Every summer the Cote St. Luc Dramatic Society puts on the Senior’s Summer Play. This play takes a well-known musical and creates a satirical version, usually with a Jewish twist to it.
In the past few years my husband, Dave, has joined the group. He was sweet Solly Brown in “Zadies and Ladies,” and the Zaidie in “My Fair Zaidie.” Despite the initial anxiety (OK let’s be honest and call it panic) engendered by appearing on stage, he has come to love the play. It is an important part of his life and the source of a new group of friends.
As much as Dave has become integrated into the group, he is a newcomer. There are members who have been part of the Society and who have been acting in the senior’s play for many years. This includes the acknowledged queen of the CSLDS, Hannah. Hannah is 80, still bravely blonde, bejewelled and bedazzled. She is a strong supporter of the society, and her extensive contacts and friends help fill the seats and garner donations to the play year after year. She usually plays the lead. Many years ago, Hannah was my patient. She remembers the time that I reassured her that she was not dying of a combination of uterine and bowel cancer but had only eaten an excess of beets.
Four months ago, her husband of 63 years, a vigorous man in his early 80, went into the hospital with constipation and died of septic shock five days later after an emergency bowel resection.
After the first rehearsal Dave tells me that Hannah is convinced the case was grossly mismanaged, that they killed her husband with neglect, they did not care about his illness because he was old and that they should have operated on him immediately. She is considering complaints, maybe even a lawsuit. When I hear the story, it sounds to me that he died from complications of a diverticular abscess. Tragic, but not malpractice.
“Does she want to talk to me?” I ask Dave. “Maybe I can explain a little so she can let go of the anger.”
When I go to pick Dave up that evening, Hannah is ready to talk. Outside the library we sit, and I listen to her story. What I realize is that while the medical and surgical treatment seems to have been correct, the communication and explanations of the illness and treatment appeared to be inadequate.
“Not one doctor ever talked to me,” Hannah is holding back her tears. “Except some kid comes and asks me if I want him resuscitated if he dies, like they don’t think he is worth saving. I am sleeping on the chair next to him, when they come early in the morning. They poke him and prod him and go away without telling me a thing. Maybe I should have opened up my mouth, demanded to see the real doctor. All my friends with diverticulitis got better, none of them died! They must have done something wrong. Why didn’t they operate on him the first day?”
I try to explain the nature of diverticulitis and diverticular abscess and what the treatment is, but she goes on. “Then on the third day, I say to the nurse, ‘He’s not getting better, he’s getting worse.’ The nurse comes back and says they are going to do a CAT scan, but then the doctor comes in and says that they are going to do emergency surgery! Why did they wait? Why did they decide to do it now? I don’t understand. Then after four hours they come out of the operating room and the surgeon says to me, ‘Your husband is in septic shock, do you know what the means?’ I nod no,” Hannah says. “‘It means he could die.’ Then he turns on his heel and leaves, just like that. Two days later he was dead.”
After this flood of words and emotions I am overwhelmed. What a terrible and devastating experience this was for her.
Part of me can imagine what was going on in the surgeon’s head. He had just spent four hours desperately trying to save a man’s life, doing surgery that he had hoped to avoid. He now knew that he had most likely failed. He must have felt devastated.
I have taught doctor/patient communication skills for many years. There are a few quotes that are ubiquitous whenever you talk about caring for patients and families during a life threatening illness. One is: “Patients may forget what you say, but they will never forget the way you make them feel.” There is also the universal quote about malpractice: “Lawsuits happen when insult is added to injury.” It is no coincidence that the Canadian Medical Protective Association’s most suggested courses are those on communication skills. The basic technique is similar to the one you use if you are on fire. If you catch fire, you should stop, drop and roll. When you give bad news to patients and their families you should:
- Stop – take a second to give them time to absorb it;
- Look – watch them to assess the impact of the news and make sure that they actually heard and understood it;
- Listen – ask them to report back to you what they heard and give them an opportunity to ask questions and clarify.
I don’t know what happened during that admission. I was not there. I have no access to the medical records, but I do know that, for Hannah, there was not enough care taken to assure that the family was kept in the loop, that they understood and were OK with the treatment decisions. This has caused terrible trauma. I may have succeeded in talking Hannah down from “I’m going to sue them till they bleed!” levels of anger to, “I’m never donating to this hospital again!” resentment. But this has not brought closure. When we spoke, she said that she wished doctors and nurses could understand and learn from what happened.
“Would it help if I wrote a story that many health professionals would read?” I asked her. “It could help them think about how to be better with patients’ families in these situations.” She agreed that this would help her feel better.
So, my dear friends and colleagues, I am fulfilling this promise.
I hope it helps, not just this family, but others.