Bad News Bears

This week's guest columnist is Dr. Claire Ronkartz, a family practice resident at University Hospital and Clinics here in Lafayette. In the first week of medical school my class was split into groups of ten students with a professor.  The groups met weekly, between anatomy lessons and biochem lectures, to discuss doctor things like "how to use an otoscope," and "how to scrub into a sterile OR."  These were fun little breaks from the monotonous all-day lectures and hours spent studying. One of these forums was a little different. It was on "Breaking Bad News," how to tell patients something terrible, like that they had cancer.  We role-played scenarios acting as patients and doctors, nervously laughing, as we practiced giving each other bad news.  We learned tips like "before giving bad news to a patient, turn off your phone," and "don't sugar coat anything, tell the whole truth," and "allow the patient ample time for questions."  It was an important exercise, and one we would revisit throughout training. Unfortunately there's no handbook to prepare parents for receiving Bad News.  If only we were discharged from the hospital with our new baby in one hand and an indexed, tabbed, parenting handbook in the other.  I yearned for such a handbook when I was 20 weeks pregnant and on the parent side of Bad News.  My husband and I learned that our baby would be born with a complex heart defect that would require surgery.  Suddenly we were no longer researching car seats or deciding what color to paint the nursery.  We were talking about at which hospital to deliver this sick baby and planning for open heart surgery. Thankfully, in the Pediatric Emergency Department, the bad news usually goes: "Gage did, in fact, break his arm," or "Liza looks like she has Hand, Foot, and Mouth disease, so no daycare for a few days."  Occasionally the bad news is more serious, and here are some tips I've learned in my own experience. When presented with bad news, the most important thing to do is to select a "captain of the ship" for your child's care.  You are wading into very unfamiliar and rocky waters, and you'll want a doctor experienced in those seas.  When our baby was diagnosed with a heart defect, that doctor for my husband and me was our cardiologist, Dr. B, who could write a chapter on "breaking bad news." When Dr. B made the diagnosis he made sure we were the only family in the office.  He sat us down, took out a sheet of paper, and drew her defect.  Then he wrote down two lists: one with an explanation of the defect, and the second on "where to go from here."  It was our plan to refer to when we were confused or stressed.  Finally, we scheduled an appointment in a month to discuss further questions.  No matter what, you will need a good, reliable captain for the journey ahead. Another tip: resist the temptation to troll internet blogs; avoid late night Google searches.  My mom always told me in high school: "Nothing good comes from being out on the road after 10 pm."  The same goes for Google!  Don't get me wrong, there's lots of good, useful information out there, but there's a lot of bad information and horror stories too.  And while knowledge is power, I refer you to my first advice- ask your captain to give you good information and websites so you can properly educate yourself and advocate for your child. Try to meet other families facing similar diagnoses.  These days, social media is a wonderful tool to find support groups and families who are walking your same path.  Meeting others and knowing that you are not alone is a huge help.  You'll be surprised how many locals are in a similar situation. Lastly, have a support system at home.  Lean on your spouse, family, and close friends.  If you live away from family, find a counselor, priest, or minister.  It's imperative that you pay attention to your own needs in order to be able to take good care of your children.  And then when things go well like they did for us, you can celebrate good news!