Breaking bad news

He had just turned 42. I could imagine him woke up that morning as usual. Maybe had sahur with his kids or kissed his wife on his way to work. It should have been another routine day.


Who would have guess that by 7pm he would be lying unconscious in a resus room with a group of strangers pressing on his chest.

The chest pain started around 6pm with no provoking factors. Crushing in nature and "it feeels like an impending doom". The ECG showed that the heart had been deprived of its birth right --> oxygen & blood supply and that caused the excruciating pain.

Without further warning his heart rhythm went berserk: supraventricular tachy (SVT), and caused the blood pressure crashed to 70/40. We need to stabilise his heart fast. I was called by Chan, the medical MO 'on call' to assist him in doing just that.

He's a moderate size guy, not the morbidly obese type, but a smoker. He's obviously anxious while his breathing was rapid and shallow. He's definity lost lots of CO2 and his ABG might shows an alkalotic picture.

I held his wrist feeling for pulse.

"Darn it, this guy is pale and sweaty, and the BP is way too low" I told Chan.

Maybe he knew that already. He didn't looked up, eyes still looking at the ECG in his hands obviously muttering about s'thing.

I told the patient what we're going to do, and 5 mins later I put him to sleep by using intravenous drugs while Chan connected 2 paddles to his chest.

"CHARGE to 100. Everybody clear!"

ZAPP!!

The machine delivers 100J of energy into the man's heart. The patient jolted while we held our breath.


We manage to arrest the SVT, but his heart suddenly went into 'heart block'. A nightmare. Within 1 minute the rate slowed down to 30 beats/min and changed to pulseless VTach. He went into cardiac arrest. Another type of battle had begun. Cycles of defibs, CPR and drugs were given plus intubation, but there was no respond at all.

One hour later his pupils were fixed & dilated. His hands were as cold as ice. No spontaneous breathing. Nothing.

"Time of death 20:05"

As i walked away to the counter i saw Chan talking to the wife. She bursted into tears in the arms of a relative. I saw his kids. Three of them ranging from 4 - 9 years old standing in a corner. The eldest seem to understand something bad had just happen to their dad. While the youngest looked unfazed by the whole commotion. I feel sorry for them, especially with Raya coming. They have now become anak yatim.

I wish there is a proper teaching in medschools on how to break bad news. Most of us learn it along the way by watching seniors. Then you sorta develop your own way of doing it. You definitely come across lot of styles, some bad examples too.

A useful method is to emphatize with the relative, to be aware that there is a lot of sadness and confusion going on. One has to be precise/clear and avoid using vague terms. I'd seen families who were still unaware of the death even after being told that the patient had passed away.

"Take a deep breath, choose your words carefully and don't rush it" my senior once told me.

Easier said than done.