London Journal of Primary Care 2011;4:83

# 2011 Royal College of General Practitioners

London Landscape

You shouldn’t go talking like that doctor Leone Ridsdale Professor of Neurology & General Practice, Institute of Psychiatry, London, UK

A junior doctor working on a surgical ward telephoned me at the surgery one morning. He said, ‘We’re transferring a male patient of yours to the cottage hospital today. He was admitted with abdominal pain. We did an exploratory procedure. He was full of cancer, so we did an ‘open-and-close’. The prognosis is weeks to months. The patient has not been told.’

I knew the surgeons were not keen on giving bad news, particularly the consultant on that firm. It had been difficult for me to manage a patient in the past, as he believed the problem had been sorted by the surgery. When a hospice opened locally the surgeon had asked the new director, ‘Are you killing patients there?’. I had been on a course at St Christopher’s Hospice on terminal care, and felt more able to talk about these things after. I arranged to visit the man at the cottage hospital when his wife could be there. She and I went to his bedside in a quiet room. I asked first, ‘Do you have any ideas or concerns you’d like to discuss with me?’. They were a quiet pair, solid, working class. They shook their heads. I explained that he had cancer. The surgeons had not been able to take it all out. We would make him comfortable, but I intimated his future life would not be long. As I returned to the nursing area his wife followed me. She asked angrily, ‘You shouldn’t go talking like that doctor. It’s not right. I nursed me first husband till he died. I’ll do it again. But I can’t do it if you go on talking like that.’ She told me in no uncertain terms that if I wanted her help, I should not mention it again. I visited again after he had been discharged home. He lived on a council estate by a common. It was so pleasant to walk there that I often thought that if my circumstances were different, I would appreciate a

house there myself. It was a warm spring day. He was sitting comfortably in the garden behind their council house. I guess that he and I both knew what was going on, but we said no more about the cancer. He died within six weeks. His wife kept her promise. She gave him a good death, as deaths go. He was at home all the time. Reading through his wife’s notes, I realised that this second dying caused her to experience once again the terrible sadness that had gone unvoiced during or after nursing her first husband. According to her notes, he had died from TB. In her book, she could not manage this second death, and talk about it too. I think her husband and I respected this. I had been on my courses about communicating bad news, and read and seen Kubler-Ross1, one of whose books had the upbeat title, Death: the final stage of growth. But this sort of thing is not for everyone. REFERENCE 1 Kubler-Ross E. Death: the final stage of growth. Englewood Cliffs, NJ: Prentice-Hall, 1975.

ADDRESS FOR CORRESPONDENCE

Leone Ridsdale Professor of Neurology & General Practice Academic Neuroscience Centre, PO41 King’s College London, Institute of Psychiatry 16 De Crespigny Park London SE5 8AF UK Email:[email protected]

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You shouldn't go talking like that doctor.

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