Telling a Family Something They Did Not See Coming...

Cut to the Chase: General Surgery Survival Series — Post 29

Somebody promised these people routine.

Maybe in clinic six weeks ago, maybe in pre-op holding while the IV was going in. It didn’t sound like a promise when it was said, and it is one now.

The colectomy was Tuesday. His drain output changed at eleven this morning, and he went back to the operating room an hour ago.

You’ve had those four hours. You saw the drain, and you were standing there when the call got made.

They’ve had a phone call, a waiting room, and eleven seconds of watching you come down the hall. All three of them stand up at once.

So you start where you started. The labs, the scan, what the team decided, built forward so the news has something under it when it lands.

None of that reaches them. They’re waiting on one sentence, and every second you spend not saying it is a second they spend certain it’s worse.

Say the thing inside the first fifteen seconds. The build-up isn’t for them. It’s so you don’t have to say it yet, and it works, which is the problem with it.

So get out of the corridor. A hallway is where people find you, and standing in one announces this is quick before you’ve opened your mouth.

Any room with a door works. Sit down, and if the only seat left is a windowsill, take the windowsill.

Nobody remembers the chair. Everybody remembers being told standing up by someone who was visibly already leaving.

Say who you are and what your job was in that room. Then say the thing.

Write it down before you go in. Six or seven words on the back of something. I’ve read one off a glove wrapper and nobody noticed, because nobody in that room is looking at your hands.

“He had a leak where we sewed the bowel back together, and we took him back to the operating room an hour ago.”

Past tense, with a time on it. And keep the word concerned out of it. I still catch myself reaching for concerned when I want to soften something, and it doesn’t soften anything, it just tells a family what’s going on inside my head, which is the one thing in that room they can’t use.

They can’t use possible either, or may need, which move something that has already happened into the future.

It’s over. You’re reporting, not warning.

After the sentence, stop talking. Whatever you add in the next ten seconds is for you, and it costs them the part where they get to react.

That second part is where this falls apart. The quiet is unbearable and you’ll want to fill it with the plan, because the plan is the part you’re good at.

It runs about six seconds and feels like a minute. Whatever they put into it is the only real information you get about what actually landed.

And don’t trust a nod. People nod because you’re a doctor and would rather not be the slow one, and they’ll nod at the worst sentence you own with the face they’d use for discharge instructions.

Comprehension sounds like a question. If nobody has asked you one, you aren’t finished, no matter how much nodding you got.

Most of this year somebody else will be doing that talking and you’ll be standing behind them. What comes to you is the elevators.

Somebody who’s been in that waiting room since six catches you there and can tell from your scrubs where you’ve just been. The question is always some version of “but he’s going to be okay, right?”

I got asked that as an intern. Elective case, a man in his sixties, and the word routine was on the consent in my own handwriting. He came out of that room on two pressors.

His son caught me by the elevators and I couldn’t stand there and say nothing to him, so I told him his father was strong and had a good shot at this. He kept that sentence for three days. When it went the other way my attending had to sit down and take it back, and the son wanted to know why I’d said something different.

I hadn’t lied to him. I had no way of knowing whether it was true, and that family spent three days pointed the wrong way.

Reassurance isn’t yours to give yet. Whatever you hand out by the elevators is something somebody else has to come back and take apart.

It’s the same rule you were following upstairs. Report what happened, and stop.

He’s out of the operating room. That happened.

He’s strong. That’s a forecast, and forecasts were never yours.

The hallway just removes the person who would have caught you at it, and it sounds like kindness on the way out.

Give him the small true parts and the next event. Dr. Alvarez is coming to find you, it’ll be about twenty minutes, let me show you where to wait.

Every sentence in that is true, none of it was yours to give away, and he has a name and a number of minutes instead of your face to read.

Months from now you’ll be in a clinic room and you’ll hear yourself starting to say the word routine.

You’ll slow down on it, finish the sentence some other way, and the patient won’t notice a thing. Then you’ll go see the next one, because there are six on the schedule and you’re running behind.

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What to Read Next: Post 30, “I’m Already Exhausted.” Everything above asks you to sit down and stay quiet at the end of a long day. How much of that you have left by then isn’t a question about character.