Delivering bad news is never easy. Depending on the exact news, I tend to be more or less proficient, most of the time. As with everything in life, we tend to be more proficient with skills that we practice regularly. Unfortunately, I have practice at delivering bad news. Sometimes a client is expecting bad news. Maybe their pet has been sick for a while; maybe she’s a very old cat, or a dog with a known illness, and symptoms have progressively worsened. These are the “evils we know” and they don’t tend to catch us (the client or me) by surprise. The talks are never easy, but in most cases no one is getting blind-sided, or at least not bludgeoned without warning.
Other cases aren’t so simple. Sometimes a client is presenting their pet to me for an apparently simple issue, and things turn south very quickly. As an example, and probably the model case, would be a large breed dog I recently examined. Charlotte had presented with complaint of a simple discharge from her left eye. Honestly, this looked like a mild case of conjunctivitis, maybe allergic, maybe bacterial, but probably something best addressed with a medicated drop and a little time. As part of my evaluation, I wanted to examine her fully to see if there might be an underlying cause for the conjunctivitis. I examined her mouth, her ears, heart, and lungs. These were perfectly unremarkable. But, not everything was normal. To be frank, I might have easily missed this – a lighter touch of the hands, straightened fingers instead of a cupped palm, and I could have easily passed over the most important findings of this exam. The lymph nodes located just below her jaw, near the top of her neck, were prominently swollen. By itself, not terribly alarming. Likely causes would include infection, either in the eye, mouth, or nose, or a systemic infection, such as a tick-borne disease. On further investigation 2 other sets of lymph nodes were also quite swollen, those located in front of her shoulder joints (front legs) and those located behind her knees (rear legs). All of these nodes were 3-4 times the normal expected size. After some lab tests and a fine needle aspirate of the lymph nodes, it was apparent that Charlotte had lymphoma, a malignant cancer of the lymphatic system. This is not the conversation either I or the client was expecting to have that day, at that time. No one wants to gain proficiency at this conversation.
Although it’s cliched, you actually can’t tell what’s around the next corner. Neither I nor my next client knows when the rug will get pulled out from underneath. It makes me thankful that I didn’t have to have this conversation with the parent of a child diagnosed with a potentially terminal illness. I’m sure the discussion is different and much more gut-wrenching, but I suspect still equally difficult for either party. For Charlotte, the “evil we didn’t know” was the one that kicked us in the pants. For her, the ultimate outcome is fairly certain. Whether we pursue one or more treatment options, has not yet been decided. In 10 or 20 years, I probably won’t remember Charlotte’s name, what her diagnosis was, or what transpires from here. The unexpected U-turn into a tragic discussion with an understanding but heart-broken pet parent will stay with me, whether I was ready for it or not.
- Todd Worrell, DVM