'I tell people when they're going to die'
Almost every day, I see people on the worst day of their lives. It is my job to tell them how their life will end. People feel utterly helpless and vulnerable at that moment. It is my job to take everything in hand and navigate them through the confusing maze of medical procedures in a difficult health system that has no real empathy for anyone.
I have seen surgeons take phone calls part way through the death talk and I've heard them tell people that they have years to live when they simply do not. But nothing I have seen compares to the night we had worked on a young car accident victim in the operating theatre for an hour or so. His injuries were so bad that we were losing the battle for his life and we reluctantly stopped our attempts to revive him. I followed my boss toward the visitor room, where there were 20 or so family members anxiously waiting.
The surgeon began to tell them about how their boy was terribly injured and that we had attempted multiple procedures and manoeuvres to stabilise him. He went on in an emotionless monotone for about five minutes, regaling them with technical medical jargon: "We packed his liver, resected his spleen, evoked the massive transfusion protocol," the family leaned closer and closer in hopeful anticipation, obviously concluding from this long dissertation that there was a reasonable chance that everything was all right. Then, out of nowhere, the surgeon ended with "and then he died."
A look of astonishment crossed the face of everyone. There was exactly five seconds of stunned silence before pandemonium erupted. "We did everything we could," he said to no one in particular as they huddled together on the floor, rocking and moaning.
I touched him on the arm and said, "I don't think they are listening to you any more." We quietly retreated from the room.
The most heart-wrenching patients, of course, are the ones I have previously operated on, intending to cure them. I am happy to see them each visit because it means they are still alive. With each clear scan, they are closer to a cure. Then one time, months and even years later, just when I dare to think they may be in the clear, a scan will reveal that their cancer is back. They feel no pain and are not unwell. The only sign of its existence is a mark on an X-ray. It is just sitting there, silently killing them.
Suddenly, the happy consultation must turn serious as I say, "Your cancer is back and this time I can't remove it." I feel like I have failed and it is deeply personal to me because I have got to know the patient so well.
It is so important not to beat around the bush and to say the words as plainly as possible. The word "cancer" has to be used in the first sentence and I am careful to pause to let it all soak in. That person won't hear another thing I say for a little while. The utter disbelief and distress make it impossible for people to make rational decisions. I send them away for a while so they can come back and we can talk after it has all sunk in a little.
For a few unfortunate souls, their time left on earth can be measured in days or even hours. This is the case for those with hepatocellular cancer, a hideous tumour that grows in the liver.
I told one patient I saw with this tumour that not only did he have this terminal cancer, but the tumour was so advanced that he could die at any moment. All he thought he had was a bad case of indigestion. Go home and wait. What could I possibly say to make him feel better? About an hour after the patient left my office, I got a call from an ambulance officer to say they had him in their van. His heart had stopped.
The most traumatic experience I have ever had when delivering bad news occurred when I was a surgical registrar. I admitted a 19-year-old who was a mother of a small child. She had terrible pain in her stomach. I opened her belly and found hundreds of blobs of fleshy black melanoma studded along her bowel. As I closed her up, I did it slowly, knowing that I would have to walk out soon and tell her father that his daughter would be dead within days. A few hours before this, I had seen a girl of a similar age, also with belly pain. I hadn't yet worked out what was wrong with her, but it certainly wasn't cancer.
I walked out to the waiting room to find the father of the girl with the melanoma. I had not met him before his daughter's operation and I was feeling more than a little emotional. A nurse was waiting there with a man who she pushed forward, telling me that this was the father of "the young girl". I began to tell him the terrible news and an unusual look came over his face. He was stunned and couldn't speak. He let me go on for about five minutes, looking weird, but seemed to be accepting what I was saying. I gave him a hug and turned to leave. When I reached the door, something made me turn around and go back.
"You are the dad of Miss X with the melanoma, aren't you?" I asked him.
"What?" he said. "No, my daughter is Miss Y with the tummy pain."
I had just told the wrong person that their daughter was dying. I started blubbing and threw myself into the arms of this poor man and this time, I couldn't let go. I sobbed that his daughter was fine and apologised that I'd made a horrible mistake. The dad of Miss Y was so relieved that his daughter would be okay that he went and bought me a cup of coffee and a lottery ticket. He tried to calm me down. I couldn't believe he was so understanding. Of course, I then had to face telling the actual father the news all over again.
I am always looking for the silver lining. It gets me through the awful parts of my job. Giving people such terrible news has taught me never to take anything for granted. Life goes by in the blink of an eye, so I try to pack as much into every day as possible. There is joy to find in any situation.
- This is an edited extract from How to do a Liver Transplant by Kellee Slater, which is published by NewSouth later this month.