Delivering news
08/02/16 04:39
A few months ago I was with a group of law enforcement chaplains and we were discussing the process of making death notifications to family members. I was telling about some specific resources that we use with situations when children need to be informed of the death of a family member and a colleague asked me how many death notifications I have made. I paused, uncertain of the answer. Actually, I don’t know the answer. I don’t count that way. I suppose there was a time in my life when I had the count because I could recall each scenario individually. But the years pass and memories become jumbled. In addition, part of my responsibilities include supporting families after they have received the news of the death of a loved one. There are many scenarios where family members make the discovery of the death. They don’t need to be notified. They know. But they need support after the trauma of their discovery. I’ve been involved in the classic notifications, when accompanied by an officer we knock on the door of a home in the middle of the night, wait for the occupants to wake and come to the door, ask to be invited in and deliver what may be the worst news of their lives.
I’ve stopped counting. And, for the most part, I don’t believe that the stories of the situations in which I have participated are mine to tell. They are the personal stories of families who have experienced sudden and traumatic loss and who are living lives that have more than their share of grief.
Recently I read an article by Lauren Small who, with Dr. Benjamin Oldfield directs AFterWards, a program in Narrative Medicine at the Charlotte Bloomberg Children’s Center at Johns Hopkins Hospital. Most major medical centers have programs of narrative medicine these days. Narrative medicine is an approach to the practice of medicine that recognizes the value of people’s narratives in clinical practice, research and education. Much of contemporary medicine teaches physicians to treat medical issues as problems to be solved without taking into account the unique psychological and personal stories of the patients involved. Surgeons are trained to be good at working on patients who are anesthetized, without considering the lives patients live when conscious.
We’ve all heard stories of “poor bedside manner.” Medical schools have recognized the problem and have documented differences in recovery rates and differences in medical progress when medical professionals are trained to treat the entire patient in the context of their personal and professional lives rather than simply treat disease as if it were somehow disembodied from its context.
Doctors are trained to be experts in the use of information to solve problems and they often have plenty of information.
They could learn a few lessons from those of us who serve in different professions. One of the things that I teach when working with new chaplains is that there are plenty of circumstances when people are not able to receive and process information. Once you have told someone that their loved one is dead, they don’t have the ability to remember the details that follow. They may participate in the conversation, they may even ask questions, but their brains are so engaged in processing the dramatic life change that has just occurred that they won’t remember the details of your conversation. We deliver information in small doses, use written materials when appropriate, and make ourselves available for additional conversations the next day, the next week, and on several other occasions throughout the grieving process. We connect people with support groups and professional counselors to give them the resources to process the information that we have delivered.
There are some doctors who don’t know that once you say the word “cancer” people are unable to process more information. The doctors retreat into their expertise and knowledge in the face of the discomfort of those receiving the news and are unaware that no one is being dazzled by their brilliance.
From the perspective of teaching, the art of delivering painful news to anyone is not a precise set of steps that can be memorized and then followed. Each situation is unique and requires more than scientific precision. It requires relationship and empathy. And I’m not sure that empathy is something that can be taught. At least it isn’t something that is acquired in a classroom. It comes from making genuine connections with other people.
Lauren Small, when working with doctors, often reads a poem written by Raymond Carver. Carver was only 50 years old when he learned that he had terminal cancer. He wrote this poem after receiving the news from his doctor:
He said it doesn’t look good he said it looks bad in fact real bad he said I counted thirty-two of them on one lung before I quit counting them . . .
Carver’s poem goes on with a stream of consciousness that powerfully captures the moment of the delivery of news of death. It expresses the process from the perspective of the one receiving the news in a powerful manner.
It may well be that the way to teach doctors and chaplains how to deal with painful situations and difficult news isn’t through lectures and seminars, but by encouraging them to engage in literature, music and the visual arts. There are plenty of life situations that require more than scientific facts.
We call it “bad news” but it is built into the process of living. Sooner or later every one of us will find ourselves in the place where we will have to absorb information that is painful. It may be news of an illness or a life-changing injury. It may be news of circumstances in the health of a loved one. It may be that the span of our lives is shorter than we had expected.
How that news is delivered can make all the difference in the world.
I don’t know if we can teach doctors or chaplains better skills in the art of delivering news, but I know it is worth the effort, even if our progress is tiny and the changes are small.
I’ve wondered if having invested time and energy in how such news is delivered will make a difference when the time comes for me to receive similar news in my life. Perhaps I will be able to recognize how difficult it is for the person delivering the news and remember to thank that person for courage and honesty. In the meantime, I pray I will never forget how precious the information I deliver is and how important it is that I deliver it with care and compassion.
I’ve stopped counting. And, for the most part, I don’t believe that the stories of the situations in which I have participated are mine to tell. They are the personal stories of families who have experienced sudden and traumatic loss and who are living lives that have more than their share of grief.
Recently I read an article by Lauren Small who, with Dr. Benjamin Oldfield directs AFterWards, a program in Narrative Medicine at the Charlotte Bloomberg Children’s Center at Johns Hopkins Hospital. Most major medical centers have programs of narrative medicine these days. Narrative medicine is an approach to the practice of medicine that recognizes the value of people’s narratives in clinical practice, research and education. Much of contemporary medicine teaches physicians to treat medical issues as problems to be solved without taking into account the unique psychological and personal stories of the patients involved. Surgeons are trained to be good at working on patients who are anesthetized, without considering the lives patients live when conscious.
We’ve all heard stories of “poor bedside manner.” Medical schools have recognized the problem and have documented differences in recovery rates and differences in medical progress when medical professionals are trained to treat the entire patient in the context of their personal and professional lives rather than simply treat disease as if it were somehow disembodied from its context.
Doctors are trained to be experts in the use of information to solve problems and they often have plenty of information.
They could learn a few lessons from those of us who serve in different professions. One of the things that I teach when working with new chaplains is that there are plenty of circumstances when people are not able to receive and process information. Once you have told someone that their loved one is dead, they don’t have the ability to remember the details that follow. They may participate in the conversation, they may even ask questions, but their brains are so engaged in processing the dramatic life change that has just occurred that they won’t remember the details of your conversation. We deliver information in small doses, use written materials when appropriate, and make ourselves available for additional conversations the next day, the next week, and on several other occasions throughout the grieving process. We connect people with support groups and professional counselors to give them the resources to process the information that we have delivered.
There are some doctors who don’t know that once you say the word “cancer” people are unable to process more information. The doctors retreat into their expertise and knowledge in the face of the discomfort of those receiving the news and are unaware that no one is being dazzled by their brilliance.
From the perspective of teaching, the art of delivering painful news to anyone is not a precise set of steps that can be memorized and then followed. Each situation is unique and requires more than scientific precision. It requires relationship and empathy. And I’m not sure that empathy is something that can be taught. At least it isn’t something that is acquired in a classroom. It comes from making genuine connections with other people.
Lauren Small, when working with doctors, often reads a poem written by Raymond Carver. Carver was only 50 years old when he learned that he had terminal cancer. He wrote this poem after receiving the news from his doctor:
He said it doesn’t look good he said it looks bad in fact real bad he said I counted thirty-two of them on one lung before I quit counting them . . .
Carver’s poem goes on with a stream of consciousness that powerfully captures the moment of the delivery of news of death. It expresses the process from the perspective of the one receiving the news in a powerful manner.
It may well be that the way to teach doctors and chaplains how to deal with painful situations and difficult news isn’t through lectures and seminars, but by encouraging them to engage in literature, music and the visual arts. There are plenty of life situations that require more than scientific facts.
We call it “bad news” but it is built into the process of living. Sooner or later every one of us will find ourselves in the place where we will have to absorb information that is painful. It may be news of an illness or a life-changing injury. It may be news of circumstances in the health of a loved one. It may be that the span of our lives is shorter than we had expected.
How that news is delivered can make all the difference in the world.
I don’t know if we can teach doctors or chaplains better skills in the art of delivering news, but I know it is worth the effort, even if our progress is tiny and the changes are small.
I’ve wondered if having invested time and energy in how such news is delivered will make a difference when the time comes for me to receive similar news in my life. Perhaps I will be able to recognize how difficult it is for the person delivering the news and remember to thank that person for courage and honesty. In the meantime, I pray I will never forget how precious the information I deliver is and how important it is that I deliver it with care and compassion.