January 5, 2018
More empathy for suffering improves patient experience
I just ran across the story of Rana Awdish and her sudden, near-fatal medical catastrophe — which put her in the critical care unit and resulted in the death of her near-term unborn baby. She is a physician and was in specialty training for critical care medicine at the time. The experience taught her a lot about the nature of suffering. It also showed her that human caring and empathy is too often missing in hospital care today. The story appeared on the NPR website yesterday, entitled Brush With Death Leads Doctor to Focus on Patient Perspective. She’s just published a book about the experience and what it taught her. The title is In Shock.
I found an essay of hers published in the New England Journal of Medicine a year ago entitled “A View from the Edge – Creating a Culture of Caring”. In it, she provides more facts about what happened, especially the way the hospital medical staff and other employees treated her while she was in the hospital. She clearly had intense emotional suffering at the same time her body systems were failing and she was near death. Sadly, it is also clear that the people taking care of her did a much better job of attending to her medical problems than her human ones.
In her recounting of the facts, she highlighted specific careless and hurtful remarks that she had overheard or that her physician colleagues had said to her face. She also highlighted some examples of tender caring others had demonstrated during her hospital stay. In her new position as Medical Director for Care Experience at the hospital, she has used those specific examples to improve the training for all employees, from physicians to housekeeping staff.
Reading the three paragraphs below transformed the essay for me; it went from worthwhile to sublime.
“Through the training that was developed, participants learn to articulate their purpose as distinct from their job. Transporters hear how meaningful it was to me when one of their own — having seen me break down when questioned by someone in radiology — took it upon himself to warn the technicians performing various tests not to ask about the baby whose small pink wristband was still in my chart. He asked his colleagues to do the same. In an 800-bed hospital, the transporters had united to form a protective enclosure around one patient.
“Similarly, radiology technicians learn what a kindness it was that they stopped trying to awaken my exhausted husband to move him from my bedside for my portable x-ray, instead throwing a lead cover over him and letting him sleep. The power of these stories shows new employees that they have a purpose and that they are valued.
“In addition, new employees are taught to recognize different forms of suffering: avoidable and unavoidable. Our goal is to find ways to mitigate suffering by responding to the unavoidable kind with empathy and by improving our processes and procedures to avoid inflicting the avoidable kind whenever possible.”
I bet every single employee can find a way to share in a purpose like that. From top to bottom on the hospital’s / corporation’s / our society’s pecking order of life, we have our humanity in common. We all have hearts and the innate ability to attune ourselves to notice another’s need or distress, and then to find a way to express caring for them.
There is an irony in the essay. Most of the examples of uncaring comments came from highly trained healthcare professionals. Most of the examples of compassionate behavior came from employees with more humble backgrounds and jobs.
Here’s another example of that, a YouTube video about Carolyn Collins, the janitor at Tucker High School. The narrator says Carolyn has found her “true calling” — a purpose she finds deeply meaningful. She maintains an extra “janitor’s closet” full of necessities for the 20 to 30 homeless students who attend that school. She came up with the idea herself. And she spends her own time and money to make sure that closet is fully stocked so those homeless kids always have access to free clothes, school supplies, snacks, and emergency food.
Notice again that this big-hearted person is a janitor. As you listen to her talk on the video, imagine her own background, her educational level, and the size of her paycheck. The narrator says Carolyn’s young son was killed in a home invasion. I think Carolyn believes the person who killed her son was a desperate person. As soon as she realized there were homeless kids attending Tucker High School, she was inspired to act. She wants them to have what they need so they can go to school, and don’t need to steal or get in trouble — or kill someone.
I find the goodness of people heart-piercingly beautiful. And I’m the one who feels humble right now.