What I Learned from a Gastroenterology Doc about Communicating Bad News

When there's a hint of bad news to come, you might think people should be "reading the writing on the wall." Despite obvious clues, news countering a desired outcome packs a wallop to the gut. Even pessimists can be in denial.

Last month, I experienced that moment. Afterward, I stumbled around the waiting room as dazed as any prizefighter dragged up from the mat. When anyone cares about a situation's outcome, bad news IS a punch in the gut.

The messenger has a tough job to do. They must relay the truth in a way that presents a harsh reality and allows people to move forward to the next steps. It requires empathy, honesty, and room for processing.

Doctor "M" pulled back the curtain, said hello to my dad, then introduced himself to Mom and me. We responded with "Jane, wife," and "Susan, daughter."

?Here are the steps Dr. M took, a formula that has likely served him well over his many years of relaying bad news to patients and their families.

1.????? He read the room.

After identifying our relationships, he asked one very pointed question.

I watched him take a breath and a step back. Something's up, I thought.

"What do you know so far?" he asked.

I also took a deep breath. I touched Mom's leg. Mom shook her head and said, "We don't know anything, Dr. M."

He turned his back momentarily and brought out a paper from the cart.

2.????? He used a simple visual aid.

Visual aids are concrete. If you need to relay bad news, it can't be based on speculation. We needed to see and understand what was invisible to us.

Dr M held the simple diagram of the vital organs between us. Mom and I huddled over it as if it had the universe's secrets.

The doctor sketched the bile ducts, scribbled a scientific word ending in "carcinoma," and then translated it. Bile duct cancer, he said, adding that we'd have to wait for the official biopsy results, but he was clear that there was a troubling mass on Dad's liver.

3.????? He stuck to what he knew.

Dr. M never actually said that Dad was dying. But he did explain what would happen when bile ducts were blocked. Dr. M described the effects of jaundice and a shriveled liver. He also detailed why the mass was inoperable.

I got it. But did Mom, I wondered?

4.????? He knew we needed time to digest.

"What questions do you have for me?" Dr. M asked.

I felt unprepared, but my questions also felt irrelevant.

Mom asked, "What can Bill eat? He's not wanting to eat anything."

"He can't eat anything?" Dr. M said with concern.

Suddenly, I felt the need to summarize the situation. I wanted to be sure that Mom understood. I spoke, with a rising question mark at the end of my voice, "So you are saying that there's a mass on Dad's liver? There's nothing you can do?"

Dr. M nodded, explaining why surgery or a transplant weren't options. Our only choice was to go to an oncologist.

He asked if we had any more questions before leaving.

I hugged Mom, whispering in her ear, "This isn't good. This isn't good news."

"I know," she admitted. Mom needed time alone with Dad, so I called my siblings outside.

Thinking back on how Dr. M relayed this news to us, I give him a solid "A." I appreciated his clarity. We felt his empathy. He did his job in ten minutes. ??

Processing the brutal death-by-bile-duct-cancer journey that was our future would not be a ten-minute conversation. Most importantly, we began from a place of understanding the urgency without arguing against reality.

Acceptance does not obliterate hope. We are learning to acknowledge that the end is near while hoping for moments when life highlights its beauty, reminds us of the capacity of our love, and says, "Yes, there’s still time to enjoy each other."

The bad news has turned into multiple conversations carrying us forward with more strength than we knew possible. Here’s more about that.?