- © 2007 Canadian Medical Association or its licensors
Adjacent to every intensive care unit, operating room and emergency department is arguably the most important room in the hospital — the Family Room. This is where the normally parallel emotional lives of patients and physicians intersect, where feelings and vulnerabilities are exposed, and where physicians make permanent impressions on family members.
Family Rooms are usually small, furnished with couches or comfortable, soft sofas, presumably to provide the physical comforts meant to offset the tremendous emotional burden of the unknown fate of a loved one. I have always been impressed by the efforts that some hospitals have made to make these rooms as pretty as possible. I have seen leather couches, potted plants, paintings on the wall, even televisions. Despite this, these are terrible rooms for families; they are in reality furnished not with sofas and various comforts, but with nerves, tension and raw emotion.
As a medical student, I have on occasion been witness to various families' most terrible moments, being told of the death of a loved one, that a daughter is brain dead, that a brother is paralyzed. The Family Room is more than a room; it is the health care system's equivalent of holy ground: a space where all are equal, where treatment is determined, and where decisions are made to sustain life, or to end it. It is the moral centre of the hospital.
I have learned things in the Family Room about breaking bad news. These are lessons borne not out of simulations or interactions with actors portraying patients, but out of difficult experiences with real patients and real emotions. I have learned that it is disastrous to sugar coat bad news and to dance around the truth. Families overwhelmingly want to know as much as possible; they are starved for information and will repeatedly thank the physician even after having been told devastating news. The strength of these families will never cease to amaze me.
I have learned that, in order to make something clear, it should be repeated several times, even if it is difficult to hear, or say.
I have learned that the moment bad news is broken, everything changes in those few seconds and a family is ripped apart. For most individuals this will be a defining moment of their lives, when someone dear to them has been lost, or irrevocably altered.
I have learned to be careful when choosing my words, because families will hang on to everything a physician says. They will begin their sentences from here on with “the doctor said …” and “the doctor thinks … .”
I have learned that things that may seem obvious to outsiders can remain beyond comprehension if not witnessed first-hand. Yes, the loss of a child will be terrible, and yes it will be hard to see, but it is equally hard to listen to a mother lament that she will not, that she cannot, bury her child.
I have learned that the walk out of the Family Room is just as difficult as the walk toward it.
No matter how big or small the space or how gaudy the paintings on the wall, the Family Room is where the physician's role is best exemplified. I have learned that breaking bad news does not get easier, that it is always difficult and that no matter how hard someone might try, the Family Room will never be pretty.