Medical students are these days taught how to break “bad news,” but I suggest that breaking bad news well is an illusion like a “good death.” Ignoring logical consistency, I do, however, concede that it’s possible to break news badly, which means that there must be better if not good ways to break bad news. One reason that it is difficult to break bad news is that you may start with wholly wrong assumptions.
I learnt this not with bad news but what I thought was good news. In one week 20 years ago two women told me that they were pregnant. My assumption was not that all pregnancies are good news but that if a woman who is a friend tells you then it must be good news. I congratulated both, and I was right with one. The other was upset.
It seems a safer assumption that telling somebody that they have cancer is bad news. (Although even here I suddenly remember an elderly man 40 years being told he had lung cancer and responding “Thank goodness, I was worried it might be TB.” He was out of date with his epidemiology.) But I’ve read this morning of a case where the assumption was wrong.
Alys Russell, the wife of Bertrand Russell, had a breast lump and was told in 1907 that it was not breast cancer. She wrote in her diary:
“Now my blissful hope of six months [that she had a cancer that would kill her] is destroyed–even the chance of death. I do so long to leave Bertie free to live with a woman who…does not bore him desperately and get on his nerves as I do…If only I could die–it’s such a simple solution.”
Alys and Bertrand were intensely in love before they married, but Bertrand had fallen out of love and Alys had spells of depression. They had been told falsely that they could not have children because of genetic problems on both sides. Russell’s aristocratic and snobbish grandmother had used the lie as a ploy to stop Bertrand marrying beneath him–and shamefully two doctors had gone along with her.
The doctor who told Alys the “good news” was no doubt gratified that he didn’t have to deliver bad news. Human beings and consequently medicine are complex: be careful with all your assumptions.