Yesterday was a bad day. Not because I had that Monday morning feeling. Not because there was already a queue before I even started. And not even because my inbox was full of results waiting for me on top of all of this. Monday was a bad day because in the middle of my surgery, there was a message asking me to call the coroner to discuss a sudden death. Now, I know we've all experienced this before, and I know that although this was my first, it most certainly won't be my last. But this patient was somebody I have gotten to know particularly well during my first year as a fully qualified GP; a patient who I got on with on a personal as well as a professional level. She was young, seemingly fit, full of life, and a joy to see when we consulted. What this conversation amounted to was the coroner's office breaking bad news to me during the middle of a busy morning surgery, so I found myself giving the information that the coroner required, with a lump in my throat, trying to hold my composure until the phone call was over.
Hearing that somebody you cared about has passed away suddenly is never easy. We're taught that giving a warning shot first is a good approach to breaking bad news. But when a professional informs another for official reasons that a patient has died, the nuances of breaking bad news don't really come into play. Perhaps we don't consider that a medical professional might care for a patient on a personal level, or perhaps we shouldn't feel this way about our patients at all. But General Practice cannot be as 'clinical' as this, as you develop intimate relationships with people you see many times, and rapport may be more important than in any other specialty, meaning that avoiding personal connections can be difficult.
On a normal day, fitting in a phone call to the coroner will probably make you run late, and add another element of stress to an already busy morning. A GP will then end up apologising to the ever growing queue of patients who have been made to wait. This is something we get used to - you practice an explanation that works well for you and reel it off when each subsequent patient arrives in a state of annoyance at your apparently bad timekeeping. But reeling off that apology isn't easy when you've just received bad news. I have to admit that it was difficult to concentrate after hearing that my patient had passed away and even harder to apply myself to the stream of minor complaints from patients that, in all honesty, didn't really need to see me. Advice comes from colleagues who tell you to 'housekeep' - 'just stop for 10 minutes and have a cuppa' - but the contemplation of adding another 10 minutes to the wait of those sitting in the waiting room just compounds the feelings panic and loss of control about the way your day is heading.
Well I made it through my day, and everything that needed to be done, was done. I got home, kicked off my shoes, poured a glass of wine, and I cried. I pondered whether my sadness was, as a colleague suggested, the consideration that perhaps I could have done something differently to prevent my patient's death. But, no, it wasn't. In all honesty, it was simple, straight forward grief. I met somebody I liked. I got to know her. I did what I could to help her in a professional capacity. But above all, I just enjoyed having a chat with her. And then she died suddenly and unexpectedly, and I was told suddenly and unexpectedly. It's part and parcel of the job, but that doesn't make it any easier. And I don't think that keeping an emotional distance from patients is the answer, as these personal connections are the simple pleasures of practicing medicine as a GP.