Too Much Information: When Prognosis Breaks Down Patient Communications

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Building a relationship with a patient can be a challenge when a serious prognosis sets the stage.
Building a relationship with a patient can be a challenge when a serious prognosis sets the stage.

I had just finished lunch and was enjoying the fresh air on the patio outside the hospital cafeteria. It was a warm spring day, the air crisp, and the patio resonated with the murmur of singing birds. The noise started as a distant yet regular pulse but I wasn't able to identify it until it got louder and closer: the thump-thump-thump of a helicopter rotor. I work in a large community hospital that is also a trauma center. Tucked against the foothills of the Los Angeles mountains, the sound of an incoming helicopter is both alarming and fascinating. I watched its approach to the helipad. The rotating blades cast oscillating shadows, and the sound echoed from the buildings. I knew transport via a trauma helicopter was a dire prediction for whoever was inside. Something had happened either on the local freeway or in the rugged terrain of the surrounding hills.

I was transfixed by the sound as it reverberated through the air and into me. I looked up in awe at the sheer size and noise of the helicopter as it lowered itself onto the roof of the building. For the few minutes it took to land and get beyond my vision, I did not look away. Whenever a helicopter arrives it does not seem to matter where you are in the hospital you can hear it and feel its approach. Like the loud drum of a rock band, it vibrates in your belly.

Oddly, it made me think of a recent patient interaction. One that did not go well.

CASE

The diagnosis was bad from the very start. Louisa was going about her daily work routine when she was literally, suddenly, nearly incapacitated by abdominal pain. Dedicated to her work as an office manager of a financial institution, and the type of person not to complain or draw attention to herself, she pulled herself together, finished the task at hand, then called her husband to take her to the ED. 

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