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The Emotional Toll of Giving Patients Bad News

The Emotional Toll of Giving Patients Bad News

This is Chapter 15 in the on-going story of Pelotonia rider Alex Kip, 23, and his battle with Non-Hodgkin’s Lymphoma (Type B) cancer.

Learn how to compartmentalize your emotions – and whatever you do, don’t get attached to your patients.

This is the advice medical school students routinely receive, yet many nevertheless go and get attached to their patients. Included on this list is Sam Penza, Alex’s oncologist.

“It’s easy to say, but difficult to do,” Sam said of the whole remain-detached strategy. “When you get to know someone and their family and go through everything with them, they get to be like family.”

Dr. Penza has become close to many of his patients at The James, including Alex

This is why it’s so difficult for Sam to give his family of patients bad news – and so uplifting and joyous to give them good news. In his case, the difference between good news and bad news can be the difference between life and death.

“It was so amazing, I actually shouted I was so happy,” Sam said of reading Alex’s last batch of scans on his home computer – and later telling Alex and his parents the great news, that his tumor had shrunk down to nothing, and could be blasted out of existence by radiation treatments.

Then the reality of cancer throws you for a loop.

The same day he read Alex’s great results, Sam learned another patient, one scheduled for a stem cell transplant, had taken a turn for the worse and her tumor had not responded well to treatment. The transplant was put on hold, and the outcome isn’t very favorable.

“That can be the hardest thing,” Sam said. “You can see one patient in clinic and give them great news and it’s such a relief and a wonderful feeling – and then right after that you go to another room and have to give someone bad news.”

Over the years, Sam has learned how to deliver bad news. It’s not easy, but it has to be done.

“My philosophy is you tell the truth, no matter what it is,” he said. “You never want to take away hope, but you have to be realistic and present the facts in order to get informed consent (for subsequent treatments). And even when things are bad, you state it, and come right back with, ‘OK, it happened … and now lets try and shift gears and come up with something that might work.’”

In some cases, there’s nothing left to try. Nothing has, or will work, and it’s time to recommend and plan for end-of-life hospice care. This – for obvious reasons – is excruciatingly difficult for patients and their families to hear, and even harder for many to accept.

“You can have a patient who’s failed six regimens (of chemo) and they still want to try another one, even though we know the likelihood of it helping is very, very rare,” Sam said. “If you give them another round it can lead to toxicity and, for the time they have left, they’ll be dealing with tough side effects.”

Sam said he has grown close to Alex, whom he describes as a young man with a dream, ready to take on the world, and a build a career as a Broadway singer and actor. And then the randomness of cancer found its way into his chest – and created a tumor that not only threatened his life, but put pressure on his vocal chords and turned his wonderful singing voice into a hoarse rasp. There’s still no way to know if or when his voice will return to normal.

“I’m in my 50s and I see someone in his 20s with everything ahead of him and then this happens to him, and I think how terrible it is for someone like him, who’s in the theater, to have problems with his voice. It’s like a double whammy and you think, ‘This isn’t fair.’”

Alex said he was lucky to have Sam as his doctor.

“I love Dr. Penza because he balances reality and hope,” he said. “He was always upfront and honest with me,  even if the news was negative, but hopeful in what he could do to help.  I understood the severity of my condition, but with his help remained positive in my plan to beat cancer.”

Sam was thrilled when he was able to give Alex the good news that his tumor had shrunk

Sam is a very spiritual man, yet admits cancer has tested his faith at times.

“A lot of times you say to yourself, ‘How can God allow things like this to happen to someone like Alex.’ That’s the most difficult thing to rationalize, and you try to come up with a logical answer or a rationalization – and realize there is none.”

While Sam can’t rationalize the unfairness of cancer and the toll it can take, he has been able to figure out a way to keep the pain of delivering bad news from overwhelming his emotions. Without this type of defense mechanism, it would be impossible for him to do his job.

And it all comes back to Sam’s faith.

“I try and take the attitude that I didn’t cause the disease and I’m doing everything I can to treat it,” he said, adding the success – and survival – rate has risen dramatically over the past 20 years, another reason for optimism on bad days. “And I rely on my faith and truly pray for my patients. Every Sunday, in church, I pray for all my patients.”

Sam also draws strength from his family.

He met his future wife, Beth, at a hospital in Youngstown. He was a medical school student and was working as an orderly, Beth was an X-ray technician. They have three children, Johnathan, 18, and twin daughters, Audrey and Katie, 16.

Sam’s work at The James requires lots and lots of hours with his patients and medical school students, and more time than he’d like away from his own family.

“They’ve very supportive and there’s no way I could do this without them,” he said. “Behind every good doctor is a great spouse – and I’m very lucky.”

Sam will often come home after delivering bad news to a patient, and Beth can read his face like a book – and knows he’s down in the dumps, and thinking about the patient and their family and what lies ahead for them.

“She’ll ask if there’s anything she can do, and I say, no, I just need some time.”

Click here to read the good news in Chapter 14 of Alex’s story – and click here to read about the day Dr. Penza had to give Alex some bad news.

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