life

Moments Matter 70: Two Weeks

It’s been a tough day.

I’ve stared at those words for a while now, unable to write anything after. And while I stared, a day became days, and then a week. And now, it’s been a tough two weeks.

I pride myself in being able to sit with differing opinions, to hold two things in one hand and consider them from all angles, to weigh them both, to see the qualities inherent in both, to imagine a situation in which I might choose the one over the other. It is, after all, what I do most often as a palliative care doctor. It’s how I’ve built my life, and how I’ve raised my kids. But lately, I’ve struggled to see things from both sides.

It’s been a tough two weeks. It’s been tough watching core values, values that guide every passing second of my life, values that shape who I am as husband father doctor human, so brazenly challenged and mocked and torn down.

It’s been a tough two weeks. It’s been tough watching something I’ve dedicated my entire life to – the study of science, the belief that we as people are better for asking hard questions and relentlessly pursuing the truth even if we’re proven wrong – so brazenly challenged with little regard for consequence. It’s been tough watching something I’ve dedicated my entire life to – the empathetic and compassionate treatment of all people – so brazenly challenged. Tough watching violence condoned and bullying lauded.

And now ICE and CBP agents can enter our churches without seeking further authority. And now, too, our hospitals.

I’m all for re-evaluation of policy and restructuring and change, and I’ll be the first to agree that change is needed in our country on many levels and on both sides of the aisle. But not at such a cost, never at such a cost. Never at the cost of sacrificing values that should, and must, be universal. Respect and tolerance and equality and compassion and empathy. Life is not fiction, it is fact. Freedom is not fickle, it is doing and saying and protecting that which makes us all feel free, be free.

All of us. Together.

I’ve struggled internally with whether to post this or not: it has lived as a draft, in one form or another, for two weeks. These thoughts are my own, though I’m comforted knowing that a great many share them. At the end of the day, I reminded myself that I write for my own health, that I write because I must, that it is my way of healing and moving on. And I reminded myself that this is not a political blog, it is a health and wellness blog.

And I reminded myself that this is not a political post, it is a health and wellness post. For me, for my children, for our country, for the world.

Moments Matter 67: The Use of Silence

The intentional use of silence in conversation is such a powerful tool. It slows things down. It gives room to breath, and emotion time to stretch. But more importantly, it gives space for patients to process things at their own pace.

There’s data to support the use of silence. Studies have shown that time spent talking, and not talking, matters: in fact, when doctors speak less in a family meeting and patients speak more, families perceive the meeting as more satisfying with less conflict. Actual time spent meeting doesn’t matter.1

This is why, when I teach my residents and fellows NURSE statements for responding to emotion with empathy, I teach it as “NURSES” to include the use of silence. The intentional use of silence is an emotional response skill just like any other, and it requires timing and practice, as well as recognition of when to jump back in.

I’ve seen the use of silence work beautifully. One classic scenario is to use silence after an “I Wish” statement. For example:

A: I came here for a cure, there has to be more you can offer!

B: I really wish there was… (silence)…

Silence in this scenario lets your patients to fill the empty space with whatever’s on their mind. This lets you advance the conversation and explore what matters most, knowing what we know. If you find that you’ve been talking for the past ten minutes non-stop in a meeting, then that’s probably nine minutes and thirty-seconds too long. Take a break. Push pause. Your patients, and your lungs, will thank you.

I’ve also seen silence not work. When I was a fellow, I tried using silence with one of my patients, and after a minute she turned to me and asked “Why aren’t you saying anything?” I didn’t try it again.

Silence doesn’t work as a communication strategy for everyone, just as naming the emotion might not work for everyone. But when it works, it’s a tremendously effective way to explore emotion with empathy.

And it shows your patients that you’re listening, and care about what they have to say perhaps more than your agenda or checklist or the next thing you have to do. It’s this sense of genuine concern and compassion that helps shine the clearest light on what matters most for our patients.

Source:

  1. McDonagh, Jonathan R. MD; Elliott, Tricia B.; Engelberg, Ruth A. PhD; Treece, Patsy D. RN, MN; Shannon, Sarah E. PhD, RN; Rubenfeld, Gordon D. MD, MSc; Patrick, Donald L. PhD, MSPH; Curtis, J. Randall MD, MPH. Family satisfaction with family conferences about end-of-life care in the intensive care unit: Increased proportion of family speech is associated with increased satisfaction*. Critical Care Medicine 32(7):p 1484-1488, July 2004.

Moments Matter 64: Believe That You Can Learn

Believe, deeply and truly, that you can learn something from every person you meet.

I’ve seen variations on this theme, but they usually involve what others can teach you, which I think puts the emphasis of learning on the wrong person. Some people are teachers whose role is to teach, most people are not. It’s up to us to learn from everyone, regardless.

It doesn’t mean you absolutely will learn something from every person you meet. It might take time, or the lesson might be hidden from sight or you won’t realize it until years later. But believing that you can learn something – that the potential exists and that you welcome it – is key to being a lifelong learner, and to lifelong growth.

Believe, deeply and truly, that you can learn something from every person you meet.

I recently met someone struggling with addiction. I learned that sitting down and maintaining eye contact, not just making eye contact but holding it without breaking, can make someone living a life full of labels and assumptions and judgment feel heard. Feel seen, and respected.

I learned that most people never looked him in the eyes, never shook his hand, never spent more than a few minutes talking to him. I learned that he never realized how much he needed someone to just sit there, and listen, and look him in the eyes while he shared his story.

I learned that he felt, for a moment, connected again to something he assumed was lost forever.

Believe, deeply and truly, that you can learn something from every person you meet.