Part of being a medical student, and doctor, is the ability to reflect and learn from situations you find yourself in. I have come to realise how important it is to actually sit down and do this. I used to think it was such bullshit the time I would have to spend filling out my Reflective Diary. I looked at the task as such a chore. But I was wrong.
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Recently, I was in a situation with a patient who had just been told that their previously localised liver cancer had now in fact spread to their brain. In the chaos of the morning ward round, the doctor explained to her the extent of the metastases and then left to continue seeing patients, asking myself and my fellow medical student colleague to stay behind with the patient. We sat with the patient in silence for what felt like ages. I didn’t know what to say. What could I say? The patient broke the silence first.
“How long do I have left?”
It was the question that no doctor can answer with any real certainty, and one that a medical student dreads.
I found out later upon discussion with the doctors that the ball park figure at best was a year; at worst, a few months. Of course at the time my response was, “I’m sorry, I just don’t know“.
We then sat with the patient for maybe twenty minutes, mostly in silence. I got her a glass of water; I knelt down next to her and held her hand. She cried. As a medical student, you learn how to break bad news. You get taught a structure in which you give the patient “warning shots” before you hit them with the bad bit. However, no one teaches you what to do after it’s done. No one tells you how how to react in that moment where someone finds out they will die. I felt helpless. There was nothing in that moment that I could’ve said or done to make the patient feel better. So I didn’t. We continued to sit in silence and I let her take in the news. It was at this moment that one of the doctors came back into the bay. She offered to call her husband and ask if he would come in. The patient agreed and we left the bedside to let her take the call privately.
After we had left the patient, we went for a coffee with the doctor and debriefed on the whole situation. We talked it out. Discussed our feelings and all that so-called “bullshit”. It’s not bullshit of course, it’s actually really important to talk about these things. To know that it’s okay to feel utterly helpless, to know you don’t have to say anything. The doctor told us that after we had left, the patient actually wanted to pass on her thanks to us for sitting with her. Turns out us sitting there, holding her hand and saying nothing, was just what she wanted.
This day was one of the heaviest days I had had in a while. I was still thinking about the patient when I got home that evening. I told the boyfriend about it that night and cried. But I felt much better for doing so. It turns out all that reflecting they tell you do both at medical school and as a post-graduate isn’t just to waste your time. It’s to get you to learn from that situation, and know what you will or won’t do the next time it happens.