Egypt : a trip down Denial –part 1

06/03/2009 at 5:27 AM Leave a comment

Denial is clearly a tool that our brains need. Life can be so unbelievably overwhelming, unfair, intolerable that to keep functioning in the face of hopelessness a little ( or a whole lot) of denial is needed. The classic case which was taught to me in med school is that people will only hear as much as they can handle. It is not my job to determine how much they can handle. 

Case in point. Place ICU, Patient in horrible shape, on a ventilator, no hope of getting off, on the terminal part of a year long downhill slide through the worst of cancer and cancer therapy.  The family is there and it is my job to tell them the most recent results of the testing. That nothing is working and he is dying. That it wont be long( hours or a day or two).

The family has been fragile and emotional throughout the stay, we worry they will collapse or be unable to deal with the news. I volunteer to give the news. The reasons for that are in tomorrows blog.

I have their rapt attention, I remind them that their loved one has been very ill for a long time, they nod. I review the course of the hospitalization they they are familiar with ( decreasing consciousness, more and more interventions), then I tell them that the testing is in and that the patient is not responding. The he is at the end of his terminal disease and there is nothing more that we can do.

they all nod, perhaps weep a little. They thank me for the honesty.

a few minutes later they question the nurses when the patient will be well enough to go home.  AHHH DENIAL, what a wonderful thing. My attending had heard me tell them ( thank goodness) and felt at the time that I had perhaps been a bit too blunt. Now it was clear that they would only absorb the parts they could handle. Over the next 24 hours they wept more and there was more drama than before, but by the end of it they accepted the status. The brain has a valve that allows things to come in slowly if necessary, or in some cases never. Denial is a tool that can be used for good or for bad. See future posts.

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Entry filed under: How things work. Tags: , .

Worst case of food poisoning Who made me God? ( with all due apologies)

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