Butler Production Co. Helps Doctors 'Breaking Bad News'

It was fake. It was a production. The parents were actors. There was a camera in the room, fully visible to the  doctoral resident going in to give them the scripted bad news.

Still, it didn't stop Pamela Garrettson, manager of public relations for the hospital, from turning away with tears in her eyes.

"This one's not easy," the mother of two young children said.

On Tuesday, Garrettson invited media to sit in on what has been dubbed the "Breaking Bad News Project," a program started last fall by Dr. Anthony Orsini, staff neonatologist for the Department of Pediatrics with MidAtlantic Neonatology Associates. Conducting its second series of bad news scenes, Morristown Medical Center residents–doctors in their first to third years of practice–are being put in scenarios they will likely have to face in their medical careers. They are being asked to present the "parents" with bad news, and asked to deal with the situation. They have to respond to such events as being told a 16-year-old star basketball player might have to get his leg amputated, or that a nine-year-old boy who wasn't feeling well the day before has died suddenly due to Toxic Shock.

Tuesday afternoon, third year resident Emelynn Fajardo delivered the bad news about the Toxic Shock to actors Leslie Reagoso and Kevin Bohl.

"He was just a sick little boy a few hours ago," father Bohl said during the scene.

"Where is my boy?!" a nearly inconsolable mother Reagoso shouted, while an uncomfortable Fajardo paused and tried to work through the scene.

Orsini said there was no program like this, preparing doctors to deliver bad news in a way that benefits the situation, and benefits those suffering. "How you break that bad news, this is an important skill," said Orsini, who has been working with a committee at the hospital for several years on the project, before grant funding allowed it to finally go forward last year. "How you deliver that news will be with them forever."

The project hit home for Bob Lukasik who, along with Cheryl Galante, run the Bleu Moon Agency, the Butler-based production company handling the "Breaking Bad News Project."

While it was nearly 40 years that Lukasik, 60, lost his mother to Peritonitis, he said he will never forget how a nurse at the hospital gave him the life-changing news.

"One night, I get a call at 3 a.m. saying my mom had taken a turn for the worse," Lukasik said. He rushed to the hospital and, when he asked a nurse about his mother, the nurse looked up from her clipboard and, without breaking stride, pointed. "'Your mom's in there. She's dead,'" he recalled the nurse saying.

"I remember the entire thing," Lukasik said. "She was busy with her charts. There were no niceties. There was complete negativity."

There was no negativity from Dr. Mary Ann LoFrumento, who actually had the case of the boy who died from Toxic Shock 12 years ago. Without hesitation, she said, "it was probably one of the worst moments of my life."

The event was so traumatic, LoFrumento called a staff meeting afterward, to openly discuss how they can and should deal with situations like this, that could benefit both the family and the doctors. "We did not make it worse; we hopefully made it better," she said.

After the scene, Reagoso and Bohl left to collect themselves, as did Farjardo. Then, Orsini and doctors Karen Knops, Colin O'Reilly and Sheryl Vassallo–who had watched from an adjacent room via monitor–reviewed what they had seen, what the resident did well and what she could improve.

The general consensus: "It wasn't fun," Farjardo said, followed by a nervous laugh.

"They were so emotional," she said. "It's hard to say everything you want to say. I wanted to explain more about what happened. All they wanted to do was be with their child."

"This is part of what we do," Knops said. "Remember: You're here to help the situation. You can be calm. Take a moment–I'm here for these people. Just your presence is therapeutic. ... It's kind of like white water rafting. You never know what to expect. But, you'll learn those skills."

In total, Farjardo was with the actors for seven minutes and 33 seconds. When asked how long it felt, however, she said, "forever," while everyone let out a tension-breaking chuckle.

LoFrumento, like most doctors, never received training in the delivery of bad news. Now, she, like Orsini, hope the project can expand beyond pediatrics, and even beyond Morristown Medical Center.

"This has been a dream of ours for a while," she said. "We know what they need to do to be better in the future. And, it's amazing to see."