Thursday, December 9, 2010

Supporting our colleagues through the "hurts"

I was sitting on one of the hospital's nursing units having a difficult telephone conversation.  Anyone working nearby could have easily discerned the situation from my end of the call:

Patient's family member wants to keep aggressive care going for a comatose, terminally ill family member against the best advice of the medical team.

Having never had to make such a decision in my own life, I am left to imagine how heart-wrenching it must be for the family.  But the ICU team and specialists caring for the patient are in agreement -- this patient will not recover.  The only question is under what circumstances this patient will die.

I tried to hear the family's wishes and concerns with an open mind.  I tried to compassionately share my opinion about the extremely low probability of any meaningful recovery.  The ICU team had hoped that my rapport with this family would lead to a plan to withdraw care and permit a peaceful death; their conversations with the family regarding plan of care had resulted only in increasing hostility. The family member I spoke with was similarily adamant.  The family will not accept any outcome short of a full recovery, I was angrily told.  They expect this patient to walk out of the hospital as he/she was before, healthy and vibrant. 

Being shouted at, with the clear implication that my judgment is unsound and my caring most deficient, was unpleasant to say the least.  I hung up the phone and put my head into my hands.  A resident sitting at the work station next to me commented, "that sounded tough."  I shared the brief details of the situation and my sadness at this patient's fate of futile tubes, IV lines, and machines.  The resident asked some thoughtful questions about making end-of-life decisions, and we conversed for a bit.  An attending nearby commented, "sounds like the family's just not ready yet."

"It just feels like...if I could have found the right thing to say, the right way to say it, that maybe the conversation could have gone better," I responded.  I didn't mind the eavesdropping at all.  I had that deep, hollow feeling that comes into the pit of my stomach when a patient or family encounter doesn't go well, and it felt good to be able to share even a little of that with trusted acquaintances.

I dutifully delved back into the electronic records of our current inpatient team, signing off resident notes, looking at new labs, checking my outpatient in-box.  I tried, unsuccessfully, to convince that deep, hollow feeling in my stomach to go away.  Several minutes passed, and my empathizers drifted off to their other tasks. 

Or so I thought.  Another colleague had been quietly working at a nearby computer station.  He walked up to me and said something along the lines of "listen, I couldn't help but overhear what happened on the phone, and I heard you beating yourself up about it afterward.  But, it sounds to me like you did the best you could.  I heard what you said to them, and it was totally appropriate.

"Some things you just can't change," he continued.  (How many times have I said that to residents or medical students?)  "You did the best that anyone could have done."

The deep, hollow feeling began to lose its grip on my GI tract.  This colleague recognized my suppressed agony and perceived a responsibility to respond to it.  With just a few kind and thoughtful words, he helped me to regain perspective on the situation.

How often do we physicians, thoughout our day-to-day lives, suffer these little (and, sometimes, very big) hurts?  Sometimes we share them with each other, but sometimes we don't want to bother anyone.  Sometimes we're too ashamed at our real and perceived failures. 

I am grateful, today, that someone recognized and responded to my little hurt.


  1. Pow! There you go again, telling the truth about physicianship. Thanks for keeping the flame alive. The compassion of the family physician equals vulnerability. Because we care, we can be hurt. If you can't be hurt, you don't care. You care and you hurt, but the caring of your colleagues speeds the recovery and the learning. Blog on.