Essays

Essays February 2014

Caring, Coping and Crying

Brie Gowen and Hugh MacLeod

My guest Brie Gowen and I begin a conversation about healthcare being a people relationship business, a touch business. Those that provide healthcare are human, and possess the same emotions, stresses and uncertainties as those who receive their care. Healthcare is complex and care providers face daily the full cycle of: miraculous birth, life-saving intervention, cure, pain, suffering and death. In many areas of healthcare delivery, there are daily and weekly tragic losses that staff endure with patients and families: losses of life, losses of human functions, and persistence of grief and suffering, where difficult decisions are the norm. 

With that the Ghost of Healthcare Consciousness swoops in and says:

“Fundamentally, healthcare organizations, departments, medical units and systems are patterns of energy; webs of human relationships, conversations and decisions among and between care providers, patients and families. One of your biggest challenges, and therefore biggest opportunity, is that you spend so much time studying and evaluating the evidence on the hard side of healthcare, such as outcomes, cost, etc., and you do not spend enough time – if any time – talking about the soft side of healthcare, the relationship patterns.”

Interesting perspective. It’s always the things we don’t know and understand that perpetuate disconnect. For example, Brie shares her personal experiences: “Working in the Intensive Care Unit (ICU) is an experience that can’t quite be put into words. It’s fast-paced, intense, and the stress of some situations can even occasionally make my own heart rate go up as high as one of our trauma patients.

“Some people love us. Some people hate us. I can promise you that you do not want to be a patient in my unit. If you are then that means you’re really sick. But I can also promise you that if you end up here you will get stellar care by a team of the best health care providers available.

“Often times we may act a little wacky though. We may seem rude at times. Maybe you catch us acting totally inappropriate for the situation at hand. Maybe you’ve even thought, “how can they act that way with all this going on with my family member?”

“Well, we have our reasons. Following is a letter to the families of ICU patients everywhere.

“Dear Disenchanted Family Member of My ICU Patient,

“So you walked in to me singing a song out loud as I hung that IV medicine, huh? You were a little bewildered, and thought, “Is that from the Sound of Music? Why is she so inappropriately jolly considering my dad has a tube down his throat?!”

“First off, it is the Sound of Music. After all, these are a few of my favorite things.

“But seriously, I’m not singing for my own satisfaction. What you don’t realize is I’m singing to calm my nerves, to keep myself relaxed. Your dad almost died before I let you back. I’m concerned for him, but I don’t want you to see that on my face. I don’t want you to worry about him. That’s my job. I just want you to love him.

“I know you just heard us laughing and cracking a joke in the hall. I get it. You don’t see anything funny with your mom being confined to that bed, attached to all those monitors.

I understand. I do. I hope you can understand that while you were waiting outside unaware we saved the young woman next door. She couldn’t breathe. Now she can. We didn’t think we’d get the breathing tube down in time…

“We also restarted the heart of the man across the hall. We shocked him so many times, and I actually broke his ribs. Just when we were afraid it wouldn’t restart, it did.

“The patient next door to him wasn’t so lucky. We tried. I begged God, but she went anyway. I held her daughter and let her cry in my hair for twenty minutes.

“Some times we have to laugh. It’s the only thing we know to do. We’re afraid if we cry, we won’t be able to stop.

“I’m really sorry if I seemed short with you when you came in to visit. I know you thought I was being rude, and I know that once outside again you complained about me, saying “she must have wanted a break instead of taking time to talk to me!”

“No. I won’t get a break today. I wasn’t trying to be rude. I was focused on the change I just noticed on your dad’s EKG. I was wondering what I could try next when his blood pressure plummets again. You see, I’m giving the maximum amount of all those drugs you see hanging. I know you’re not ready to say goodbye. I’m not ready to give up. That distracts me sometimes and makes me a less than perfect conversationalist.

“I want you to know that when I see your mom in this condition I feel your pain. I think of my own mom who has passed away. When their conditions mirror each other, so similar in presentation, it’s like peeling the scab off my grief. I don’t let you see that, but I choke back my own tears while you cry.

“Oh dear mom, as you try to maintain your composure while your child remains unresponsive, I have to fight to keep from sobbing all over your shirt while I hug you. Your plight is a very real confrontation of the frailty of our children. I don’t like it as a mother. I will sweat blood to fight for your baby’s life, no matter the age. I know it could be mine just as easy.

“My dear sir, as you cry over your ailing spouse, I’m sorry that I have to walk away. I’m sorry I can’t be stronger for you. For a moment I place myself in your shoes. I imagine my spouse laying there, and I grieve with you. Then I get back on the horse and I fight for your bride. I just wanted you to know that.

“My singing, dancing, laughing behavior might make you think I’m indifferent. Or my distraction and firmly set expression might make you think I don’t care.

“But I do.

“What you don’t see is when I pull into my driveway at the end of the night after my long shift has ended. Often times I put my car into park and I cry. All the stress of fighting for them, all the grief pushed away, all the emotions finally have time and catch up to me. I don’t sing or laugh. I weep.

“Then I wipe my eyes and go inside. I hug my babies a little tighter. I hold my spouse a little closer. Then I go to bed early so I can come back in the morning and fight another day.”  

We close with a passage from the essay, “Empathy: A Foundation for New Conversations”:

“Tapping existing sources of pride in healthcare organizations can build momentum and energy and dramatically improve how an organization delivers patient services. The greatest challenge in building respectful relationships is to support someone’s struggles and differences, to hear and acknowledge the way they feel and think – even when they are scared or angry – and to listen without judgment and without taking responsibility for each other.

“This is true respect – accepting one another for who we are, believing in our inherent worth and capability, allowing each other to be human and make mistakes, while holding each other fully responsible and accountable for our behaviour and our communications.

“When we are empathetic, we have the capacity to perceive the subjective experience of another person. We demonstrate empathy when we imagine another person’s feelings, emotions and sensitivities, think about how we might feel in their situation, and then behave in an appropriate way. To be empathetic, it is necessary to be self-aware. When we are self-aware, we are in touch with our own emotions and, therefore, are more able to read others’ feelings. Empathy leads to quality relationships, integrity, trust and good communication.”

About the Author

Hugh MacLeod, CEO Canadian Patient Safety Institute, Patient, Husband, Father, Grandfather and Concerned Citizen.
Brie Gowen, Registered Nurse, Christian, Wife and Mother.

References

Original letter obtained from a blog post by Brie Gowen titled, “A Letter to the Family of My ICU Patient” posted on Savor the Essence of Life. Find it and more at savortheessenceoflife.com.

MacLeod, H. and W. Nicklin. 2013. “Empathy: A Foundation for New Conversations.” Longwoods Ghost Busting Essays. 

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