“Breaking the bad news”

As we mostly refer it to, is often one of the worst nightmares of a medical practitioner. While announcing the death of a close one remains the most dreaded of all, often there are various facets to this heart-wrenching phenomenon. As a psychiatrist, the profession inherently doesn’t expose you to dealing with death and the aftermath quite often. But, nature in its own manner sporadically uncloaks you to unexpected circumstances, sometimes worse than breaking the bad news in its most common form.

What could though, be worse than death of a near one?

It was an usual history of psychosis. The middle aged lady just admitted in the ward, had been now suffering from it for 5 years. Nothing so very different clicked during the usual history taking procedure until the husband uttered about the speech and gait disturbances the patient had developed for the past few months. It still didn’t bother much until a similar history in 3 family members was confirmed, all of them had died at an age earlier than 40. Enter jitteriness.

A Neurology referral was sought, Huntington’s disease was suspected and the sample for genetic testing sent. While the report in itself took time, the gut feelings of the treating team were quite clear , as if the result had already come. 10 days later, the test reports just confirmed the clinical suspicion and more importantly, the intuitions.

The prospect of genetic counselling was deliberated upon by various departments in concern and it was concluded to postpone it to when imperative, since the children of the patient were still very young.

The patient now harbouring a couple of devastating illnesses, with one of them ultimately being nothing but lethal, it was then the turn to explain the husband about the illnesses and the prognosis.

Though various protocols exist to break the bad news to facilitate smooth adjustment to the shock, the whole event in itself is discomforting to clinicians and devastating at the least to the bearer.

The husband was called to a room to get the process undergoing. But before we could move much ahead, the husband had already sensed the situation and he went on

“Jaanta hun sir ki yeh theek nahi ho payegi. Aanuvanshik (genetic disorder) bimari hai, iska koi ilaaj to hai nahi. Iske pita ji, bhaiya aur chacha bhi issi bimari se yeh duniya chod ke gaye the. Isko bhi ab wahi lakshan hai. Iske pass bhi ab shayad jyada saal nahi bache hai. Main to bus itna chahta hun ki baki ka jeewan iska shanti se nikle. Ilaaj ke chakkar main bahut ghum liya , ab isko aur pareshan nahi karna chahta…Bura to lagta hai par ab kar bhi kya kar sakte.

Rahi bacho ki baat…to shayad aisa theek hai…abhi se unko bata kar kya karna ki unhe bhi yeh bimari ho sakti hai…jab samay ayega, jaroorat padegi, to unki bhi jaanchein kara denge”

Apparently coming to terms with the situation so smoothly, thousands of moments of agony must have passed through the troubled man before finally being able to get some reconcilement. He had been juggling and struggling for years now with his wife’s illnesses on one hand and his work and responsibility of the children on the other. All he had now wished for is a few peaceful last years for his wife, very swiftly hiding his pain behind his glowing face.

As for the patient, her psychosis in its truest sense, had brought along with it apathy ( a complete sense of indifference to almost anything) coupled with loss of touch to reality, so very grim in this case. Probably, just probably, nature had blessed her with psychosis to protect her from the dire reality she would have had to face otherwise.

What could then be worse than death of a loved one? Presumably, knowing that a loved one is inevitably facing death at close quarters.

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