Monday, 4 February 2008

The Grim Reaper Comes to Town

Today was communication skills part 2 and today, in 3 hours, we learnt how to talk about death. In fact, we learnt how we talk to a wife about her dying husband. I was excused from the simulated patient experience this week having done it last week although a sadistic little bit of me wanted to have a go. There were 3 scenarios this week all based around Mr and Mrs Prostate, unfortunately Mr Prostate was dying of metastatic disease. The first scenario, Mr Prostate had just been admitted after his GP had failed to control his pain adequately. His wife had hugely unrealistic expectations about her husband’s condition and was busy planning a 2 week break in the Lake District whilst poor Mr Prostate was actually dying. His wife wanted to speak to you, as the F1 to see what you were doing for him. The second scenario was based a couple of days later and Mrs Prostate wanted to speak to you about her husbands worsening condition. In the final scenario, a day later, Mrs Prostate had come to collect the death certificate and wanted a word with you.

This is the first ‘teaching’ that we’ve had on dying and death and to be honest, although I was initially quite skeptical, it was quite useful. The simulated patient/actor was very good indeed she made the experience quite believable and I’m almost embarrassed to say it was quite moving at times, I dread to think what it’ll be like for real.

Several important things came out of today’s communication skills. Firstly the potential mismatch between relative’s expectations and reality. It is very easy to skirt around the topic of death and not approach it, but this can reinforce unreasonable expectations. The student who dealt with the second scenario where Mrs Prostate was very upset and at times angry, tried exceptionally hard to hint that Mr Prostate might becoming towards the end of his life, but the patient was left confused. The student felt unable to mention the words dying or death, which is perfectly understandable, after discussion the group decided it was important to try and prepare the relative for the worst, even if that meant discussing death. I believe the phrase was “hope for the best, prepare for the worst” and I think that sums things up quite well.

This post is rather emotionally numb, not at all like I intended it to be. Today’s situation wasn’t real, but it happens every day in real life. In 6 or so months time that might well be a real situation I find myself in, I can say for certain that I’m not looking forward to that! Although 3 hours is an extraordinarily small amount of time to spend on such a topic, I do feel ever so slightly more prepared for such an eventuality in the real world, it won’t make it any easier though.


Ms-Ellisa said...

It must be one of the hardest things to do, telling someone that they or their loved one are dying.

Personally I fear the moment that I will have to deliver such news myself.

Jessica said...

Have u try the Medical online bookstore

I get all my textbooks for this semester from this bookstore. All are brand new textbooks and half price discount textbooks.

Good luck and wish some help.

hehe ^_^

Anonymous said...

Three hours is nowhere near enough time to prepare you for communicating with a dying person and their family. Having just been through this experience with my sister, who died from adenoid cystic carcinoma, aged 39, i can concur that hospital medics do not have the first idea how to support someone who is dying (we are both nurses and we had to take the lead in raising the subject and planning her care). However i have nothing but admiration for the hopsice consultant and team. You (medics)should be taught to refer all patients who will require palliative support straight to a palliative consultant - ideally through a hospice. Care of the dying is a specialism equally as challenging as surgery or paediatrics, but sadly hospice funding is woefully inadequate (less than 50% funding from NHS). We are all going to die and for a lot of us it will not be quick and sudden, but slow, and without specialist managment, painful, undignified. I hope some of your peers are considering palliative medicine as a career choice, with the aging population more and more palliative consultants will be needed.