As a palliative medicine physician, part of what I do every day, is assist other physicians in delivering what is often bad news. All to often as well, I am asked to be the very person to help convey that news to a patient, as communication is part of our expertise in the medical field. Now here in Kenya, I am learning how to provide this type of news with my oncology colleagues. In the US we have the luxury of "medical interpreters," who are paid clinicians skilled in medical language to help us provide important information to families. At MTRH, my team including my RN and clinical officer are both my team members, and my translators in these difficult scenarios.In palliative care, part of our skill set is in how we communicate important information with empathy, understanding, support, and most importantly, with a sense of non-abandonment of patients. One of my greatest challenges in Eldoret is having 'family meetings' with seriously ill patients and their families, and trying to communicate information in a language I speak superficially at best. (Though I am taking Kiswahili lesson's twice a week!)
Our team held a family meeting with nearly 20 people, squeezed into a tiny "psychological counseling" room, to discuss the results of the "investigations" (Kenyan medical jargon for lab tests and imaging) and plan of care for their father. The patriarch of a large farm in Western Kenya, his family had been awaiting news of his care and diagnosis for several weeks. In this public hospital it can take nearly 72hrs at time for lab results to return, up to several weeks for biopsy results, and depending on whether the radiology equipment is functioning, days to weeks for a CT scan and interpretation. So it is very common here for families to wait weeks before being given any news on a diagnosis, and thus prognostic information to help make decisions for treatment.
When I arrived at the bedside, the family was standing vigil nearby, having gotten word from the nurses that the Daktari was coming. It was obvious from the hallway that their father was actively dying. He was unresponsive, with a faint pulse, and his hands and feet were cool to the touch, all signs that he likely had minutes to hours of life left. After examining him, reviewing the chart which showed significantly abnormal liver function testing, an abdominal ultrasound showing a pancreatic/gall bladder mass and dilation of his bile ducts, and the oncologists concern for cholangiocarcinoma, I grew anxious to explain the bad news to come.
The family understood that he had a mass in his abdomen, and had been told that his jaundice was from the mass, yet outside of this information, it was obvious from the feeling in the room, that they understood he was very ill. I expressed my worry about his condition, and through my nurse as interpreter, explained that their father was dying of incurable cancer. I was speaking to his son who was acting as the interpreter to the family in their tribal language, and after the final word was spoken, I felt a collective sigh of relief.
What I did not know was that the family had been very worried that they had not been doing everything they could for their father. His son was relieved to hear from me that they had done everything possible by bringing him to MTRH, and that despite the fact that he was dying, they were glad that they understood what was happening. The unknown, the worry, and the anxiety was lifted away with even this terrible news. I too felt better, knowing that the burden of this information was actually helpful rather than devastating. At the end of the meeting, the patient's son concluded with a the prayer of thanks, asking that the "doctors have the strength to continue this difficult work." I continue to pray that I do.
