Delivering the bad news


Direct and uncomplicated, in a soft and nurturing voice, that is the best way to give bad news.

“Mrs. Jones, I’m sorry, but your daughter didn’t make it, the damage was just too severe,” comes across much better than “Hi, Mrs. Jones, I’m Dr. Miller. It was an absolute honor to help your family as much as I could. I’ve been practicing as a surgeon for 15 years and I have a very good reputation and widely renowned skill. I want to assure you that I did everything I could but it was just too late. Your daughter didn’t make it,” or “Mrs. Jones, maybe you should sit down for this, I know this must be difficult and I hate to have to be the one to tell you this, but your daughter is dead.”

Delivering the bad news is terrible, every time. The words hit their audience, and the pain is immediately evident, the range of emotions going from shock to fury to disbelief to anguish to deep depression to guilt to fear, and never in a predictable order. But there are ways to make the difficult better. Or at least less terrible.

As a social worker, over the years, I have had to sit with clients in some of their darkest and most painful spaces, as they process through neglect, abuse, and trauma of every kind, from cheating husbands to recently lost freedom to major drug addictions. Every human has been through hard things, and they come to therapy to talk about it. Sometimes, though, I have to be the one to sit with them and tell them the bad news.

There is no easy way to tell someone that I have had to call Child Protective Services, or that I have to give a difficult report to a probation officer, or, worst of all, that someone they knew, and perhaps even loved, is no longer living.

When I’m delivering terrible news, I tend to mentally divide the people I’m talking to into three categories, as I watch to make sure they are going to be okay. One, I watch for those impacted by standard grief: loss, emotional pain, shock. This category encompasses everyone at varying levels, for hearing the news about a terrible trauma happening to someone else, even someone not known well, is enough to elicit low levels of pain. Two, I look for people who have old wounds now being opened up by the difficult news, specifically those who have past traumas that are being brought to the surface. Example, Sandy hears about a coworker’s suicide, and is immediately reminded of the suicide of her father from years before. These types of trauma recall are more acute and have a wider range of impact. I worry about the last category the most, though. Three, I make sure to be extra sensitive toward people who may be already at capacity with current life stress. Examples, Joann has cancer and is now dealing with her best friend’s death in a car accident, or Mark is fighting for custody of his children in a terrible divorce battle and now is now learning about his beloved boss’s fatal heart attack. The onset of grief in those who are already at capacity comes in unpredictable ways.

When I give difficult news, I sit with the person for a few minutes afterwards to make sure they are stabilizing and okay, then I make sure they have someone with them. Depending on the severity of the shock, I recommend they get a ride home and have someone safe to be with. As often as possible, I recommend the person remove as much stress as possible and engage in self-care, treating themselves as if they just got out of surgery. I recommend blankets and a couch, a favorite movie, a glass of wine or mug of hot chocolate, and a hot bath. I tell them it is a bad time to spend money, to begin a major project, to have a difficult time with a loved one, or to drink alcohol–grief is going to happen, and it is best to provide the body with as much comfort and ease as possible. Too often those in grief wind up sick afterwards.

Recently, someone asked me what the hardest kind of bad news was to deliver. The news of a death of a loved one is always the worst. But there are varying kinds of that as well. When someone dies as the result of a medical event, such as a heart attack, there is a certain comfort that comes with that as we can reason with ourselves that it was there time. Grief in these situations comes naturally, generally. But when someone dies as the result of a preventable accident, or worse, as a result of the negligence or violence of someone else, it is a much more painful and confusing prospect, and grief takes much longer, often, and brings an entirely different kind of pain.

The worst, however, is having to tell someone that a loved one has died as a result of suicide. That brings a tremendous amount of anger, anguish, and extreme and acute pain that the loved ones never quite heal from.

Grief is baffling, and healing takes time. I see people shift from crying uncontrollably to laughing at happy memories to painful anger toward God to abject numbness. It’s natural to feel like a crazy person while grieving.

Grief is painful, and ranges from brief to sharp to all-encompassing, coming in drops over long periods of time. It is heavier in the beginning, then less frequent as the days go by and the sun keeps rising.

And though it is difficult to be the one to give the bad news, it is my honor to be able to help those in their times of need.

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