How to give bad news

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Years ago, my sister lost her newborn son to a birth defect. She knew about the defect prior to his birth, and had been assured that everything would be fine. Unfortunately, within hours of his birth, there were other complications, and an additional undetected defect that meant he had no chance of survival. The problem was that my sister refused to accept that her baby would die within 24 hours.

What do you do when a patient is in denial and refuses to accept such a grim prognosis? How do you make a patient understand when there is no hope?

You're welcome :) I'm just glad that I got it right.

Your initial post showed me that I was looking at the problem the wrong way, probably because of the circumstances involved with me sister. She has never come to a point of understanding, and in fact is now mentally and emotionally damaged to an extreme that I fear is permanent. Maybe that was already starting to happen from the moment she heard that her son would not live. I just assumed that her reaction was normal, but considering how she is now, 4 years later, I'd say that her initial reactions probably weren't the norm either. I know everyone greives in thier own way, but with her, it was like she didn't hear anything that was said.

After all this time, I'm fuzzy on some details but one example is that the baby was missing a valve related to his digestive system, and she could not understand why they couldn't do a transplant. His liver was destroyed, and again she wanted a transplant, and there were a host of other things as well. Now, I understood why she asked about transplants to begin with, seems like if somethings broke, you get a new one, right? But when the whole surgical team sat us down and explained why none of these things could be done, I could see thier point.

My sister, on the other hand, started trying to find loop-holes in what they said, and started thinking up outlandish ideas on how to fix each thing. So, how do you explain to a normally intelligent woman that even though the afterbirth LOOKS like liver, you cannot cut off a piece and use it as a liver?

So, I guess my question was aimed at this type of behavior, but I think your answer still applies. The understanding will come when they can accept it.

Sorry to hear your sister is not coping well. Hang in there and support her the best you can.

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You don't MAKE THEM UNDERSTAND, they will soon enough, just let them have hope and support them by answering questions and making them comfortable.

... there's nothing wrong with having hope, sometimes it's all people need to cope.

Yep!! If you can gently find out if they have a theological or other belief system that they can find comfort in...and have the appropriate rep (e.g Imam, Preist, Rabbi, fellow Buddhist, etc) counsel and comfort them, that helps too.

Don't ever say, "I know how you feel..." Even if you've experienced loss. Patients tend to find that belittleing and almost condescending. If you can, however, open up a dialogue (if your pt is open to it) as to how you coped, resources you used, etc. if you exp a loss such as theirs, THAT may help.

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Sorry to hear your sister is not coping well. Hang in there and support her the best you can.

I wish I could but unfortunately I no longer have any contact with her, due to many different things. First, I was pregnant at the same time she was, and it was difficult for her to be around me after my son was born. Then, due to her lack of coping skills she started using drugs. She did reach out to me once and ask for help, and I tried to help her, but by this time she was very "out of it" and it fell to me to take steps to remove her older child from her care ( that child is with her father now). Sadly, about 6 months ago, I heard that she was pregnant again.

I didn't know what to feel when I heard. Part of me is worried sick about any baby in her care since The amount of drugs she did seemed to destroy her mentally. On the other hand, I worry that if anything should happen to the baby, that it would be a final blow for her that does her in. No matter what happens, I can't see it being good for her. :crying2:

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Hopefully it will go better this time for your sister.

I don't know if you have ever heard of the stages of death and dying (Kubler-Ross), but it's just one theory of how people deal with death. The first stage is denial or shock, many people feel this right away when someone dies or shortly before the death. But I don't think it's healthy if it lasts several years. People go through the stages (denial, anger, depression, bargaining, and acceptence) at different rates and don't necessarily go through them in the same order.

Is your sister in any sort of therapy? Dealing with grief is very difficult for some people, getting some therapy may help.

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Hopefully it will go better this time for your sister.

I don't know if you have ever heard of the stages of death and dying (Kubler-Ross), but it's just one theory of how people deal with death. The first stage is denial or shock, many people feel this right away when someone dies or shortly before the death. But I don't think it's healthy if it lasts several years. People go through the stages (denial, anger, depression, bargaining, and acceptence) at different rates and don't necessarily go through them in the same order.

Is your sister in any sort of therapy? Dealing with grief is very difficult for some people, getting some therapy may help.

I doubt that she's in therapy, it's not her kind of thing. Yes, I have read about the stages of grief. I think my sis is stuck in denial and will never come out of it. The last time I seen her, she was telling me wild stories about how she thinks her ex stole the baby for his new wife, and paid of the nurses to pretend that he was dead. I kept reminding her how we bathed and dressed him after he passed away, but logic couldn't overrule her wishful thinking :crying2:

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