not be numb to this power.
Footnotes
Competing interests
Dr Hollis Roth receives compensation for teaching Learning Essential Approaches to Palliative Care at Pallium Canada in Ottawa, Ont. Dr Roth has worked on a pilot project in palliative care and in a heart function clinic at Chinook Regional Hospital in Lethbridge, Alta, which has received funding from Boehringer Ingelheim. She sits on the Medical Advisory Board of OneDay Dreams, a national nonprofit organization dedicated to fulfilling end-of-life wishes for terminally ill adults in Canada.
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