99% Invisible - 306- Breaking Bad News

Episode Date: May 9, 2018

When a doctor reveals a terminal diagnosis to a patient -- that process is as delicate a procedure as any surgery, with potentially serious consequences if things go wrong. If the patient doesn’t understand their prognosis, for example, they could end up making uninformed decisions about their treatment. That's why many medical schools now offer training for students on how to break bad news, bringing in actors to help them learn how to navigate this critically important and very high-stakes moment. And that’s not the only connection between acting and this particular facet of medicine. It turns out that one of the first doctors to recognize the challenges of this particular kind of doctor-patient communication wasn’t just a physician -- he was also a comedian. And he drew on that experience to transform the way that doctors break bad news. Breaking Bad News

This is 99% infosable. I'm Roman Mars. Imagine you're in a hospital room waiting to hear the results of a test you had. The doctor comes in. You might sense on some level what's about to happen. You know, I got the results back and reviewed them with the double doctor, and it's difficult for me to say because unfortunately I have some bad news to tell you. The muscles in your shoulders tense up. Your hands suddenly feel clammy. They found a mast in your decently colon. Okay. Okay. And so we did a biopsy.

Okay. Okay. And what a biopsy does it it lets us know what kind of cells there are to see if it's positive for cancer. Okay. And then you get some very bad news. The results came back that is an invasive animal carcinoma. Okay. And what that means

is that you do have colic cancer. Oh, so I don't know. The cancer is basically untreatable. When the cancer is as far advanced, there is no cure. I'm very sorry to give you this news. I know this must be very difficult for you. And I know it's not a totally unexpected thing. It's very, uh, an instant minute.

Oh, yeah. Wow, I'm so sorry. Oh, it's... Then after about 10 minutes, a timer goes off, and the encounter is over. So she's messing up. Thanks. Please feel free to call.

She's right there. Sorry. 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. I do remember that student and I thought he did a really really nice job. That's Mark Perra, 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. 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. But as difficult as it is, Mark is playing an important role for med students like Ardena Ziri. It's never like it's 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. In medicine, bad news is defined as any information that drastically and negatively alters a patient's outlook for the future.

John Fassil is a radio reporter and part-time medical school videographer. He actually set up cameras to film that encounter between Mark and Arty so that Arty could be evaluated on his communication skills. And I was really surprised by how calm and compassionate Arty 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 a sports analogy to deliver difficult information. As in, it's the bottom of the ninth, and there's one out left. 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. 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 moment. A moment that most of us will experience one way or another. But that's not the only connection between acting and this particular facet of medicine. Over the last 20 or 30 years, I've been endless, anecdotes that you described the doctor came in and said, you'll be dead Friday.

Goodbye. And left. 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. There are ways of doing this.

There are ways of breaking bad news. 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. In 1968 Rob Buckman was on stage in London's West End, doing his strip-tees. I think the essence of it is that it was a... um... the strip routine that you might have expected a female burlesque dancer to come out and do with Robert in this extraordinarily physically unlikely guys. Going through all sorts of gestures, getting his head stuck in his pullover and like, I they want to get all grace. No no no no.

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 at the theatrical club. 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 who liked on Oliver. The footlights put on reviews each year that featured comedy and music. And back in the late 60s, Rob Striproutine was a highlight. He did take it absolutely seriously. He came out and did it as if people were meant to be aroused by this routine

He made great play with removing his watch as if this were specially erotic although there was absolutely nothing Except taking off your watch like we all do There was no real punchline to it was there except except that he had a flower painted on his stomach And that was rather sweet. Robert gunned a 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 Footlight's Clubroom, housed in the second story of a local fish shop.

He slept only three or four hours the night. 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. Around the same time Rob was on stage in London's West End doing a strip routine, a psychiatrist named Dr. Elizabeth Kubleross was working on a pretty radical project. She was spending time with dying patients at a hospital in Chicago, listening to their stories.

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. In 1969, Kubla 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.

Kubla Ross also encouraged doctors to speak more frankly with their patients about that. She said they needed to stop tiptoeing around the subject. 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, quote, gloomy prognostications, unquote. Instead, they should be ministers of hope and comfort. 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. In the 50s, the word cancer wasn't used. Dr. Walter Bale is a psychiatrist and a professor at the MD Anderson Cancer Center. It's part of the University of Texas in Houston. 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. 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.

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

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 50s. And around the same time, palliative care emerged as a concept in medicine. 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.

These developments, along with the work of Elizabeth Coup le 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. A doctor who's totally irreverent take on medicine would ultimately help him transform the field. Rob's work in the Cambridge Footlights got him noticed by the BBC. While still training as a doctor, he wrote and 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. Pink a given moment, there was a vi-pink medicine, vi-pink medicine, vi-pink medicine, what? 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 seen as the stodgy and distant authority figures, so they made a good target for satire. One of Rob's recurring characters on the show was a malingra, a guy pretending to be sick, who keeps showing up at the hospital with different, ridiculous excuses. What is it? It's about my bowels. it. It's about my bowels. I mean, what's the matter? Aren't they regular or something? Oh no, no, I am regular. Every morning on the dot of eight o'clock. Every morning on the dot of eight o'clock, I mean, that's marvelous. What are you worried about? I don't wake up till nine. Rob's success caught the attention of another

footlights alarm. Mostly, we laughed a lot because he was funny. We was one of the half dozen people that I spent most of my time laughing with. 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 Potter's. Anyway, when I reached him, he was getting ready to go on safari. 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. In 1979, John Cleese was producing the Secret Policeman's Ball, a comedy show

that benefited Andesdy International, and he asked Rob if he'd appear in a sketch with him and Michael Palin, the old money python bit known as the cheese shop sketch. No, they're not good manners. Some cheese if you please. Oh, yes, sir, yes, sir, what would you like? How about a little red lister? I'm afraid, but, please, oh, wait, that's too much. Yes, it's a very city 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 cheese in the shop. Dovenser, Parmesan, mozzarella, quibokrem. As the man puts it, it seems to be a shop entirely uncontaminated by cheese. Finish, we didn't be the cheese, perhaps. Not today, sir. emanated by cheese. The whole time this ridiculous exchange is taking place, a Greek bazooki 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. And then at a certain point my character got so irritated by the lack of cheese that I turned and snapped at the Greek dances.

We stopped! I got it! And then stopped and slunk off. Rob's appearance with Monipython 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. 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. 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. That's Rob from a TV documentary he made about his illness as he was becoming sicker. It's called your own worst enemy. It began very simply and very mildly with pain in my right wrist, and when I moved my wrist, it creaked at that point. Rob had dermatomyocytus, a very rare autoimmune disease. 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. 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. 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.

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 the color, the things you enjoy, But all the color, the things you enjoy, have simply the tone of the illness about them. 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. 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.

It must be awful for you. I'm sorry. And I very nearly burst into tears and hugged him because he gave me permission to feel ill. The doctor was telling Rob that it was okay to have feelings about being sick, but 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.

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. 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. 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 woolly socks in my bag. By May of 1980, Rob's condition had turned around. 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 night and go to bed at midnight and live a normal life, which is really fabulous. 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. Where there's life returns, as doctors Miriam Stopperd and Rob Buckman explore such topics as cosmetic surgery, unwed mothers and the nursing profession. But 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. 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. 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. 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 handicapped and so on, but I didn't collapse. I didn't, how, I wasn't a hero by any means, but I wasn't a different person.

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. So when I recovered, I was then able to say, OK, I've been under fire, and I stayed the same. Now I can be brave when talking to the patients. 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. Dr. Patricia Shaw was a cancer researcher at the same hospital where Rob worked in Toronto. She goes by Pat. Pat and Rob met in the most Dr. Lee meat-cute scenario imaginable. 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 he really met our first conversation.

One thing led to another, and they got married in 1988. It was around this time that Rob started writing more. He had a large piece of solid mahogany that he'd brought with him from England, and his favorite spot was to sit at the desk at his computer. So even though he was really busy at the hospital, he spent a huge amount of time after those hours working in his study. 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. 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. When Rob Bachman 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. That's Dr. Walter Bale again. He was also studying Dr. Patient Communication when Rob's book came out. He understood that bad news was a series of steps that could be broken down into a series of steps. Walter and Rob would eventually write a set of guidelines based on Rob's book. They called their strategy the spikes protocol. Spikes was an acronym that stood for

Sending, Perception, Invitational, 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. You didn't worry that it sounded too, I don't know, spiky. No, we didn't even think about it because it was so elegant.

Everybody remembers that. 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. In some of the videos, Rob performs improvise scenes with actors playing patients or family members, just like you heard already doing with Mark

at the beginning of this episode. Not real, but really intense. Here is the six step protocol, which has the rather ineligrant and threatening acronym spikes. 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 cleanx right at hand, 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? 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 where you'd like me to handle the information? Yes, please. Yeah. 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 and I'd go ahead and tell you what it was. 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. And the all-important E for emotions, at knowledge and namely 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. And then S, strategy and summary. So, what do we do from here? What we do from here is very important. Whatever it is that's going to happen next, make it clear. As you can hear from those scenes, Rob was masterful at breaking bad news. He was calm, present, compassionate, and clear. Andy was good at it, not just because he'd been a patient, but because he'd been a comedian.

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. 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. And that was pretty devastating. Again, Rob's wife Pat. 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. 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. After his flight got in, he didn't arrive and he wasn't answering his text messages. It wasn't too unusual. He 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. Doctors aren't the only ones who have to break bad news.

He talked a bit of nonsense and then asked if I was Mrs. Buckman and then eventually got going around to saying that the rob had passed away. 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. There was so much about missing Rob. There was so much about having to deal with the realities of what happens when somebody dies. 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. In real terms, you know, like finance and insurance and all that kind of stuff.

So it was hard. Even though it's six years later and it still makes me a bit teary thinking about it. Beyond Rob's death, spikes has endured. It's been absorbed into the mainstream of American medicine. 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 already, the medical student from the top of the show? He used spikes to navigate his encounter with Mark, the actor. Oh gosh. Yeah, I think if I hadn't had those spikes protocol training beforehand, I would have been completely lost. I would not have known, kind of where to go next. 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. 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 last 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, you know, they're dying. 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. 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. 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? 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. 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. You know? I'm blowing the day to take a walk in the sun And following my face until it is new mode. That message wasn't actually played at Rob's funeral even though he'd joke that he wanted it to be, but you'll hear more from Rob and from Monty Python's John Cleese. Right after this. So I'm back with reporter John Feseel to talk about some of the remarkable, here and forth pretty much unseen comedy that he found while he was reporting on Rob Buckman.

But we couldn't fit it into the story itself, so this is a little extra bit for you, Monty Python fans. So Roman, are you a Monty Python fan? I would say I went to a Monty Python phase. A phase? A phase, you know, like in junior high where you find them and you think, I'm really special for liking this when no one else liked it because it was just on PBS. That was my face where I watched all of them and I love them, but I haven't tipped my

fandom alive. So, like, I'm a huge Monty Python fan and when I started reporting the story, I had no idea there was any connection between Rob and Monty Python. So finding that out was like a big deal. And then I also found all this rare stuff that hardly anybody has seen. Stuff I got from tapes that Rob's widow pulled out of storage. Oh, that's so cool. Like what? Give me an example. Well, so right around the time Rob was writing how to break bad news in the early 90s, John Cleese got in touch with him and he had this idea for a series called Videos

for Patients. I said it always seemed to me that it would be a very good idea to make videos for people who had just been told by their GP that they had some sort of medical problem, because when you're told that, you always get anxious, and that is absolutely the worst time to take in information. The idea was to make a bunch of videos describing various medical conditions in detail so that patients with those conditions could replay them whenever they needed a refresher. And almost all of them start with this little sketch that kind of spoof-spraking bad news.

And some very beautiful music. 90 CD-ROM music. Alright Doctor, what's my problem? Well, you've got leg ulcers. Leg ulcers. So Cleese plays a patient inquiring about his condition and Rob the doctor proceeds to lay some heavy medical jargon on him. I see what exactly are leg ulcers. Well, quite simply, a leg ulcer is the consequence of tissue hypoxia following on his

chemia due to venous stasis, evidenced by proximal varicositis and incompetent perforators, or of course due to arterial insubiciency. There's full thickness epidermal lusciousness. So as Rob's talking, the camera slowly zooms in on Cleese who looks increasingly confused and upset. He leans in, squints, looks over his shoulder. By the time the camera lands and close up, his face is slack and his eyes are wide with terror. Are there any questions? Um, nope, no, are you sure?

Yep, fine. Then I'll see you in six weeks. Bye-bye! Bye-bye! Then Cleese gets up and walks off stage, revealing to the audience that he's on a set. As it happens, I haven't got a legass, and of course, doctors don't really talk like that. Although sometimes it can feel a bit as though they do. But the time I get whole, I always realize that I

haven't understood everything that the doctors said, and that there are always some questions that I should have asked, but for some reason didn't. And that's exactly why we've made this video. Yeah, so then the rest of the video is just Rob going over the conditions slowly and in painstaking detail. A leg ulcer is what happens when the skin over a part of your leg can't grow properly. They made almost 50 of these videos on everything from breast cancer to something called glue ear, which I've never heard of, but they ran into a problem.

But we hit a major problem which none of us had anticipated and I'm not entirely sure one could have anticipated it. What was the problem? They had trouble selling them. No, it doesn't. We set up all sorts of schemes, but we just couldn't really shift that we could never find a way of getting people to give us 12 or 13, Creed, for a 25 minute lecture, people wouldn't pay.

So that's why you've never seen them. But now you can see them on our website. Yes, you can. You can see one of those videos, and you can also see footage of Rob's strip routine from the footlight stays. And the stuff he did with Terry Jones. Right, so Rob Buckman also worked on some videos with another member of Monty Python,

Terry Jones. Can you tell me a little bit about those? Yeah, it was literally the last thing he ever did. He died on the plane on the way back from working with Terry and London. And these videos you can see online already. They're called the top 10 tips for health. The goal was to provide practical tips for staying healthy,

although really when you're watching it, it just feels like you're watching two old men goof off. Here's Rob and Terry and drag as two old ladies. Oh, my darby tea is violating wall paper. Oh, really? Do you cook it? No, I did straight off the wall. Did you recognize the spam lady voice, Roman? I do. I also, this reminds me of one of my favorite sketches from the show, which is... Like, hello, Mrs. Smoker. Hello, Mrs. Non-Smoker.

Been shopping? No, been shopping. What you buy? A piston engine. What you buy that for? It was a bargain. Anyway, that one I know by heart. Oh, man, that was good. So there was in another sketch in that video series, they actually directly make fun of breaking bad news. I'm afraid you've got tight two diabetes. Well, isn't that nice? of Breaking Bad News. So Terry Jones is still alive, but unfortunately, he's suffering from dementia. So we weren't able to interview him. He and Rob are really close, though. Terry actually wrote Rob's obituary in the Guardian after he died. I remember when you were putting the story together, when you got the interview with John Cleese, I was just shocked. The

day that he was involved in being that he talked to you. How hard was that to manage? Oh, man. So I actually got that interview through Rob's daughter, Joe. Joe Buckman is a screenwriter in Los Angeles and she participated in the interview too. I think it meant a lot to her. Rob's death was so sudden that I kind of got the sense from his family that the wounds have never fully healed.

So for Joe, the chance to hear John Cleese talk about her dad in such glowing terms, I think it was really meaningful for her. And it felt really good to be there and to hear that. Wow, that's so nice. I'm so glad that that happened. Yeah, Rob's family has been really great and supportive of this story, but particularly Jo, she was really my partner in crime, you know,

helping me with the Cleast interview, which is obviously a get and then also helping me get some of the archival you heard in the story. Oh, that's so great. Well, thanks to Joe Buckman for all of your help. Yeah, Joe. Shout out to Jo. 99% invisible was produced this week by John Feseel,

edited by Delaney Hall, mixed in tech production by Sharif Yusuf, music by Sean Riel. Kurt Colestead is the digital director, our senior producer is Katie Mingle. The rest of the team is Emmett Fitzgerald, Avery Trouffleman, Taren Mazza, and me, Roman Mars. Special thanks to the staff of Rush Medical College,

Dr. Mary Mulkehi, and Dr. Miriam Stoppert. And thanks one more time to Rob's family, Joe Buckman, Dr. Patricia Shaw, Jenny Buckman, Matt Buckman, and Dr. Joan Fanden Endey. We are a project of 91.7 KALW in San Francisco and produced on Radio Row, in beautiful, downtown, Oakland, California. We are a part of Radio Topia

from PRX, a collective of the best, most innovative shows in all of podcasting. We are supported by our listeners, just like you. You can find 99% of visible and joint discussions about the show on Facebook. You can tweet at me at Roman Mars and the show at 99PI org, or on Instagram, Tumblr, and Reddit too. But the only place you can see videos for patients with Rob Buckman and John Cleese is

99PI.org. Thanks.