Breaking Bad News

Roman Mars:
This is 99% invisible. I’m Roman Mars.

(knock on door)
Patient: “Come in.”
Doctor: “Hey, how are you?”
Patient: “Good. How are you?”
Doctor: “Good. So this is you.”

Roman Mars:
Imagine you’re in a hospital room, waiting to hear the results of a test you had, the doctor comes in.

Doctor: “You know last time you were here two weeks ago?”
Patient: “Yeah.”
Doctor: “Well, one of the things we did was perform a colonoscopy.”
Patient: “Yeah. It was not fun.”
Doctor: “Yeah. And, uh-”

Roman Mars:
You might sense on some level what’s about to happen.

Doctor: “You know, I got the results back and reviewed them with the help of Dr. Lu.”
Patient: “Okay.”
Doctor: “And this is difficult for me to say because unfortunately, I have some bad news to tell you.”

Roman Mars:
The muscles in your shoulders tense up, your hands suddenly feel clammy.

Doctor: “They found a mass in your descending colon.
Patient: “Okay.
Doctor: “Okay. And so they did a biopsy.
Patient: “Okay.
Doctor: “And what a biopsy does, it lets us know what kind of cells there are to see if it’s positive for cancer.
Patient: “Okay.”

Roman Mars:
And then you get some very bad news.

Doctor: “The results came back that it is an invasive adenocarcinoma. And what that means is that you do have colon cancer.”
Patient: “Ooooh.”

Roman Mars:
The cancer is basically untreatable.

Doctor: “When the cancer’s this far advanced there is no cure.”
Patient: “Oh.”
Doctor: “I’m very sorry to give you this news. I know this must be very difficult for you. And I know it’s not what you’re expecting.”
Patient: “Oh yeah. Oh, um, okay.”
Doctor: “So sorry.”
Patient: “No. It’s a …” (sighs)

Roman Mars:
Then after about 10 minutes, the timer goes off and the encounter is over.

(timer rings)
Doctor: “Please feel free to call any time if you have any questions for me.”
Patient: “Thanks.”

Roman Mars:
Okay. Everyone take a deep breath. That was not actually somebody being told they had terminal cancer. It was part of an exam for med students at Rush Medical College in Chicago.

Marc Pera:
I do remember that student and I thought he did a really, really nice job.

Roman Mars:
That’s Marc Pera. He played the patient. He went the whole day being told by medical students that he was dying and then reacting as if that was actually happening.

Marc Pera:
It’s, yeah, it’s difficult. It’s a long day. It’s a long day. It’s a little like a demented theme park job. (laughs)

Roman Mars:
But as difficult as it is, Marc is playing an important role for med students like Arti Neziri.

Arti Neziri:
It’s never a good feeling to break bad news to patients, but I understand that no matter which field I go into or which specialty, this is something that we all will have to endure at some point.

John Fecile:
In medicine, bad news is defined as any information that drastically and negatively alters a patient’s outlook for the future.

Roman Mars:
John Fecile is a radio reporter and part-time medical school videographer. He actually set up cameras to film that encounter between Marc and Arti so that Arti could be evaluated on his communication skills.

John Fecile:
And I was really surprised by how calm and compassionate Arti was. Many doctors struggle with breaking bad news. I’ve heard stories about a doctor leaving a voicemail to tell a patient she had cancer. And I heard another story about a doctor who used the sports analogy to deliver difficult information, as in “it’s the bottom of the ninth and there’s one out left”.

Roman Mars:
Breaking bad news is as delicate a procedure as any surgery and there can be serious consequences if things go wrong. If the patient doesn’t understand their diagnosis or what the next steps are, they could end up making uninformed decisions about their treatment.

John Fecile:
Which is why many medical schools now offer training. They bring in actors to help students learn how to navigate this critically important and very high stakes moments. A moment that most of us will experience one way or another.

Roman Mars:
But that’s not the only connection between acting and this particular facet of medicine.

Rob Buckman:
Over the last, you know, 20 or 30 years, there’ve been endless anecdotes just as you described. The doctor came in and said, “You’ll be dead Friday. Goodbye.” And left.

John Fecile:
It turns out one of the first doctors to recognize this problem, he wasn’t just a physician, he was also a comedian and he actually drew on that experience to transform the way that doctors break bad news.

Rob Buckman:
There are ways of doing this. There are ways of breaking bad news.

John Fecile:
His name was Rob Buckman. And his very unusual life prepared him perfectly to tackle what might be the hardest part of a very hard job.

Roman Mars:
In 1968, Rob Buckman was onstage in London’s West end doing striptease.

Pete Atkin:
I think the essence of it is that it was the strip routine that you might’ve expected a female burlesque dancer to come out and do. With Robert in this extraordinarily physically unlikely guise going through all sorts of gestures-

Russell Davies:
Getting his head stuck in his pullover and I mean it wasn’t all graceful.

Pete Atkin:
Yes. No. No. No. Not at all.

John Fecile:
This is Pete Atkin and Russell Davies, two of Rob’s best friends. They were all students together at Cambridge University and they were all members of the Footlights, a theatrical club.

Roman Mars:
It was a big deal to be in the Footlights then and it still is today. The group has turned out tons of famous comedians. Like half the comedy troupe, Monty Python, and more recently people like John Oliver. The Footlights put on reviews each year that featured comedy and music and, back in the late sixties, Rob’s strip routine was a highlight.

Pete Atkin:
He did take it absolutely seriously. He came out and did it as if it people were meant to be aroused by this routine.

Russell Davies:
He made great play with removing his watch as if this were especially erotic. Although there was absolutely nothing except taking off your watch like we all do. (crowd laughs) There was no real punchline to it was there? Except that he had a flower painted on his stomach and that was rather sweet.

Roman Mars:
Rob had gone to Cambridge with the intention of becoming a doctor. By day he studied medicine and took classes in biochemistry. By night, he wrote and performed sketches in the Footlights club room housed in the second story of a local fish shop. He slept only three or four hours a night.

John Fecile:
After Cambridge, Rob went to a teaching hospital. And it turns out that he entered medicine just as a big shift in medical culture was happening. One that changed the way doctors thought about their patients.

Roman Mars:
Around the same time, Rob was onstage in London’s West End doing a strip routine, a psychiatrist named Dr. Elisabeth Kubler-Ross was working on a pretty radical project. She was spending time with dying patients in a hospital in Chicago listening to their stories.

Dr. Elisabeth Kubler-Ross
I just sat and listened to dying patients and tried to be their spokesman. If you can only sit and listen and hear what they say, they teach you not only about dying but about living.

John Fecile:
In 1969, Kubler-Ross published a book based on her research called “On Death And Dying”. You know the five stages of grief. That’s where that comes from. The book became an international bestseller and brought conversations about dying into the home.

Roman Mars:
Kubler-Ross also encouraged doctors to speak more frankly with their patients about death. She said they needed to stop tiptoeing around the subject.

John Fecile:
Which is what doctors had done for most of the history of modern medicine. The original code of ethics established by the American Medical Association in 1847 said it wasn’t the role of doctors to make “gloomy, prognostications”. Instead, they should be ministers of hope and comfort.

Roman Mars:
Doctors were afraid that disclosing a bad diagnosis would actually be damaging and could even drive patients to suicide. This attitude remained unchanged through much of the 20th century.

Dr. Walter Baile:
In the 50s. The word cancer wasn’t used.

John Fecile:
Dr. Walter Baile is a psychiatrist and a professor at the MD Anderson Cancer Center. It’s part of the University of Texas and Houston.

Dr. Walter Baile:
There was a lot of deception that went on around how sick people really were. You couldn’t talk about the patient dying, so you can imagine nobody really was able to say goodbye.

Roman Mars:
In 1951, the Journal of the American Medical Association actually published methods for deceiving cancer patients and their families. They’d recommended giving evasive answers or using confusing euphemisms like calling cancer an ulcer or an infection. The same article recommended that cancer patients who learned the truth of their diagnosis and reacted badly to it, be given lobotomies.

John Fecile:
And this attitude was pervasive. In 1961, a survey showed that 90% of doctors preferred not to disclose cancer diagnoses to patients. Despite another study showing that the vast majority of patients wanted to know the truth.

Roman Mars:
But then things started to change. In the 1960s, doctors developed effective treatments for cancer.

Dr. Walter Baile:
The two big advancements were chemotherapy and radiation therapy. The research just exploded. Patients have a lot more to hope for than they did in the fifties.

John Fecile:
And around the same time, palliative care emerged as a concept in medicine.

Dr. Walter Baile:
We began to realize that controlling pain and other symptoms could give people a peaceful death. The modern palliative care movement, together with hospice, has really made death less fearful for people.

Roman Mars:
These developments, along with the work of Elizabeth Kubler-Ross all started to change the way our culture talked about death and dying, and it was in this context that Rob Buckman became a doctor.

John Fecile:
A doctor who’s totally irreverent take on medicine would ultimately help him transform the field.

Clip from The Pink Medicine Show:
“Oh, doctor can you help me cause my knee’s-”

Roman Mars:
Rob’s work in the Cambridge Footlights got him noticed by the BBC. While still training as a doctor, he wrote in performed on radio and TV. In 1978, he and his writing partner were given their own comedy program. It was called The Pink Medicine Show.

Clip from The Pink Medicine Show:
“Think I’ll give them all a dose of my pink medicine. Try pink medicine. Why pink medicine? Eh.”

John Fecile:
The Pink Medicine Show was like SNL or Mad TV, but all medical sketches. There was actually a lot of comedy about medicine at this time, especially in Britain. Doctors were seeing as these stodgy and distant authority figures, so they made a good target for satire.

Roman Mars:
One of Rob’s recurring characters on the show was a malingerer, a guy pretending to be sick, who keeps showing up at the hospital with different ridiculous excuses.

The Pink Medicine Show –
DOCTOR: “What is it?”
PATIENT: “It’s about my bowels.”
DOCTOR: “Your bowels. I mean, what’s the matter? Aren’t they regular or something?”
PATIENT: “Oh, no, no. I’m regular every morning on the dot of eight o’clock.”
DOCTOR: “Every morning on the dot of eight o’clock I mean, that’s marvelous. What are you worried about?”
PATIENT: “I don’t wake up till nine.”

Roman Mars:
Rob’s success caught the attention of another Footlights alum.

John Cleese:
Mostly we laughed a lot because he was funny. He was one of the half dozen people that I spent most of my time laughing with.

John Fecile:
That’s John Cleese. You know Monty Python, Faulty Towers, A Fish Called Wanda, the James Bond movies. I think he’s in one of the Harry Potters. Anyway, when I reached him, he was getting ready to go on safari.

John Cleese:
Well, I’m off tomorrow for three and a half months. So I’m in the usual state of wondering what I’ve forgotten to pack.

Roman Mars:
In 1979, John Cleese was producing The Secret Policeman’s Ball, a comedy show that benefited Amnesty International. And he asked Rob if he’d appear in a sketch with him and Michael Palin. The old Monty Python bit known as “The Cheese Shop Sketch”.

The Cheese Shop Sketch –
JOHN CLEESE: “Now there my good man, some cheese if you please.”
THE CHEESE SHOP: “Oh yes sir. Yes, sir. What would you like?”
JOHN CLEESE: “How about a little Red Leicester?”
THE CHEESE SHOP: “I’m afraid we’re fresh out of Red Leicester.”

John Cleese:
Ah. Yes. It’s a very silly Python sketch in which a man goes into a cheese shop to buy some cheese and it slowly becomes obvious that they don’t actually have any, any cheese in the shop.

The Cheese Shop Sketch (continued) –
JOHN CLEESE: “Gorgonzola?”
THE CHEESE SHOP: “No.”
JOHN CLEESE: “Parmesan?”
THE CHEESE SHOP: “No.”
JOHN CLEESE: “Mozzarella?”
THE CHEESE SHOP: “No.”
JOHN CLEESE: “Triple creme?”

John Cleese:
As the man puts it, it seems to be a shop entirely uncontaminated by cheese.

The Cheese Shop Sketch (continued) –
JOHN CLEESE: “Venezuelan beaver cheese perhaps?”
THE CHEESE SHOP: “Not today, sir. No.”

John Fecile:
The whole time this ridiculous exchange is taking place. A Greek bouzouki band is playing in the background of the shop. And there are two guys doing a weird dance with their arms around each other’s shoulders. One of those guys was Rob.

John Cleese:
And then at a certain point my character got so irritated by the lack of cheese that I turned and snapped at the Greek dancers.

The Cheese Shop Sketch (continued) –
JOHN CLEESE: “Will you stop playing that-”

John Cleese:
Who then stopped and slunk off.

Roman Mars:
Rob’s appearance with Monte Python marked one of the high points of his comedy career. But if you look closely, you might notice his face looks pale and a little puffy. That’s because after finishing his medical training and establishing himself in the comedy world, Rob got really, really sick.

John Fecile:
Soon Rob would learn firsthand what it was like to be a dying patient and this role reversal, from doctor to sick person, would transform how he thought about his work as a physician and the process of breaking bad news.

Rob Buckman:
In April 1978, I contracted a very interesting and fairly rare disease. Interesting, not just because it affected me and turned me from a doctor into a patient, but also because it’s one of a group of diseases in which the body’s defenses attack the body itself and in which you become literally your own worst enemy.

John Fecile:
That’s Rob from a TV documentary he made about his illness as he was becoming sicker. It’s called “Your Own Worst Enemy”.

Rob Buckman:
It began very simply and very mildly with pain in my right wrist and when I moved my wrist it creaked and at that point…

Roman Mars:
Rob had dermatomyositis, a very rare autoimmune disease.

John Fecile:
The disease causes your body to malfunction and attack its own muscle tissue. So Rob wasted away and he developed these rashes all over his body.

Rob Buckman:
At one point, I couldn’t actually put my hands behind my head because so much of the skin was inflamed. It was like wearing a leather jacket that had been shrunken onto you. I was sort of encased in it.

John Fecile:
Rob was married at this point and had two daughters. One of the more poignant moments of the film captures Rob trying and failing to pick up one of his girls. He talks about how weak and vulnerable he feels.

Rob Buckman:
What happens is very, very simply, the color drains out of everything. It’s the same scene. It’s the same family. It’s the same house. But all the color, the things you enjoy have simply the tone of the illness about them.

Roman Mars:
For a while, Rob’s condition was so bad that his doctors thought he might not make it and the experience of being that close to death was profound. Years later he’d recall an especially important encounter with one of his physicians.

Rob Buckman:
And I was sitting there and I was very arthritic and I had all kinds of problems with the skin and bowel and everything like that. I was in deep trouble. And I was feeling lousy. He said, “You’ve got this. You’ve got that. You’ve got the other. You’ve got the skin. You’ve got the muscles. It must be awful for you. I am sorry.”

John Fecile:
“It must be awful for you. I’m sorry.”

Rob Buckman:
And I very nearly burst into tears and hugged him because he gave me permission to feel ill.

Roman Mars:
The doctor was telling Rob that it was okay to have feelings about being sick. That the negative emotions were a valid part of the experience. The doctor was paying attention, not just to Rob’s physical state, but also his emotional state.

John Fecile:
And while this might seem obvious, it wasn’t especially common for doctors to do this back then. This moment was simple but important. It would go on to become the cornerstone of Rob’s approach to doctor-patient communication.

John Fecile:
And then little by little, Rob started getting better. He was having blood plasma replacement therapy and a new drug he was taking started to work.

Rob Buckman:
The last four weeks have been like a gift. I can drive my car. I can straighten my elbows. I can dress myself. I can put any kind of socks on, even wooly socks.

Roman Mars:
By May of 1980, Robert’s condition had turned around.

Rob Buckman:
I can go for walks in the park with the kids and not feel too bad about it. And I can stay awake all day and watch television in the evening or whatever and I can go to bed at midnight and live a normal life, which is really, is fabulous.

Roman Mars:
For Rob, normal life meant going back to his incredibly intense work schedule. He was more successful than ever training as a specialist in oncology, which is the branch of medicine that deals with cancer, while simultaneously co-hosting a popular TV science show called “Where There’s Life”.

Clip from “Where There’s Life” –
“Where There’s Life” returns. As doctors, Miriam Stoppard and Rob Buckman explore such topics as cosmetic surgery, unwed mothers, and the nursing profession.

John Fecile:
That intensity wasn’t good for his marriage. He and his wife ended up getting a divorce. And in 1985, Rob moved to Toronto to take a job at a hospital.

Roman Mars:
In Canada, Rob had to restart his life completely. But it was there he would end up making his most lasting contributions to the field of medicine.

John Fecile:
He started studying the way that doctors communicated with people they were treating. Specifically he was interested in how doctors interacted with dying patients because he himself had recently been a dying patient. This is from an interview he gave in 1999.

Rob Buckman:
The great thing about being ill, from my point of view, was that I found out that I could tolerate, I mean, I did tolerate a fair amount of pain and handicap and stuff, but I didn’t collapse. I wasn’t a hero by any means, but I wasn’t a different person.

Roman Mars:
His big realization was that doctors didn’t need to hide information from their patients and tiptoe through tough subjects. Sick people could withstand a lot.

Rob Buckman:
So when I recovered I was then able to say, “Okay, I’ve been under fire and I stayed the same. Now I can be brave when talking to the patient.”

Dr. Patricia Shaw:
He walked in my room like a breath of, not fresh air, it was sort of like a wind. This huge energy sort of exploding into the room and I’d never actually met anybody quite like him before. I think most people haven’t.

John Fecile:
Dr. Patricia Shaw was a cancer researcher at the same hospital where Rob worked in Toronto. She goes by Pat.

Roman Mars:
Pat and Rob met in the most doctorly meet-cute scenario imaginable.

Dr. Patricia Shaw:
He was told that I had the best microscope. I had the newest microscope. And so he came in to see me and that’s how we really met, our first conversation.

Roman Mars:
One thing led to another and they got married in 1988. It was around this time that Rob started writing more.

Dr. Patricia Shaw:
He had a large piece of solid mahogany that he’d brought with him from England and his favorite spot was to sit at this desk at his computer. So even though he’s really busy at the hospital, he spent a huge amount of time after those hours working in his study.

John Fecile:
Rob wrote a book called, “I Don’t Know What to Say: How to Help and Support Someone Who is Dying”. It’s kind of like what to expect when you’re expecting, if what you’re expecting is that somebody close to you is going to die soon. It’s a very frank but easy to read book that covers everything from basic listening skills to the sexual needs of the dying to survivor’s guilt.

Roman Mars:
And then in 1992, Rob published the most important book of his career. It was titled “How to Break Bad News”. The first medical textbook on the subject.

Dr. Walter Baile:
When Rob Buckman wrote the book on how to give bad news, it was from his experience as an oncologist having to give it several times a week.

Roman Mars:
That’s Dr. Walter Baile again. He was also studying doctor-patient communication when Rob’s book came out.

Dr. Walter Baile:
He understood that bad news was a series of steps. It could be broken down into a series of steps.

John Fecile:
Walter and Rob would eventually write a set of guidelines based on Rob’s book. They called their strategy the SPIKES protocol.

Roman Mars:
SPIKES was an acronym that stood for setting, perception, invitation, knowledge, emotions, strategy and summary. It’s a pneumonic device that doctors can use as they prepare to give bad news and then during the actual conversation with the patient so that it doesn’t fly off the rails.

John Fecile:
You didn’t worry that it sounded too, I don’t know, spiky.

Dr. Walter Baile:
No, we didn’t. We didn’t even think of about it because it was so elegant. Everybody remembers that.

Roman Mars:
Soon Walter and Rob were giving presentations on SPIKES at hospitals all over the world. They made videos for medical schools which demonstrated how SPIKES could help doctors navigate these difficult conversations.

John Fecile:
In some of the videos, Rob performs improvised scenes with actors playing patients or family members. Just like you heard Arti doing with Marc at the beginning of this episode. Not real, but really intense.

Rob Buckman:
Here is the six step protocol which has the rather inelegant and threatening acronym SPIKES.

SPIKES Instruction Video –
ROB BUCKMAN: The letters stand for: “S” for setting.
Getting the physical context right. Sit down. Try to look relaxed. Make eye contact except if the patient is either angry or crying. Important to have Kleenex right at hand.

ROB BUCKMAN: Perception. Assessing the patient’s perception of his or her medical situation.
“When you got that chest pain or when you found that lump in your breast, what did you think was going on?”

ROB BUCKMAN: Then comes the pivot of the whole interview. When you ask the patient what he or she would like to know, hence “I” for invitation.
“Do you want to know the exact results of the bone scan and know what is going on? Is that the kind of way you’d like me to handle the information?”

ROB BUCKMAN: “K” for knowledge. Giving the medical facts.
“Dr. Wilson took a little bit of that growth from the lung and we looked at it under the microscope. I’ll go ahead and tell you what it was.”

ROB BUCKMAN: Give the information in small chunks and always check that the patient understands what you are saying after each small chunk.
“It showed that the growth was malignant growth, a cancer, in other words of the lung.” “I have cancer of my lung?”

ROB BUCKMAN: And the all-important “E” for emotions. Acknowledge and name the emotion that the patient is expressing.
“This is obviously a great shock to you. This is difficult to believe. This must make you feel awful. This is overwhelming.” Your ability to empathize with the patient’s emotions is the single most important characteristic of good and supportive news breaking. Without it, you’re going to appear insensitive and of little support.

ROB BUCKMAN: And then “S”, strategy and summary.
“So what did we do from here?”
“What we do from here is very important.”.

ROB BUCKMAN:
Whatever it is that’s going to happen next, make it clear.

John Fecile:
As you can hear from those scenes. Rob was masterful at breaking bad news. He was calm, present, compassionate and clear. And he was good at it, not just because he’d been a patient, but because he’d been a comedian.

Dr. Walter Baile:
It’s the ability to put yourself in your audience’s shoes and understand what makes them tick, right? So if you’re a comedian, you want to know what you can do to make people laugh, right? If you’re a doctor, you need to put yourself in people’s shoes and imagine what they need in order to make sense out of the process of giving bad news.

John Fecile:
Even though Rob had recovered from his illness, it had taken a toll on his body and he had health problems for the rest of his life. A case of shingles left him paralyzed on one side. He had difficulty dressing himself and walking. And he couldn’t drive a car.

Dr. Patricia Shaw:
And that was pretty devastating.

John Fecile:
Again, Rob’s wife Pat.

Dr. Patricia Shaw:
To have this insult. Leaving him with this permanent deficit I think was really, really damaging and he had a hard time coping with that.

Roman Mars:
But in his typical Rob way, he kept working on his many projects. In 2011, he flew to London to film a series of health videos with Terry Jones, another member of Monty Python. Then he got back on the plane to Toronto.

Dr. Patricia Shaw:
After his flight got in. He didn’t arrive and he wasn’t answering his text messages. It wasn’t too unusual. He’s traveled so much. Flights got delayed. I went to bed and about midnight there was a knock on the door and there was a policeman at the door.

Roman Mars:
Doctors aren’t the only ones who have to break bad news.

Dr. Patricia Shaw:
He talked a bit of nonsense then asked if I was Mrs. Buckman. And then eventually got around to saying that Rob had passed away.

Roman Mars:
Rob had died in his sleep on the plane from an undiagnosed heart condition. He was only 63. It took Pat a long time to get over the shock.

Dr. Patricia Shaw:
There was so much missing Rob. There is so much about having to deal with the realities of what happens when somebody dies.

John Fecile:
And even though Rob himself had talked openly about death and dying, even though he’d spent years writing books that encouraged people to be frank about these subjects, he wasn’t actually ready for his own death.

Dr. Patricia Shaw:
In real terms, you know, like finance and insurance and all that kind of stuff. So it was, it was hard. Even now, six years later, it still makes me a bit teary thinking about it.

Roman Mars:
Beyond Rob’s death, SPIKES has endured. It’s been absorbed into the mainstream of American medicine.

John Fecile:
Just recently, the American Society of Clinical Oncology started recommending that doctors use a protocol when giving bad news. They offer SPIKES as a good example. And SPIKES is taught in many medical schools in the US and Canada. As well as schools in Europe, Asia, and South America. You remember Arti, the medical student from the top of the show, he used SPIKES to navigate his encounter with Marc, the actor.

Arti Neziri:
Oh gosh. Yeah. I think if I hadn’t had the SPIKES protocol training beforehand, I would have been completely lost. I would not have known kind of where to go next.

Roman Mars:
SPIKES isn’t the only set of guidelines for breaking bad news and it may not apply to every bad news situation. In some scenarios, like in an emergency room, doctors might not have the time to be that delicate.

John Fecile:
And time is one of the main things working against doctors as they try to do their jobs thoroughly and compassionately. These days the average physician visit lasts about 21 minutes. More than half of visits lasts 15 minutes or less. It can be really stressful to try to convey necessary information in that amount of time, especially if somebody is freaking out because they’re dying.

Roman Mars:
And throughout the course of their careers, many doctors will have to break bad news over and over and over again. It’s emotionally exhausting.

John Fecile:
SPIKES helps doctors do what they need to do in the limited time they have. It turns the awful task of breaking bad news into a clear and simple set of steps. What it really is is a protocol that can help doctors be more like Rob, or at least the person he tried to be – open, honest, and empathetic. Here’s John Cleese again.

John Cleese:
I think it takes empathy. How can you talk to someone, whether it’s a group of people or a single person? How can you talk to them if you don’t have an empathetic feeling of basically who they are, what they know already and what they need to know?

John Fecile:
Rob’s funeral was held in Toronto. The same minister who married Rob and Pat led the service. Before Rob died he requested that this song be played as people exited.

Music from the song “Daydream”:
“What a day for daydream. What a day for a daydreaming boy.”

Rob Buckman:
At my funeral service, I want to record a message which is played as the people are leaving and it’s just me. And I’m going to say, “Thank you so much for coming. Unlike the rest of you, I don’t have to get up in the morning.”

Music from the song “Daydream”:
“I’m blowing the day to take a walk in the sun. And fall on my face on somebody’s new mowed lawn.”

Roman Mars:
That message wasn’t actually played at Rob’s funeral even though he joked that he wanted it to be.