In any medical school students are taught to recognise each bone and organ, the function of intricate webs of muscle and tissue and the role of each vein in the human body. But one of the most important skills is often forgotten. How do you tell a mother her baby has died?
Maura McElligott, a nurse who has worked in many London hospital’s intensive care units had to learn through practice.
Maura was a very junior nurse when a young child died from meningitis. It was suddently her job, with an accompanying doctor, to break the appalling news to the child’s father.
"It was a nightmare", she remembers. "The man went crazy and started shouting at us and hitting the doctor. We had to call the security guards."
That was one of Maura’s first grievous moments in a long career that would be full of them.
Maura says that around a third of her patients’ families: "will receive the worst news one can imagine." So she has had a lot of opportunities to think long and hard about how to break bad news.
"Suffering is something you get to see a lot, but a good nurse must never get used to death. If you reach a point when you don’t mind giving people bad news anymore, it means you are burnt out and it might mean it is time to quit."
The stress of facing up to bad news on a daily basis, let alone having to deliver it, is often cited as the main cause of resignation in the nursing and medical professions.
"It contributes significantly to burn-out and high levels of stress," says Dr Ray Owen, a psychologist specialising in the subject.
Everyday practise doesn’t necessarily make doctors or nurses more able to cope with such emotionally demanding tasks. But, according to Owen, if they could always detach themselves and remain icy, the consequences would be worse still. "It would run the risk of them doing the job less well. The best answers are appropriate training, teamwork and a good network of support from your colleagues,” he concludes.
Maura, who found out through experience what she wasn’t taught in school, now shares her wisdom with future nurses in lectures she gives at City University. She tries to prepare her successors-to-be for the tough moments they will be expected to overcome.
"We, as nurses, develop close relationships with patients and relatives; rather than the doctors, who were traditionally in charge of talking to families. This means we are often in the best position to talk to families and ease their pain when tragedy hits. But this adds even more weight to a profession that is already stressful in itself".
Maura is living proof of the toughness being a professional nurse entails. No matter the expertise accumulated over her decades of labour, she sometimes feels the impulse to leave Intensive Care and devote herself to a less-demanding job. "But then I convince myself that families need someone to help them through these hard times and that I am good at this, having learned the hard way… so I always stay."
Charles Jones, a junior policeman in Brighton, also devotes a great deal of his time to breaking bad news. However, for him it is usually a sign of professional achievement. "When I arrest a criminal, it is terrible news for him, but a big relief for society. That is what policemen are for," he says.
But sometimes breaking bad news is not so self-satisfying. When charles is assigned to do what his police station calls: "the worst job in the world", it means someone is going to receive terrible news.
"What struck me at first was that when I knocked at anyone’s door, even if it was just to ask for some information, the reaction was always the same: panic. As soon as they see a policeman at their door, everybody thinks something terrible has happened. So the first thing I try to say is: "Don’t worry, nobody is dead." But unfortunately, I can’t always say that."
Charles’ most distressing experience as a policeman happened a few months ago.
A problematic teenager died and some of Charles’ colleagues suspected it had been violent. So, before the family could have access to the body, the doctors needed to examine it for a long time. “I had to stay with all of the boy’s relatives in a room. I didn’t know what to say to make them feel better. I felt terrible," Charles remembers.
In a job where death and violence are omnipresent, developing a strong mind is as important as being physically fit in order to survive, says Charles. He believes breaking bad news sometimes has a short-term effect on him: "especially when children are involved." But, after a couple of days, he has usually overcome even the harshest situation. "I have to if I want to go back to work every morning," he says . If I let my feelings stay in the way, I would feel forced to quit."
Some bad news may not be a matter of life and death, but breaking it can be equally distressing.
After losing a loved one, it is difficult to think of something harder that being dismissed from a job you enjoy. Roy Campbell, a Human Resources Advisor for a British University, has seen grown men break down into tears the other side of his desk. "When we have to make someone redundant, it is my job to tell him or her", he says.
"I am here to support the managers’ decision, so if I sympathise too much, it means I’m not doing my job properly. It is not easy to tell someone they don’t have a job anymore, but you have to remain professional."
Campbell believes there are always objective reasons behind any dismissal, so his job is often regarded as the toughest in the company. For him the giving of bad news is simply something that "needs to be done."
However, he also likes to point out the good side to his daily activity: "I must say that I break more good news than bad. It is very rewarding to call someone in and tell them thay have been given the job they have dreamt about for a long time."
However, despite his professional attitude, there are always situations that anyone would rather avoid.
"I have never dismissed someone I really appreciate, like a colleague from my department. I don’t know what my reaction would be in such a difficult situation. To be honest, I hope that it would never happen. But ultimately if it did, it would be something I would be expected to do. Therefore I would do it professionally"
*Some names have been changed for security or confidentiality reasons.