‘It doesn’t look good’
A brutal phrase from a doctor delivering the news that she had stage 4 cancer was a body blow for mother-of-two Jo McKenzie-McLean. Nadine Roberts reports.
Each word is a barb that’s stuck in Jo McKenzieMcLean’s head since being told she had stage 4 bowel cancer in January 2021. ‘‘It doesn’t look good,’’ the doctor said.
The lack of empathy when delivering the devastating news still grates on the mum-of-two, who details the minutes her life changed irrevocably with a clarity born out of shock, in the first episode of the new Jo vs Cancer podcast.
For McKenzie-McLean, the physical environment was as devastating as the harsh way the seriousness of her illness was delivered. When she arrived at Clyde Hospital, in Central Otago, to hear the results of a CT scan after a long battle to find out why she had been unwell, she felt like an inconvenience.
It started when a mute nurse led her into a small room that looked as though it was part of the ambulance bay. As she sat alongside her own mother, she noticed an overflowing rubbish bin full of tissues and the room seemed dingy. Clearly, it was not the consulting room she had expected.
The doctor who came in was brutal, telling her matter-offactly that there was something wrong with her bowel. It was cancer . . . and it had spread to her liver.
From there, the rest of the conversation was a blur, although the memory of what took place has subsequently replayed in her mind in a never-ending loop.
Sadly, her experience is not that unusual, according to her Dunedin-based medical oncologist Chris Jackson and Auckland medical oncologist George Laking (Te Whakatōhea).
Laking, who is the comedical director of the Cancer Society of New Zealand, says he regularly hears of patients suffering a traumatic experience because of the way in which their diagnosis was delivered.
He believes communication skills are at the centre of the issue, saying there is ‘‘huge scope’’ for them to be strengthened. ‘‘It’s a teachable, learnable skill.’’
As a young doctor, Laking made mistakes when delivering bad news, and recalls relaying the results of a CT scan to a patient in a ward after the patient asked him for his results while he was doing his daily rounds.
Laking told him his disease was incurable and treatment was not working, but realised immediately that the information had ‘‘landed heavily’’.
Later, a senior colleague at the hospital, who was also the patient’s relative, advised Laking he hadn’t handled the situation correctly. He was told he should have ensured a support person was present. ‘‘There was a lesson in that. It stayed with me.’’
Now Laking ensures he has prepared before a patient comes in, including choosing the right space for the conversation. In a ward, he makes sure to take the person to a comfortable private room. ‘‘People will remember the time, the place and the circumstance of the situation. If it’s happening in a shabby room, it’s sending a message that we don’t care.’’
Laking doesn’t believe the physical spaces in the health system are conducive to healing, and that lack of space can cause a ‘‘moral injury’’.
A big proponent of tikanga Māori, he follows Māori health protocols including considering the wairua (spiritual), hinengaro (psychological), tinana (physical) and whānau (extended family) in every conversation he has.
Before even knowing the results of a CT scan, he proactively schedules a meeting with the patient. ‘‘That’s a good habit to get into.’’
He asks the patient to bring a support person, so someone is present to retain the information being given. It also helps to unload the burden from the person receiving the results.
While cancer can feel like power is being taken away from a person’s life, Laking believes the essence of cultural safety practised in a consultation room can help patients steer their destiny.
From choosing how they want the results delivered, to who they have accompanying them, the decisions can give the power back at a time when people feel they have lost control of their lives.
‘‘A big part of the job is getting an idea of where people are at and how much information they want to receive.’’ While you should not give false hope, Laking has a personal theory of how people can confront a scary diagnosis. ‘‘You have to look it in the eye,’’ he says.
Rather than allowing it to frighten you all the time, Laking advises taking cancer ‘‘out of the box’’ periodically to take a strong look at where you’re at as well as thinking about what you have to be hopeful about before putting it ‘‘back in the box’’.
‘‘Make a conscious decision to put a lid on all that horrible stuff and live your life the way [you] want to.’’
Chris Jackson has heard many stories of diagnoses being delivered in a terrible way, saying it can cause a ‘‘strong and enduring memory’’ that can be ‘‘extraordinarily painful’’.
Like Laking, he believes in preparing before delivering results. He makes sure there are no distractions – no cellphones, pagers or the likelihood of people entering the room – and the setting is private and comfortable.
‘‘You have to remember this will be an extremely impactful and an important conversation for that person. There is nowhere else you should be thinking about being or doing.’’
Once the diagnosis is revealed, it’s important to give people time and space to absorb it, he says.
Patient reactions vary, from crying, to wanting to know what’s next, while some people don’t want to know how serious their condition is.
Jackson says it is possible to be a great technical doctor with little to no empathy. But he says the most talented diagnosticians and clinicians he’s come across are ‘‘extraordinarily compassionate because that’s what drives them to be better’’.
‘‘I think the day that you think a patient is just another number is the day you need to hang up your stethoscope.’’
* A friend of McKenzie-McLean has set up a Givealittle page for those who would like to contribute to her treatmentrelated costs.