In the TV series Breaking Bad, the main character has a terminal illness and turns to a life of crime to ensure financial security for his family before he dies. The term “breaking bad” refers to both raising H-E-double-hockey-stick and to a life of crime.

In the world of critical care, “breaking bad” implies having to tell the patient and family bad news. Not an easy task. Historically, this art isn’t taught. To protect their own emotions and fears, the person delivering the news may emotionally disengage and use medical terms instead of “leaning in” to the complexity of the situation and reactions that ensue.

Ideally, the patient and family are in a quiet private setting where they are told in person by a sensitive individual that pays attention to their emotional cues. It should be delivered in a way that finds out how much the patient knows already and how much they want to know. Some people want big picture, others want all the details, and others might not know what they want. Conversation should be respectful and medical jargon kept to a minimum while allowing time to acknowledge the patient’s and family’s responses and reactions. Once all the questions are answered, the conversation should end with a summary of what was discussed and a plan for the next steps.

Receiving bad news or a new medical diagnosis that impacts our lives in a major way can really throw our whole sense of self off balance. We look much closer and deeper at our own relationship with everything in our small piece of the world that we have known up to that point. Especially with our family and close friends. Then we look at our own mortality and it gets very real. That’s when conversations about advance directives are so important. Depending on the severity of the disease, it can include hoping for the best while preparing for the worst and also addressing emotional, spiritual and physical needs. Finding someone strong enough to “go there” with you makes such a difference as you plan for the rest of your life.

“The end of life has its own nature, also worth our attention.” – Mary Oliver

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