Another Horrible ED Sign

The patient with a Loving Family, a Job, Good Insurance and an abnormal test.  Terrible.

When they come in, with their abnormal test (a sono in this case) from an outside place, from a doctor who sends them to your ED with ‘you need more tests’, it’s hard to keep the stiff upper lip.  The family, well dressed and pleasant, just make it worse.  I know what’s coming.  I’d encourage them to run for the door, if I thought it’d help.

The sono usually says “…blah blah blah mass in the blah blahfurther imaging is recommendedblah“.

While this usually isn’t a true emergency, let’s face it: the patient deserves an answer and their doctor has given up (or in) and has sent them to me.  (And it’s not like I don’t know how to order CT’s, I do).

While waiting for the CT you imagine it’s all going to be nothing, unlike the ones before.  Very very occasionally it’s good news, and relief all around.

The vast majority of the time that CT has been utterly horrible news for everyone involved.  There are tears, and referrals, and ‘…I don’t know for certain, you need a biopsy, because diagnosis leads to prognosis…’ and I feel rotten for about a week.  Unlike the family, for whom I’ve just unmasked Death, who get to have him as a constant companion.

I don’t know if it’s because they seem so normal, or I see myself in everyone in the room, or guilt.  Dunno.  But it’s horrible.


  1. I’ve been on the receiving end of a CT scan with the result, “highly suspicious of malignancy”. Not to get too Clint Eastwood on you, but we ALL have it coming. Death is the constant companion of all.

    My doc gave me the same mindless reassurance of “We can’t know for sure that it’s cancer..blah blah blah.” I don’t know if he realized that that sort of response was recognized instantly for the BS that it is. My clinical curiousity about other conditions that masquerade as cancer was nil by that time. The doc to whom I was referred for the follow up addressed me with a more comforting get-down-to-business approach, “This is a VERY serious situation….blah blah…give you absolute best care…still must wait for biopsy results then things are going to move fast…blah blah” All of those phrases made me feel like I was in good hands and that there was a definite plan which I didn’t have to worry about. Best thing the first doc did was get on the phone in front of me and make my next appointment for me,and he described the great doc he personally knew rather than cutting me loose with just a phone number when I was overwhelmed.

  2. It’s like the time a patient’s wife asked me, after her terminally ill husband had been hospitalized for another respiratory Code Blue episode: “What does it mean when the doctor asks us ‘what we want him to do’ the next time this happens?”

    There was no way in hell I was going to explain that the doctor was asking if they wanted the patient to be declared a DNR or something. I bailed and requested the patient’s doctor explain it to them….

  3. At times it’s good to be inside a room where there are only films & cases. Not real people with jobs, families & lives that have suddenly gone from good to bad or worse.

  4. When I had suspicious pelvic masses my doc got on the phone in front of me and booked my ultrasound & CT herself, US in the am & CT in the afternoon. Then she wrote out a lab slip for my bloodwork & told me to come see her between imaging studies. When she got my US she immediately added chest to the pelvic & abdominal CT. Then she slid her chair out from behind her desk and gave me the knee-to-knee consult, telling me that I was going to need a hysterectomy. Then after examining me again, she got on the phone in the exam room while I was dressing and booked my appointment with the gynecologic oncologist.

    What kind of coward hands a patient a CT film and sends them off to the ED to avoid a difficult conversation?

  5. Steve Lucas says:

    It is terrible because you care. Some doctor somewhere has decided he/she did not want to deliver the possible bad news because that would disturb their work flow. While a handy psychological trick, they have just denounced being a doctor, and affirmed their decision to become a technician.

    Good for you, this is a job I could not do.

    Steve Lucas

  6. TheNewGuy says:

    It’s never easy to deliver that kind of news; it hits the patient like a physical blow.

    On the other hand, I’ve encountered a significant number who were not only unsurprised by the news, but seemed to already know. They simply nodded their head as if to say “Yep. I thought so.”

    It’s a painful conversation to have in the ED. It’s the kind of news should be delivered by somebody they know and trust… not some joker like me they don’t know, have never met, and probably won’t ever see again.

  7. I feel you. Just had to do the same thing myself last week. (Tell the patient, that is; not send him off to an ER.)

  8. I was told that I most likely had AML by the ER doctor at a local suburban hospital here. (I was told to go to the emergency room by my family doctor who we had been seeing for over 16 years. He later apologized to me for not telling me directly what he suspected. ) BUt I also have a problem with the ER doc. My husband had been with me initally but had to leave to pick up our son so I was alone in the room when the ER doctor entered with the results of the blood test. He casually announces that I most likely had leukemia, asks if I had ever been exposed to radiation, tells me a few other things and then leaves the room and leaves me alone with a horrible diagnosis. Could he not have waited until someone else was with me in the room to tell me the bad news? The ER was virtually empty while I was there so I am sure that he wasn’t too busy. This was not handled well either by my family physician or the ER doctor.

  9. Cases like these are one reason I am glad I am a nurse, and not a doctor. In general, nurses should not give out abnormal test results to a patient. Their primary care doctor should, so they can fully explain the prognosis, treatment options etc. This can put us nurses in horrible situations when we know the horrible result, and the patient pleads with us to tell them. What should we do?

  10. Finnan Haddie says:

    I think you should lie and say the results were given to the doctor, not you, so you don’t know. I’ll ask a nurse if my results are back but I won’t ask what they are because I know they’re not supposed to tell me. Hell, I won’t even ask the resident, because I suspect they’re not supposed to tell me either.

  11. trentlaceysunxxp says:

    I really liked it. But not bad, it would be to add a few important sections.


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