'You get me?'

The furore surrounding the Liverpool Care Pathway (or, as the Daily Mail are currently calling it, 'pathway to death'' or something like that) has caused much discussion in my hospital, as you might imagine.  My feelings on this issue are best shared another time.  But one thing it has made me reflect on is whether I really explain what I mean - i.e. 'You get me?'

Here's the problem - doctors are human, are not perfect and have feelings.  Shocking I know.  And no matter how many times you have been trained to deliver bad news, it ultimately goes against your instincts to tell someone, explicitly, something awful.

'I think you might have cancer'

'I think your dad/mum/wife/husband might be dying'

Those two words in particular - 'cancer' and 'dying' - are surprisingly hard to get out.

There's two reasons for this - first is, it's just really hard telling something these things.  And I know that's what we're trained to do, but you know that once those words have passed your lips, little else you say will be heard.  Even if the cancer is in its early stages, or very treatable, it's heard (understandably) as cancer, and that's that, despite what you say after that.

And secondly, despite popular belief, it's not actually all that easy to know, particularly with the latter, if it's true.  Dying is not a finite art.  Until I started training for this, I'd never seen someone die before.  What I do know is this - everyone will die.  And I wouldn't wish dying in discomfort or pain on anyone.  So if someone might be dying, yes, of course, do everything you can to actively manage the situation with whatever treatment is needed; but also consider that if this is going to be this person's last hours on earth, it should be with dignity and peace.  These two things are not mutually exclusive.

But either way, this whole issue of the LCP has made me think first and foremost of all the patients who have died since I started working, and how closely we have worked with the patient and their families to make sure everyone is informed and comfortable to the end.  It is so difficult to say these final, definitive words about what we think is going to happen next.  But it is not enough to 'think' we have explained what is going on - hiding behind medical words or terms which are not explicit enough is insufficient.  It is far harder hearing this sort of difficult news than delivering it - I will never ever forget that it is my job to be sensitive, explain clearly and make sure we are all singing from the same hymn sheet.