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It was my first rotation of third year, and I had never been
more excited. I was fresh out of the gate, as they would say, ready
for anything. I was thrilled to finally use all the information I
had been learning for the past two years. I couldn't wait to see
the patients, and I was enjoying every minute of it. Every day I
was learning something new which was heightening my experience.
Early one morning a woman in her late sixties came to the office
for her usual annual exam. I grabbed her chart and called her to
come back. I introduced myself and proceeded to take a thorough
history. In the review of systems it was discovered that the
patient noticed a sore on her right nipple that had not gone away.
She had tried over-the-counter fungal ointment but the sore
persisted. I took note and proceeded through the rest of the
interview. After presenting the patient to my attending, we felt
that it was important to examine the lesion on her breast. After a
thorough bilateral breast exam my heart dropped to my stomach.
During the exam we had palpated some axillary nodes on the affected
side of the lesion. From what little experience I had I knew that
was concerning. As my attending explained our plan to the patient I
couldn't help but think about what I had discovered. I tried to
remain expressionless but internally my medical student mind was
racing. I kept thinking to myself that I was glad that I took a
thorough history. What if I had missed this? I got it together and
focused on watching my attending handle the situation perfectly.
Our patient was informed of the possible causes of this
presentation and was reassured that we would do all the necessary
tests to come to the right diagnosis.
A week went by and I was doing my normal tasks as a medical
student when my attending called me to his office. I sat down and
he said, "Norm, we got the results of our patient's biopsy." He
handed me the pathology report, and I immediately recognized the
patient's name. I scrolled through the rest of paper, and as I read
my heart sank to my stomach once again. At the bottom of the page
it stated, "final diagnosis: invasive breast carcinoma."
As quickly as I had read the report my attending said, "Our
patient is coming in today and I would like you to discuss the
results with her." He paused and went on to say, "This encounter is
vital for you as a student to experience. You will learn more today
than you probably will this entire rotation." I could not believe
what I had just heard. A feeling of inadequacy fell over me. I
asked myself how I would be able to do it. I asked the attending if
he really felt I was the right person, and he replied with a
confident, "yes." He went on to coach me on how to approach this
delicate subject. We discussed how to properly deliver news of this
magnitude. Before leaving his office, he once more reassured me
that I could handle the situation.
When the time came to call the patient back in, my attending was
right by my side. When we entered the room, I could tell that the
patient was worried. My attending broke the ice, and we exchanged
greetings. I continued by saying, "As you know we are here to
discuss the results of the testing you just had done." I paused,
and she quickly replied with, "I have cancer don't I?" A whirlwind
of anticipation filled within me. What do I say now? I went right
to the point, responding with, "The results came back positive for
breast cancer. Today we would like to discuss with you what we are
dealing with and our options for treatment." As the patient
processed the news her eyes started tearing up. She was now visibly
distraught. I gave her a tissue and reached out to hold her hand. I
told her, "We will fight this disease together." With my attending
standing near me and filling in the gaps as they lay we discussed
with her our detailed plan of action. We answered her questions and
informed her of other options that would help during her treatment,
such as support groups. As she left the interview room, she
expressed her gratitude. I escorted her to the lobby. On the way
she said to me, "I know that wasn't easy but I just wanted to thank
you for everything." I thanked her for her bravery and said
On my way home that afternoon I found myself reflecting on my
encounter with this patient. I thought about what my attending had
told me earlier in the day. This experience was essential for me. I
faced my anxiety of delivering bad news and I was able to curb the
emotions that came along with it. As human beings we naturally want
to sympathize with someone who is saddened. What I learned from
this encounter was that my patient was actually looking for someone
who was not as scared as she was. I believe that this is probably
true for most patients who are receiving news like this. They look
to us for courage. Walking with them through uncertain doors and
standing next to them when the future is uncertain gives them the
courage to press on. This experience helped me grow, and is one
that I will never forget. I encourage each of you to take on the
challenge of breaking bad news when a supervised opportunity
arises. Although the conversation will be a difficult one, you may
surprise yourself by finding your courage just in time to share it
with the person who needs it most.
Norman L. Beatty
Ross University School of Medicine
Class of 2013
July 2012 Issue of IMpact
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