🩺 The Art of Breaking Bad News – A Lesson Beyond the Textbook

 🩺 The Art of Breaking Bad News – A Lesson Beyond the Textbook

Published by Dr. Shane Halpe – Family Doctor & Medical Educator
📍 Faculty of Medicine, University of Moratuwa | 🕊️ Inspired by a teaching moment in Jaffna

Modern medicine is not just about diagnosing illnesses or prescribing treatment. At its core lies the sacred responsibility of communication—especially when the news is hard to hear.

Whether it's informing a parent about their child’s autism diagnosis, telling a patient they have cancer, or discussing end-of-life care, breaking bad news is part of the everyday reality for doctors. And yet, it's one of the most emotionally demanding and least formally taught skills in medicine.

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💬 Today’s Teaching Moment in Jaffna

This morning, I was part of a teaching session with 4th-year medical students doing their Psychiatry rotation at the Faculty of Medicine, University of Jaffna. The session was on breaking bad news—a topic often glossed over in textbooks, but deeply relevant in practice.

In one of the exercises, my colleague role-played the father of a 15-year-old boy diagnosed with an aggressive bone tumour: osteosarcoma. The student had the task of gently and clearly breaking this devastating news. As expected, the exercise was intense and emotionally charged—mirroring real-life clinical encounters.

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🧠 A Story That Left an Impression

As the discussion unfolded, our consultant shared a powerful anecdote from his early career. He spoke of his time working as a junior doctor under a respected orthopaedic surgeon, Dr. Punchihewa.

Unlike many of his peers, Dr. Punchihewa spent less time in the operating theatre and more time with patients and their families—listening, explaining, and offering emotional support.

His philosophy?

> “You can always mend a broken bone, but you cannot mend a broken mind.”

This left a lasting impression on everyone in the room. It reminded us that the true essence of medicine lies not just in fixing bodies, but in healing hearts and minds.

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💡 More Than Just Clinical Skills

This experience taught me an important lesson:

Being emotionally intelligent, empathetic, and sensitive to patients’ emotions is just as important as clinical knowledge and technical skills.

In an era dominated by AI and medical technologies, we must not allow the human touch to fade into the background. Machines may help us diagnose and monitor, but they can’t replace a kind word, a comforting presence, or a moment of shared silence in a time of grief.

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📚 The Way Forward for Medical Education

As educators, we must ensure our students don’t just learn how to treat illness—but also how to treat people. Teaching soft skills like breaking bad news should be given the same importance as clinical training.

If not, we risk creating a generation of doctors who may know how to cure a disease—but not how to connect with the person behind the illness.

And that would truly be bad news for the future of our profession.

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📖 “You can always mend a broken bone, but you cannot mend a broken mind.”

Let this be a guiding principle for every doctor, teacher, and medical student.

Lunch at the Kovil: A Taste of Community and Culture

 Lunch at the Kovil: A Taste of Community and Culture

Dr. Shane Halpe 

It was Wednesday, supposed to be business as usual. But, something remarkable happened.

It was midday after work, and as usual, I was wondering where to go for lunch. My colleague and I typically rotate between the medical faculty canteen, the traditional eatery Ammachi on Palali Road, or a non-vegetarian spot called Hotel New Selva on KKS Road. Lunch in Jaffna has always been a little highlight of the day—simple, hearty, and satisfying.

As I wandered near Kondavil, I heard the rhythmic sounds of percussion and flutes echoing through the air. The music was coming from the nearby Arasady Pillaiyar Kovil. The festive melodies were loud, vibrant, and so captivating they made you want to dance. A large crowd was gathering in procession. At the center, a group of men and young boys—bare-chested and solemn—were carrying Lord Ganesha on their shoulders and necks with reverence. It was a powerful sight. Some of the older men bore thickened necks, a lasting sign of years spent bearing their deity with devotion. Women in bright, beautiful sarees followed behind in reverent joy.

Just then, my friend called out to me, “Anna, why not join me? Let’s go to the Kovil for lunch.”

I was surprised. “Lunch at the Kovil?” I asked.

A few nearby medical students explained—it was the beginning of the temple festival, a 10-day celebration. During this period, the temple community organizes almsgiving—offering meals, either lunch or dinner, to anyone who comes. No invitation is needed.

I decided to join.

I was guided to sit on the floor along the wall of a large hall, shoulder to shoulder with others. Men and women sat separately. The entire community was present—young and old, rich and poor, people from different walks of life, castes, and classes. There was no hierarchy here. No discrimination. Only unity.

We were served a sumptuous rice and curry meal on banana leaves—various vegetable curries, fragrant, warm, and plentiful. There was enough for everyone and then some. It reminded me of the dansala held during Vesak, but this was my first time experiencing something similar at a Hindu temple.

As I ate, I realized how special this moment was. It wasn’t just about the food—it was about the spirit behind it. The kindness. The sharing. The quiet, powerful truth that no one was left behind. Everyone was welcome, and the only requirement was to simply be human.

Sharing a meal with friends and strangers is a deeply intimate act. It breaks barriers. It fosters unity. Today, I witnessed a beautiful example of communal harmony—rooted in culture, tradition, and the joy of giving.

And most of all—it was fun.

From Fast Food to Heartburn: A Wake-Up Call for the Body and Soul

From Fast Food to Heartburn: A Wake-Up Call for the Body and Soul

Dr. Shane Halpe 

It all started on Sunday. I arrived in Jaffna late at night via the NCG luxury bus and got off at Chunnakam. Breakfast came much later in the day—just a couple of toasties. I skipped lunch altogether, as I had to join a field meeting at 1:30 p.m. I figured it was a good opportunity to extend my fast.

Much later in the evening, our hosts kindly offered us tea and ordered some snacks at a café. I had a coffee with milk and indulged in what was served—fish and chips, onion fritters, and some spicy devilled chicken. That ended up being my lunch.

Later that night, hunger returned with a vengeance. While walking through Jaffna town, I saw a fast-food outlet still open alongside an ice cream shop. I thought to myself, “Why not? You’ve earned it.” So I gave in to the craving—a burger and some ice cream to cap off the day.

But something was wrong.

Soon after, I developed a bloated, heavy feeling in my stomach. It quickly progressed to a burning sensation in my upper abdomen. Lying down became unbearable. I realized I was experiencing heartburn—what we call gastroesophageal reflux in medical terms. Nothing helped. I stayed awake the entire night, unable to sleep. I drank a small pack of milk from the fridge for relief, but it only provided a temporary reprieve.

The ordeal repeated itself over the next two nights. Still no proper sleep. Still bloated, still uncomfortable. I tried everything—cold water, propping up with two pillows, lying on my left side, yoghurt drinks, fresh milk, Gaviscon, Eno, Omeprazole, Domperidone, Mosapride—you name it.

In the midst of my discomfort, I attended a casual get-together at a local restaurant. Friends offered a drink, but I immediately refused. “No, I can’t bear this pain anymore,” I said.

One of my friends then opened up about his own struggles with chronic gastritis. He had developed complications in his esophagus due to prolonged reflux and had since given up alcohol for over two years. He eats small meals, avoids acidic and spicy foods, and carries Omeprazole with him at all times—he even offered me a tablet on the spot. Listening to his story, I felt both humbled and convicted.

As I write this, I realize how poorly we sometimes treat our bodies. We indulge in fast food, oily meals, sugary drinks, caffeine, and alcohol—often while sitting for hours with little physical activity. We take our bodies for granted.

A thought crossed my mind—something rooted in my Catholic upbringing:

“ Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? Therefore, honor God with your bodies.”
— 1 Corinthians 6:19–20 (NIV)

But honestly, I’ve been treating mine more like a dustbin than a temple.

This experience was a painful reminder that our bodies deserve reverence. It’s time we make a change—take our health seriously, and begin to care for ourselves in ways that are mindful, respectful, and rooted in gratitude.

Let’s begin treating our bodies as the sacred temples they are.

Finding My Voice: A Journey Beyond Fear and Judgment

Finding My Voice: A Journey Beyond Fear and Judgment

- Dr. Shane Halpe 

Yesterday marked a personal milestone in my life.

No, it wasn’t about passing an exam, winning a championship, or graduating from university. Yesterday, I sang two songs in front of an audience—and to me, that was a significant achievement.

Let me explain why.

As a child, I was terrified of singing. I disliked the sound of my own voice and avoided singing during church services. Even though I began reading the Bible during Mass, I never dared join the choir. That all changed one day when the church pianist gently encouraged me to give it a try.

I joined the English Choir at Our Lady of Fatima Church in Maradana and found not just music, but friendships that have lasted to this day. Slowly, without realizing it, I began to overcome my fear. A mentor we fondly called “Neville Uncle” helped shape my confidence, urging me to sing out loud, to come closer to the mic. I began to hear something new: that maybe I had a good voice—a God-given one.

Though I continued to sing in church, I still avoided public singing. I recall once trying to sing with friends at university, only to be met with teasing. Though said in jest, those words wounded my confidence. And so, I retreated from the stage.

Years later, after passing my postgraduate Family Medicine exam, a colleague asked me to sing at a celebration. Nervously, I accepted. I practiced with YouTube karaoke tracks and sang “Quando, Quando, Quando.” To my surprise, friends praised my voice. It was amateur, yes—but it broke a barrier I’d carried for years.

That moment led to another.

Yesterday, a colleague asked if I’d sing at the Faculty of Medicine, University of Jaffna get-together. I said yes—despite not knowing many people there and navigating language barriers. I sang “Can’t Help Falling in Love” by Elvis Presley and “Master Sir,” a Sinhalese classic. Even the Acting Dean came over to commend me. I was deeply moved.

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Looking back, I am grateful.

Grateful for the chance to push past fear.

Grateful for the people—my parents, teachers, mentors, and friends—who helped me grow.

Grateful even for the critics who said I wasn’t good enough.

During my time at SAITM, I heard so much negativity. Media narratives painted us as “spoiled kids” who didn’t deserve to be doctors. A doctor once mocked me at the National Hospital, calling me a “backdoor medical student.” I was in my first year. The pain was real.

But I’ve learned this:

Society may try to break you. But if you surround yourself with people of faith, hope, and courage, you will rise.

Even your enemies can become your greatest motivators.

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So here’s my message to you:

🌟 Believe in yourself.

🌟 Enjoy what you do.

🌟 Surround yourself with good people.

Be thankful for the journey. For the battles. For the growth.

And keep striving to become the best version of who you are.

Live victoriously—every single day.

When a Wasp Delivered a Birthday Blessing

When a Wasp Delivered a Birthday Blessing

By Dr. Shane Malitha Halpe

October 2021 marked the beginning of my journey as a doctor beyond the safety net of internship. I had just completed my final rotation and was appointed as a Medical Officer (Relief) under the Regional Director of Health Services in Puttalam. My assignment? A rural divisional hospital in Kottukachchiya—about 12 kilometers inland from Puttalam town.

Kottukachchiya was quiet and unassuming. The hospital, a Type C divisional facility, had been without a doctor for nearly six months. Staff spoke of doctors who had either been transferred, gone on maternity leave, or left for postgraduate training. When I arrived, I was alone—appointed as Medical Officer-in-Charge by default. There was no nursing officer, no second doctor but a visiting a dental doctor. Just a midwife, a few attendants, a dispenser and an ambulance driver.

It was a humbling start.

Although I had trained in paediatrics and surgery, I had little experience in general practice and virtually none in administration. Every form, every protocol, every decision—I had to figure out on the spot. My daily work revolved around OPD consultations, antenatal care, and medical clinics. The pace was slow, the workload manageable. The staff were kind, though not accustomed to high-pressure situations. Most patients came with everyday complaints—coughs, joint pain, minor infections, and check-ups.

Saturdays were half-days, and I looked forward to them. On one particular Saturday, I was especially eager to get home—it was my mother’s birthday. I had packed early, hoping to catch the afternoon bus to Wattala. By 11 a.m., the OPD had quieted down. I was almost ready to leave.

Then came the three-wheeler.

It rushed into the hospital compound, carrying two women—mother and daughter—surrounded by anxious villagers. They had been attacked by a swarm of wasps while riding a motorcycle. Panic filled the air as they were wheeled into the dusty, rarely used ward. I heard someone shout, “Doctor! Come quickly!”

I rushed in.

The younger woman appeared distressed but stable. The mother, however, was pale, clammy, and semi-conscious. Her pulse was thready. She was sweating and cold to the touch. Her blood pressure? Undetectable. My heart sank. I had never managed a case of anaphylaxis on my own. But amid the chaos, a lesson from my final year medicine rotation under Prof. Kolitha Sellahewa echoed in my mind:

"Anaphylaxis? Give adrenaline. Adrenaline!"

I called for the cardiac monitor—it hadn’t been used in ages, and no one knew how to operate it. I connected it myself. I asked for adrenaline—only two vials remained in the hospital, and one was expired. I took the viable vial.

With trembling hands and a pounding heart, I drew up 0.5 ml of adrenaline (1:1000) and injected it into the patient’s thigh. I prayed as I watched and waited.

Slowly, to my relief, her condition began to stabilize. Her pulse strengthened. Her blood pressure returned—120/80 mmHg. The adrenaline had worked.

Realizing the limitations of our rural facility, I arranged an immediate transfer to Puttalam Base Hospital. She was safely loaded into the ambulance, stabilized and conscious. Only then did I allow myself to breathe.

As I turned to leave, I mentioned to the midwife—half-apologetically—that I was now late for my mother’s birthday and hadn’t even bought her a present. She smiled gently and said:

“Doctor, you’ve already given her the best birthday gift. You saved a life today.”

That evening, when I finally made it home—disheveled, drained but deeply thankful—my mother met me with a warm hug. The midwife had already called to share what had happened.

With tears in her eyes, she whispered:

“Thank you, son. This birthday, you gave me the most precious gift a mother could receive.”

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Looking back, that day in Kottukachchiya was more than a clinical experience. It was a rite of passage. I stepped into responsibility, leaned on my training, and learned that even the most basic of settings can become the backdrop for life’s most profound lessons.

It reminded me that healing isn’t always about technology or titles.

Sometimes, it’s simply about being present—when it matters most.

And perhaps, that’s what Family Medicine is truly all about.

𝗣𝘂𝗿𝗽𝗼𝘀𝗲 𝗟𝗶𝘃𝗲𝘀 𝗢𝘂𝘁𝘀𝗶𝗱𝗲 𝘁𝗵𝗲 𝗖𝗼𝗺𝗳𝗼𝗿𝘁 𝗭𝗼𝗻𝗲

𝗣𝘂𝗿𝗽𝗼𝘀𝗲 𝗟𝗶𝘃𝗲𝘀 𝗢𝘂𝘁𝘀𝗶𝗱𝗲 𝘁𝗵𝗲 𝗖𝗼𝗺𝗳𝗼𝗿𝘁 𝗭𝗼𝗻𝗲

By Dr. Shane Malitha Halpe

A Sudden Shift in Plans

I still remember the day I chose Jaffna.

At the time, Family Medicine was a newly emerging discipline in Sri Lanka, and accredited training centers were few and far between. To make matters more complicated, two of the three centers near Colombo were abruptly removed from the list due to a technicality. It caused a wave of uncertainty among many trainees, narrowing our options overnight.

What felt like a setback for most, I saw as a challenge—and a chance.

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Choosing the Unfamiliar

When I heard that a Senior Registrar had begun training in Jaffna, it sparked something within me. During selection day, while many clung to the hope of remaining near Colombo, I made a different choice. I opted for Jaffna—400 kilometers away from the familiarity of home, friends, and even language.

My colleagues were surprised. “Why Jaffna?” they asked, some even feeling sorry for me. I didn’t speak a word of Tamil, had never lived that far from home, and couldn’t even cook a basic meal.

But deep down, I knew I was ready to grow.

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The Long Journey North

It was Easter Sunday in 2024, when I left Katugastota, where I had just completed my last posting, and headed north. The vehicle was packed to the brim—with bags, books, and even my bicycle.

In Jaffna, I moved into a small hostel near the university, sharing space with a senior colleague. It wasn’t luxurious by any means, but it marked the start of something remarkable.

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Baptism by Fire (and Sun)

In the morning, I cycled to the Family Health Centre in Kondavil, under the relentless northern sun. The heat was unforgiving, but the sea breeze carried some relief. My supervisor—firm, punctual, and no-nonsense—believed in tough training to ensure smooth exams. His motto: "Training should be hard, so the exam is easy." In time, I saw the truth in those words.

We saw patients in clinics, went on home visits, taught medical students, and engaged in field work. Despite the intensity, I found a rhythm. I began to adapt. Slowly, Jaffna stopped being foreign and started feeling like purpose.

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Discovering Myself in the North

What began as a reluctant assignment became a rediscovery of self.

I forged new friendships, immersed myself in the culture of the north, and began writing—something I hadn’t done in years. I published my reflections, presented my work at the WONCA academic sessions, and even addressed the Sri Lanka Medical Association. I saw myself differently, not just as a trainee, but as a contributor to the field of Family Medicine.

When I passed the MD in Family Medicine, I realized that this journey had transformed me.

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Return to Jaffna—By Choice

Now, as a Senior Registrar, I’ve chosen to return to Jaffna, this time with a few fellow colleagues. Once again, I heard the familiar surprise: “Why go there again, bro? Colombo is easier!” Some teased, “You’re single—maybe that’s why!”

Yes, perhaps being unattached made it easier. But the truth? I felt I still had something to give—and something to learn.

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Hard Roads, Strong Spirits

This second phase had its own challenges. No fan. No air conditioning. No water supply in the hostel. Traveling was expensive, and I missed the comfort of home-cooked meals, a cool room, and neatly washed clothes and even water to drink . But strangely, I felt content. I found great places to eat to nutritious and healthy meals for surprisingly cheap places. Got myself a fan from a local electronics store which cooled me down. Got into the habit of washing my clothes with washing powder and a bucket of water. Also found places to which provide filtered drinking water 1 litre for Rupees - which helped me realise the value of good drinking water. 

I felt peace. I felt strength.

I had developed something I never truly understood before—resilience.

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From Struggle to Strength

As I continue my journey toward becoming a specialist, I reflect often on the choices that brought me here. In a world obsessed with convenience and comfort, I’m grateful I chose discomfort—because that’s where I grew the most.

I’m reminded of Nelson Mandela, who endured 27 years of imprisonment before leading a nation to freedom. That image reminds me: greatness often grows in the soil of adversity.

And so I write this today, not just as a doctor, but as someone who chose the long road, the hot sun, the hard days—and found a deeper joy on the other side.

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Have you ever stepped out of your comfort zone and discovered a part of yourself you didn’t know existed? I’d love to hear your thoughts in the comments below.

📍 #FamilyMedicine #JaffnaJourney #MedicalReflections #OutOfComfortZone #SriLankaHealthcare

In Their Words: Discovering Humanity Through Language and Loss

In Their Words: Discovering Humanity Through Language and Loss

By Dr. Shane Halpe | Reflections from the Clinic | Myliddy, Sri Lanka

Above: The sun rising over the clinic at Myliddy – a new beginning for an old land.

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Learning to Listen

Today in Myliddy, a quiet fishing village slowly finding its rhythm after decades of conflict, I stepped into more than just a clinic—I stepped into the lives and languages of a community with untold stories.

I was supported by a demonstrator who helped translate between Tamil and Sinhala. In between patient consultations, we shared something beautiful: I practised basic Tamil, and in turn, taught him a few Sinhalese phrases. It felt joyful—liberating even. Language, I’ve come to realise, isn’t just about communication; it’s about connection.

Tamil in Translation

I tried using Tamil as patients arrived. I asked their names, ages, and about their symptoms. But when I ventured into open-ended questions like “What made you come today?”, the replies were long, emotional, and—for now—beyond me. It sounded like Greek!

Thankfully, my assistant filled in the gaps. I kept referring to my notes, scribbled with Tamil phrases in English letters. It was a humble start, but every word felt like a step toward something larger—a bridge across difference.

To my surprise, patients responded warmly. A simple “Eppadi irukkeenga?” (How are you?) brought a smile. Even broken Tamil was better than silence. It reminded me that when we make the slightest effort to understand, people open up.

Stories That Stay With You

Two of my patients that day shared more than symptoms. Both were middle-aged mothers of one child. Both had husbands who had left for France and never returned—remarried, unreachable, offering no support. They weren’t legally divorced, just abandoned.

I gently asked about their mental health. Their responses were calm, grounded. They had learned to carry on—alone, with strength and quiet dignity. I realised then how deeply personal struggles can remain unseen in a typical clinical encounter unless we create space to hear them.

Myliddy: A Town Reclaimed

Later, I learned that Myliddy had once been under military control—its residents displaced, its homes empty. Only in recent years have families returned. The town is rebuilding itself, stone by stone, story by story. It’s a place of resilience, shaped by conflict but determined to heal.

A Doctor’s Reflection

Medicine often teaches us how to diagnose, prescribe, and treat. But today taught me something different: to listen, to learn, and to care in the language that matters most—the patient's own.

Healing begins long before a prescription is written. Sometimes, it starts with the courage to ask simple questions… and the humility to hear long answers.

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🌿 Have you had moments when language became a bridge—or a barrier—in your own life? Share your thoughts in the comments below.

Follow this blog for more reflections from the field, stories from the clinic, and insights into community-based care in Sri Lanka.