Delivering bad news

Sometimes when I think I am delivering "bad" news, the person receiving the news doesn't perceive it as bad, at all.

I am reminded of a patient I saw when I was a fellow. Not that giving bad news is ever easy, but it was particularly hard at that time as I took on all the personal responsibility for the news I was delivering as if it were somehow my fault. In this vein, I went to see a very young man with liver masses and peritoneal masses. We biopsied the massess and indeed they were colorectal cancer.

This was a terminal illness and he was only in his 20s, which many would feel is particularly heart breaking and unfair. However, he had a delusional disorder which led him to the fixed and unwavering belief that he had cancer. He had felt this way for many years. He had seen doctor after doctor and had legions of tests (all negative) before someone sent him to a psychiatrist who diagnosed him with the delusional disorder.

When he got admitted for abdominal pain, I don't think anyone thought we'd actually diagnose real cancer - he was too young, and it would be just too ironic to "fulfill" his delusion. But that's exactly what happened. When I went to see him with my attending, I said, "Sir, I'm afraid I have some bad news." He was listening carefully, knowing that we were oncologists, with an almost excited look on his face. "The tests have come back and you have colon cancer". He sat up in bed and pumped his fists in the air, and exclaimed in a loud happy voice, "Yes! Finally someone believes me!" We went on the discuss the ins and outs of treatment, and likely progression of his illness. When I asked if he had any questions or concerns, he only asked if I could call his family to let him know he had been right all along. It seemed that by "giving" him the cancer diagnosis, I removed the stigma of his delusional disorder. That was a very strange day indeed.