“SPIKES is an acronym for presenting distressing information in an organized manner to patients and families.” – Clinical Journal of Oncology 

S- Setting

There is no guarantee of privacy since you share your house with four housemates, but you’ve done your best; the others are at work, it’s just you and your husband. You are his only significant other, which is maybe part of the problem, so there is no one else to invite to this meeting. Push your textbooks to the side of the table. Ask him to sit down. You’ve already sat where you can see the kitchen clock over his shoulder. Turn off your phone. If you haven’t established rapport by now, there’s no chance you ever will.

P-Perception of condition

Ask your husband what he knows about the state of your marriage. Listen to what he has to say and quietly assess his level of comprehension. Accept denial but do not confront at this stage. He will tell you that everyone has rough patches, but you will see the deadness behind his eyes.

I-Invitation to inform

Ask your husband if he would like to know more about how your marriage is going. Accept his right to not know; if he goes that route, offer to answer questions later if he wishes. When he becomes angry that you are offering to tell him about your marriage, unilaterally, as if you were the only person involved, do not get distracted. Stay on script. When he finally says, sure, Alice, why don’t you tell me, go ahead, I would love to know more about OUR marriage, take a moment to consider if there is any guidance about how to proceed in the face of sarcasm. Unfortunately, the data on how to break bad news is limited. Plunge forward.

K-Knowledge

Use language intelligible to your husband, with consideration to his education, sociocultural background, and current emotional state. He has not spent hours watching YouTube lectures on heteropatriarchy. Instead say you’re just going in different directions. Give information in small chunks. Check to see if he has understood what you said. Give the positives first: you’ve had a good run, and it’s not like you have the same friends so your support systems won’t have to pick sides. Give facts accurately about treatment options (none), prognosis (terminal), costs (actually not that bad, thankfully).

E-Explore emotions/sympathize

Identify the emotions expressed by your husband, i.e., sadness, anger. Then identify the source of the emotion. Give your husband time, then respond in a way that demonstrates that you have recognized a connection between the emotion and the source, i.e., I see that you are angry because I am leaving you.

S-Strategy/summary

You’ve glanced discreetly at the clock and you are on schedule. Close the interview. Ask whether he would like you to clarify anything else. The question why are you like this seems more like an expression of emotion than an actual request for information so you can ignore that. Offer an agenda for the next meeting, i.e., I will speak to you again when we have the paperwork from the lawyer. Remember: unhappiness is a normal response. Get up. Walk away.

 

Margaret Adams’s stories and essays have appeared in over two dozen publications, including The Threepenny Review, Best Small Fictions 2019, Joyland, and Pinch. She is a healthcare worker and a writer, and she currently lives in Vermont.