Explain a total anomalous pulmonary venous connection diagnosis to parents and plan the surgery — OSCE

Communication framework

Acknowledge the fear and the suddenness first. Before any explanation, acknowledge how frightening it is to see a baby who was well at birth become so sick so quickly, and that they will naturally be looking for a cause. Do not rush past their fear; name it and sit with it for a moment. The parents will only hear your explanation once they feel heard. ^[7]

Explain the diagnosis in plain language. The heart has four chambers, and after blood picks up oxygen in the lungs it is supposed to come back to the top left chamber to be pumped to the body. Your baby was born with the pipes from the lungs plumbed into the wrong side, so all the oxygen-rich blood comes back to the right side instead of the left. On top of that, one of those pipes is narrowed, so the blood cannot get out of the lungs easily, which is why the lungs have become wet and your baby is working hard to breathe and is blue. ^[7]

Reassure on cause and guilt. Nothing you did or did not do caused this. It is a problem with way heart formed very early in pregnancy, before most women even know they are pregnant, and it is nobody's fault. You could not have prevented it, and the fact that your baby was well at birth is normal for this condition, because the changes that happen in the first day of life are what bring it to light. ^[7]