When a piece of debris in space sends out a distress message via Twitter, I can't help but take note. This particular message read as follows: "Your people predict I will burn up in Earth's atmosphere early 2017. You'll get messages until then. I don't want to die."
How poetic, I thought and then did a bit of research. 'Fengyun' is a piece of space junk currently orbiting Earth at 28,000 km/hr. Fengyun, and two other pieces of space debris form part of 'Project Adrift', devised by Cath Le Couteur and Nick Ryan. It is an artistic exploration of the secret world of space junk, and the problems with it. You can see a film about it here.
But let me give you a bit of the past medical and social history for this particular palliative care patient, before we look at approaches to managing his or her distress:
Fengyun was once an important part of Chinese weather satellite FY1C, until it was blown into thousands of fragments by an experimental anti-satellite missile. Fenyun might burn up soon, but millions of other pieces, including Fengyun's estimated 2840 siblings, will continue to circulate with some associated dangers.
If you allow me to be a bit tongue and cheek, it seems as though someone, in not too kind and compassionate a way, has broken it to Fengyun that he/she is going to die. It was communicated by electronic means. The satellite fragment is now understandably frightened and distressed.
It did remind me of palliative care encounters and stories here on Earth. The way news is broken about inevitable death, due to, for instance, an illness like secondary cancer, is at times insufficient. "I was told over the phone that it's terminal.", or "They were on a big ward round, came to my bed, one person who didn't introduce himself spoke to me from the end of the bed, and bang: -You're dying!- "
Breaking bad news is a very complex communication task. Many doctors and nurses will have heard of various forms of guidance to help deliver bad news, one of which is the SPIKES mnemonic (1) and I will try to summarise what I might have done initially to help Fengyun:
STEP 1: S--SETTING UP the serious illness conversation:
Get the setting right and ensure privacy. Fengyun might wish to have significant others with him/her, in this case perhaps @VanguardAdrift, another piece of space flotsam in the upper reaches and not at imminent risk of burning up.
STEP 2: P--Assessing the Patient's PERCEPTION
Before discussing the astrophysical findings, the palliative care space practitioner uses open-ended questions to create a reasonably accurate picture of how the patient perceives the situation. For example, "What have you been told about your orbiting situation so far?" or "What is your understanding of the reasons we ran the earth re-entry probability test?".
STEP 3: I--Obtaining the Patient's INVITATION
While a majority of satellites may express a desire for full information about their prognosis, some may not. Not wanting information is a valid psychological coping mechanism. Examples of questions asked of Fengyun might be, "How would you like me to give the information about the results of your orbiting pathway?"
STEP 4: K--Giving KNOWLEDGE and Information to the Patient
It is important to warn patients/satellites that bad news is imminent and this may lessen the shock that can follow the disclosure of bad news. Examples include, "Unfortunately I've got some bad news to tell you".
It is vital to start at the level of comprehension and vocabulary of an individual. Importantly, try to avoid technical words like 'atmospheric drag', 'biopsy', or 'aerodynamic heating'.
STEP 5: E--Addressing the Patient's EMOTIONS with Empathic Responses
Responding to the individual's emotions is one of the most difficult challenges of breaking bad news. Emotional reactions may vary from silence to disbelief, crying, denial, or anger. In this situation the good palliative space physician can offer support and solidarity to the patient by making an empathic response.
STEP 6: S--STRATEGY and SUMMARY
Satellites with a clear plan for the future are less likely to feel anxious and uncertain. Before discussing a plan, it is important to ask them if they are ready at that time for such a discussion.
In summary, it is vitally important to keep in touch and follow things up. Sometimes, Fengyun, when the patients I see know that time may be short, they initially react with shock, but many take solace in the fact that we all must face death at some point in our lives, and that others have gone through similar experiences. And that there is always something else that can be done. There is nothing new under the Sun.
(1) Bailea W, et al SPIKES- A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer doi: 10.1634/theoncologist.5-4-302 The Oncologist August 2000 vol. 5 no. 4 302-311