The hum of hospital staff moving to and fro filled the PICU. Beeps, alerts, and the teetering sound of life and death were commonplace here.
It was Friday. The night resident team had just scurried out of the hospital, sign-out complete. Left with my list of to-dos for the day, I began to pre-round on my patients. As I refreshed my “new alerts” tab in the EMR, a new blood culture resulted. Positive.
The sounds of the PICU seemed to still, as a blaring alarm prompted a rush to my patient's room.
A resuscitation ignited at the bedside. The room buzzed with controlled chaos as the medical team, synchronized in its effort, worked fervently to code my patient. A 4-year-old with acute lymphoblastic leukemia, now bacteremic with multisystem organ failure. She was rapidly decompensating, even on maximal pressor and ventilatory support.
The cold precision of resuscitation and fragile hope hung frigidly in the air.
Minutes of CPR came and went. Shouts for orders of “epi” filled the room. Over the cries for orders of calcium, bicarbonate, and electrolyte infusions, came perhaps the most important order:
Call her mom.
Some time passed and Mom entered the hallway.
Your child is dying.
The ICU and oncology attendings told her in the bustling hallway. I watched as they delivered the news in hushed tones, the mother's face etched with disbelief and grief. I remember pulling a chair from the nearest nurses' station for her to sit. The clunky sound of the floor scrubber squeaked by. There was faint laughter at the end of the hall from people unaware of the moment unfolding on this side of the hall. A plastic chair in the middle of a hallway during quite possibly the worst moment of a mother's life didn't feel like enough. It wasn’t enough. This was a conversation that demanded a more intimate and private setting. She deserved better.
I walked to the front desk of the unit to ask if there was another place, quieter, more private to have this conversation. I walked back to the team, and they took Mom to an unoccupied office space on the unit.
I stayed at the bedside of my patient — pulses returned, albeit critically ill, tenuous, and on the brink of death. I wondered what it must have been like for her mother to find out her child was dying — and for that to have happened in the middle of a hallway. The setting seemed incongruous for such a delicate moment.
Reflecting on that moment has helped me understand the profound impact that setting has when breaking bad news. Physical space can become an unspoken character in a person's narrative — an overlooked element that shapes the way patients and their families hear and process bad news. Good communication skills are critical, especially in ICUs, where patients can be at risk for imminent death and experience rapidly worsening clinical changes.
Choosing the right setting when delivering life-altering news to patients and their families requires a delicate balance between the clinical demands of a medical emergency and the human need for privacy and compassion. I think of that mom often. I hope that she is OK, I hope that she has grieved, and I hope that somehow, she knows that she and her daughter have made a positive impact on the way I have and will communicate with my patients for the rest of my medical career.
Sometimes, good communication entails not just what we say, but where we say it.
What has helped you with breaking bad news? Join the conversation below.
Dr. Tasia Isbell is a pediatrician at Boston Children's Hospital and Boston Medical Center. She enjoys cycling, traveling, and exploring the world through cuisine. She tweets at @DrTasiaIsbell. Dr. Isbell is a 2023–2024 Doximity Op-Med Fellow.
Illustration by April Brust
