Having to tell someone their family member is terminally ill and unfortunately not going to live past a few months is one of the very daunting tasks doctors are expected to perform. Considering real life isn't a "Grey's Anatomy" episode, I could only imagine the feels when there is no director there to yell 'cut' and end scene.
Doctors everywhere, thank you. You all are the real MVPs.
(Content has been edited for clarity.)
A Hopeful Candidate
“I’m not a doctor but a nurse. I had a patient who was 31-years-old. We admitted her with weight loss, dehydration, intractable nausea, fatigue, and abdominal pain. Her mother had just passed three months before her admission due to colon cancer. We diagnosed her with uterine cancer. Though I didn’t give her the initial diagnosis, as that is the doctor’s role, I was the one present with the family trying to answer questions about the options and what to expect.
She was initially a hopeful candidate for surgical removal of the tumor, and it was tough trying to help her cope with never being able to have children. Her boyfriend couldn’t handle the situation and left the relationship. I have no idea what their relationship was like or how long they had been dating, so I don’t judge him. It was just so hard to watch her grappling with the loss of her mother, the loss of hope for having a baby, then feeling abandoned by her significant other.
We then found out that the cancer was stage 4 and surgery was no longer an option. We tried chemotherapy, but this was an aggressive and rapidly progressing disease.
I had to explain to the family how the metastasizing tumors reaching her brain caused her sudden dementia and confusion. She was in the hospital for about four months before she passed.”
Moments Of Lucidity
“I’m a neurologist and psychologist at a hospital (I get the title doctor from having Ph.D., if that matters).
The most emotional conversation I’ve ever had to have with any patient was with a lovely elderly couple and their daughter. The couple met in school, and had been together ever since, had one child, and were both retired comfortably. They were living in a granny flat behind the daughter’s house but were still very independent.
They had both been coming in for neurological exams, because they had been experiencing some memory loss, and we were keeping track of their progress with various tests.
Long story short, I had to tell this couple and their daughter that they were both exhibiting the early signs of dementia and that it was likely going to get worse over time. Thankfully they had periods of lucidity still, and so we were able to set up some management plans for them, but the daughter looked like we had just ripped her whole world away.
I’ve never seen someone in so much pain be so strong, she was confident and supportive and reassuring them, but I could see that she just wanted to break down right there.
She would come back every few months for counseling, we run a separate clinic too, and I kept seeing her after the couple passed away, and she was doing much better.
From having a parent with dementia myself, I could only imagine the pain of having both parents succumb at about the same time.
It’s so hard to see patients come in who are that far gone. Most that I see are in the earliest stages, but we’re so far away from any real interventions, it’s hard to give anyone any hope.
The moments of clarity can be the hardest and most painful for the family too, having to know that your relative knows what is happening while it’s happening, is hard.
A good friend of mine struggled with their mother having dementia. Her husband would tell her that she should ‘let her mom go’ and that she ‘wasn’t herself anymore’; which is equal parts a heartless thing to say, and somewhat technically correct (even if we should never say that).
The academic discussion about whether the person remains after the neurons that maintain the personality and memories wither is an interesting one, but has to stay academic, as loved ones are not prepared for that discussion.”
He Thought It Was Diabetes
“I have a patient I’ve seen for four years. He was a nice guy and had a couple of minor health issues. His wife had been going through treatments for cancer (then brain cancer) since I’ve met him and she was finally doing well.
He came in with unintentional weight loss about two months ago, though noted that he felt pretty good overall. He had lost about 20 pounds in two months without trying. He thought maybe his diabetes was just a bit out of control as that was how his diabetes had presented initially.
We did a workup that took a while, and the bottom line is he ended up finding out that he had pancreatic cancer. We had to bring him and his wife in and explain that while she was doing much better, he likely had a short time to live.
You’re not supposed to get close to patients or necessarily get attached, but this one was hard to do. When I saw the results of his CT scan initially I just felt dread and sadness. I just DREADED having to tell them the news. I felt horrible for them. I just wanted to be able to put it off forever. But it had to be done.”
The Damage Was Done
“I work in nursing and my colleague dealt with a lad in accidents and emergencies. He was young, just broke up with his girlfriend and overdosed. He was unconscious, but the damage was done; all his organs were failing, and there was no chance of getting matching transplants, not that he would survive an attempt to replace all his vitals in one go. He eventually came round (not sure if naturally or woken from an induced coma – I forget), realized what he had done, thanked the nurses for saving his life and chalked it up as a close call and now realized he wanted to live.
The doctor had to tell him he was going to die in a few hours. They could make him comfortable to say his goodbyes, but there was nothing else they could do to save him. He spent the rest of the night with his family and died a few hours later.
Now I’ve seen some crap, but that would probably have ended my career if I was a doctor.”
Off Days
“I’m not a doctor but used to teach lunchtime English as First Language classes at a hospital and the heart surgeon came in one day with a long face.
He had one kid come in who had no real symptoms, but the valves into his heart were narrowing so without surgery he was doomed in the long term.
The doctors decided to cut out one small valve and one big valve and transplant the big valve to where the small valve had been removed and put an artificial valve where the big valve had been.
The transplant didn’t take, and the kid died. He’d just come in from an hour of the parents screaming at him for killing their kid; they were taking it especially badly since the kid wasn’t displaying any symptoms before the operation.
And this guy was good at his job, he had awards for open heart surgery on premies and did a successful heart AND two lung transplant of a woman who had lung cancer spread of her heart, but everyone has things go wrong.
I just know I could never do a job where the off days involve people dying. I didn’t know what to say to the doctor at the time.”
More Than Dehydration
“I’m a doctor now, but this happened when I was a neurosurgery extern in LA. I was in surgery and got paged from our other hospital that a kid (19-years-old) was found unconscious in the hospital hallway and was initially brought in for dehydration and a high fever. We couldn’t leave in the middle of surgery and had him transported to our hospital. As soon as he got there, we did all the scans and exams and realized he had bled everywhere in his brain and was now brain dead (bacterial meningitis was the final diagnosis) and we had to tell the family. I spoke Spanish, and attending did not. I tried explaining to them that there was nothing we could do from this point forward. The family didn’t understand, and finally asked point blank ‘is he going to die?’ and I responded ‘yes’ and they all started screaming.
The worst position to be in is when family and friends think you can do something to help their loved one, and despite all the training sometimes it’s impossible. It’s a horrible feeling because you wish you could do something. I still think about that one kid.”
Paediatrics In India
“I grew up in the U.S. but went to medical school in India. A few years ago, during my pediatric rotation of internship, I had an 11-year-old patient with worsening seizures and other neurological symptoms. He was from a rural village and had slipped through cracks of the vaccination program, and as it turned out, he had a history of measles as an infant. We diagnosed him with subacute sclerosing panencephalitis, a progressive and fatal complication of measles with an onset years after the initial infection. It was heartbreaking trying to explain to the parents that their child had months to a year left and that the cause was something that happened almost a decade ago.
Similarly, I was completely surprised by the growing anti-vaccination movement when I moved back to the U.S a few months later. When the Disneyland connected measles outbreak occurred, I could hardly contain my rage. Some people listen to these stories and take them to heart. Most remain obdurate, truly believing an autism connection. The rarest and most frustrating arguments I’ve had (with an own family member even) are with those that don’t want to because they don’t believe a government should tell us what to do. Despite some being from a generation in the U.S where they remember older friends and family having polio, or grandparents dying of smallpox, they have some reason or another to not ‘believe’ in vaccines. I find that a lot of people just have short-term memories regarding these things. It’s been a generation or two since the U.S has had the scars vaccine-preventable diseases leave behind. In India, those stigmata, like polio paralysis are still very apparent.
On another note, one of the attendings during my emergency rotation has a son who has autism. It was an absolute pleasure to get to know such a wonderful young man. There isn’t much concerning public education and other programs for autism in India, but it is growing. His mother is incredible in being a part of that, sharing his art and shining a light on the notion that it isn’t an affliction that should be viewed negatively, but more like another operating system that views and interacts with the world differently.”
Tumors Of The Eye
“My dad is an ophthalmologist (eye surgeon). He always goes back to the same experience.
Retinoblastoma is cancer that mostly affects children. You can detect it if the usual ‘red eye’ in flash photos is white in one (or both) eyes. It can be hereditary. Treatment is possible, but if not caught early enough, the only way to try to save the patient is to enucleate (remove) the eye.
When he was a resident, there was a 5-year-old girl in the hospital. She’d had her left eye enucleated a few weeks prior. In a follow-up scan, they found tumors in her right eye as well and had determined they needed to enucleated it as well.
She came out of that surgery with her head bandaged up. Her parents were by her bedside when the nurse removed the bandages. Once they were off, this five-year-old girl sat up, and just said:
‘Daddy, I can’t see you.'”
According To The CT
“I didn’t tell the diagnosis to the patient, but diagnosed it yesterday on his CT scan, and it has weighed heavily on my mind. The patient had stage IV colon cancer, his colon perforated, and infection from the bacteria in his colon spread to his private, and there was likely also infection around his aorta. They took out the colon and the private. Amazingly, he was discharged from the hospital.
He came back a few days ago. Repeat CT showed the infection caused a huge aneurysm (dilation) of his aorta, and it is leaking blood. So basically it is going to rupture, and he will die almost instantly. Or, maybe it slowly leaks out, and death happens more insidiously.
I can’t imagine being told you have a ticking time bomb inside of you and may have hours, days, or MAYBE weeks.”
A Optimistic New Mother
“I had a patient whose newborn baby wasn’t expected to live. The baby’s condition was a surprise to the mother and her family. I got to sit in while the doctor tried to explain that the baby was doing poorly. The mom and family remained optimistic. Fast forward to a few hours later and the doctor returned to tell the patient, in a shared room, that her baby was doing VERY poorly and wasn’t expected to make it. The doctor was frustrated that the (very young) mother wasn’t reacting the way she wanted. The doctor told me that she was at the end of her ‘bag of tricks’ and was upset that the mother wasn’t responding to her sudden news (granted this poor girl JUST gave birth to a medically unstable baby that she had no forewarning about). I ended up having to try to talk the mother into seeing her baby, knowing basically nothing other than the prognosis was very poor. It was horrible all around.
The way the doctor approached the situation, the way the mother was too young and optimistic (and said things like she’ll see him later). All the while trying to remain as neutral as possible while attending to four other mom-baby pairs that were happy as can be. I believe the baby ended up passing in the next couple days.”
The Impact Of Your Words
“I’m obligatory and not a doctor, but I’m in my residency. I was shadowing a doctor for a week. We come up to a room with a child and his mother waiting, the doctor didn’t tell me anything about the situation, so I was going into the room blindly. The doctor walked in and asked the mother to come out in the hallway with him. She came out with us into the hall, and the doctor let her know the child (7-years-old) had an advanced brain tumor and isn’t likely to make it another three months. She dropped to the floor and started crying. It was freaking heart-wrenching.
I later asked the doctor why he didn’t let me know what he was going to do. He said a big part of this career was learning the impact of your words. You may never be told you have three months to live, but if you can feel just a little bit of the shock, horror and pain your words inflict on someone, it will truly make you a better doctor.”
All Black Vision
“I’m an ophthalmic assistant. Recently, we had a woman, in her late-60s, referred to our eye clinic from the Emergency Room. She was a pleasant lady. The woman stated she had a dry eye condition, and her dry eye had made her vision gray and blurry for the last few weeks. She had been increasing her artificial tear use, but she woke up with ‘all black vision’ in one eye. As she was telling me this, I know there was no way dry eye causes these symptoms. She was lucid but thought she needed artificial tears. She faithfully had her eyes checked every year by her daughter who’s an optometrist.
Her diagnosis: end-stage glaucoma. She was permanently blind in one eye; the other eye had permanent peripheral vision loss. The cupping of her optic nerve should have been an indicator of glaucoma years ago. Her eye pressure on the now-blind eye was above 60 (normal pressure is below 25). It could’ve been diagnosed, and treated, and likely never hit this point. People don’t FEEL glaucoma. To the patient, this seemed sudden, but it’s a process which takes time, usually several years for her type of glaucoma.
As the doctor was explaining the reason for vision loss, it was sad to see this sweet woman in denial, disbelieving, and planning on a second opinion with her optometrist and daughter. Pretty sure she was still just hoping to get better artificial tears to clear the black vision. The lady’s whole life is now going to change; she won’t pass a DMV vision test, lose her depth perception and is now considered legally blind. I can’t imagine the guilt the daughter will have for not catching the condition, and I’m trying to figure out WHY not. Maybe they only were checking for glasses prescription every year, and not dilating to look at eye health?
Anyway, it makes me very sad to think of them at future family events.”
‘She Was Unnaturally Yellow In Complexion’
“I had a lady follow up with me in the office after being discharged from a different hospital system without a diagnosis as to why she was jaundiced (being unnaturally yellow in complexion). I knew something terrible was brewing, so I ordered a STAT MRI of her liver and found a cholangiocarcinoma (tumor of the bile ducts) in a location which was incurable. I had her back in the office within 48 hours and told her the news as gently as I could. She just said, ‘this must be hard for you.’ I just lost it and started crying immediately. I couldn’t believe she thought of me at that moment. We hugged and cried for a while, and she was appreciative.
She was sent on to oncology. She ended up opting for palliative care to maximize the quality of remaining time and passed away after three or four months.”
“I Never Found Out What Happened To Him”
“I work in physical therapy. We had a semi driver who had a spinal chord injury from a driving accident. His parents disowned him because he was gay, wouldn’t help with his medical bills or let him stay at their house. He had lived out of his truck and was essentially homeless. We tried to keep him approved to stay in the hospital as long as possible, but eventually, we had to tell him we couldn’t keep him there anymore and it broke everyone’s heart. And because of his injuries, none of the homeless shelters could take him because they didn’t have the facilities to accommodate him. I moved to a different unit shortly after so I never found out what happened to him.”