Sitting with Patients: A Lesson for Doctors

Posted March 24, 2017 by heysonnie
Categories: Blogroll, Cancer, Health Care, Hope, Life

Tags: , , , , , , ,

As Colon Cancer Awareness Month draws to a close — AND as the House of Representatives is poised to vote on the terrible AHCA — I’m reposting this. It has to do with any kind of hospitalization — or even office visits.

It was 2001. After being sick for awhile Melinda rushed me to the ER. They kept me, soon saying, “This is your diagnostician” and “This is your surgeon.” And “Cancer…” I had meatball surgery since there was no time to prep, and it was almost too late. Then a week in an induced coma. Next was a CCU room. I had tubes running in and out of me, and I still didn’t know if I would live. Melinda had to get some work done, so I was alone and crying softly to myself when my surgeon came in on her rounds. She had stood before, but this time she pulled up a chair, sat down, and held my hand. I don’t know if she was there for seconds or minutes or an hour, but I felt better. I had hope that I’d have a future.

I had never seen someone so yellow.

It was as if someone had taken a highlighter to the whites of her eyes and coated her skin with a layer of mustard. In actuality, the cancer in her colon had crept to her liver, where it blocked bile from taking its natural path out of the body, causing the ominous yellow chemical to spill into her blood and tissues. She had left the hospital two weeks ago, hoping to die at home, but came back with worsening pain and bloating in her belly — and because she couldn’t stand to look at herself in the mirror.

“Doctor,” she said softly — it was a title that still didn’t feel quite comfortable to me, a newly minted doctor, especially coming from a patient several decades older than me. “You remind me of my nephew.”

She asked me to sit for a few minutes and, shamefully, I hesitated. I had eight more patients to see before rounds and was already running behind. But I sat — listening to a dying woman’s fondest family memories, my mind racing through a seemingly endless list of boxes I had to check that morning. When my pager went off five minutes later, I excused myself, promising to return in the afternoon to finish our conversation.

But I didn’t.

There were new patient admissions. Emergencies on other floors. Notes to be written, consultants to be called, outside hospital medical records to be procured.

When I got home that night, I kicked myself for forgetting to stop back to see her. I briefly considered going back to the hospital but, exhausted, told myself she’d be asleep by now and vowed to arrive early the next morning to spend extra time with her.

She died that night.

The most draining aspect of medical training, it turns out, is not long hours, brash colleagues or steep learning curves — it’s the feeling that you’re often unable to be there with and for your patients in the way you want, in the way you’d always imagined you would be.

For hospitals to run efficiently, it is widely thought that they must operate like companies. There’s a certain number of patients to be seen, doctors to see them, diseases to be managed, procedures to be performed, and hours in which all this must occur. For patients to feel cared for, we must treat them like family — with all the time, energy and compassion that entails.

It’s a tension with which doctors at all levels of training struggle. But the problem may be most acute for new residents who are generally the ones expected to gather, relay and document patient information; to enter orders and coordinate care between medical services; to be the first to respond to patient, family and nursing queries.

So far, residency educational reform has focused on the quantity of hours worked, not necessarily improving the quality of time spent at work. But limiting how long residents spend in the hospital may have actually exacerbated the problem. By squeezing the same clinical and administrative work into fewer hours, do we inadvertently encourage completion of activities essential in the operational sense at the expense of activities essential in the human sense?

It’s no secret that trainees now spend less time at the bedside than ever before. Residents today spend eight minutes per day with each patient — or about as much time over all seeing patients as they do walking around the hospital, and a quarter as much as they do sitting behind a computer screen. The next wave of reform must focus on understanding how best to ensure resident time is spent on direct patient care and meaningful clinical activities.

Part of the answer may be reducing individual workload by training more residents. But, without extending already lengthy training programs, this also carries the risk of precluding residents from managing enough clinical encounters to graduate as competent independent physicians. More promising reforms are those that allow trainees to focus on the types of activities they chose careers in medicine for by off-loading or eliminating other activities. These may include: improving the ease of communication with nurses and consulting medical services; enlisting medical scribes to assist with documentation; minimizing admission and discharge paperwork; streamlining transitions to outpatient care; and automating certain routine procedures and processes.

On some level, though, efficiency-empathy trade-offs are an inevitable and inherent tension in medicine — a function of busy hospitals with complex patients and limited personnel and resources. But I wonder also if this is a trade-off we too readily accept and whether the pendulum has swung too far toward the alter of efficiency.

Surely patients want to be seen and treated in a timely manner, but when we sacrifice empathy for efficiency we fuel what lays at the core of patient — and physician — discontent with modern medicine. We hide behind buzzwords like “patient-centeredness” and “shared decision-making” without being able to offer the time that gives these terms true weight. Ultimately, reconciling this tension may mean reconceptualizing “efficiency” to include the tremendous value that exists in having more time to spend with our patients.

When I think back to that morning with my patient, and many mornings like it, terms like efficiency and productivity seem to lose their meaning. I think of the countless opportunities for compassion I squander every day in pursuit of something far less meaningful to patient and doctor. And I think, next time, I’ll sit.

Dhruv Khullar, M.D., MPP, is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter: @DhruvKhullar.

https://well.blogs.nytimes.com/2015/03/19/the-importance-of-sitting-with-patients/

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Hope Where There Is No Hope (or Is There?)

Posted December 2, 2016 by heysonnie
Categories: Blogroll, Hope

Tags: , , , ,

Diana Bass is an author, speaker, and independent scholar specializing in American religion and culture. She wrote this post on Facebook. Sadly, in our post-election world, she’s had to limit the audience of her posts because public writings have been slammed by trolls. It’s exhausting.

But here she tells a story of a young Black woman who doesn’t have a comparable version of that, who is out there among the trolls on a daily basis. So far this woman has hope. Hope — the theme of the first week of the Advent season. We need to remember this; like Diana, we need to turn from the evil to the light, to acknowledge and lift up those who do the right thing.

__________

I’m in a hotel this morning in Florida where some sort of conservative conference is being held. At breakfast, four older white men were at the table next to me. One was a media activist-pundit (who I think I recognized). They were talking VERY loudly bragging about how they have “total power” and how they are going to destroy everything President Obama did, how easy it is to manipulate people to get them to vote for them and how they planned on taking over every single county government in the state of Florida.

There was a young African-American woman waiting on them. She did her job with thoroughness and kindness. As I watched, they spoke of disgusting racist things and openly extolled DT in front of her — who they seemed to think was invisible. And the more they bellowed their retrograde views, her body actually recoiled as she tried to serve them.

I was VERY angry. VERY ANGRY.

When she came over to my table, I told her that those guys might be white and I might be white but I thought they were assholes and that I wasn’t on board with their plan, how sorry I am about what happened. I told her that wanted to go over to their table and slap them upside the head. She laughed.

She said, “You know, one day all this hate will finally die out. It doesn’t bring life. It cannot survive the long term.”

I said, “I kind of hoped it might die before I do.”

She said, “Well, that’s probably a bit too soon! But I have hope. Hate has no life of its own. Another generation or two. It will die.”

“Meanwhile, we work for our communities. We love our families, care for our neighbors, celebrate life.”

And she went on, “And meanwhile, we work for our communities. We love our families, care for our neighbors, celebrate life. And them?” She gazed over to the table with a mixture of resignation and pain. “They are the last of a dying world.”

As she spoke to me, her back straightened, her eyes glowed, passion filled her voice. And finally she said, “It is really nice, however, that a white lady like you noticed how awful they are. Thank you. We all need to pay attention and do our part.”

She is 27.

Post post-election words from Anne Lamott

Posted November 20, 2016 by heysonnie
Categories: Blogroll

Tags: , , ,

I have passed through the initial five stages of grief: denial anger bargaining depression and acceptance. Now I am in fascination—cobra hypnosis, newly apoplectic every day by the latest. I believe I have actually keened within recent memory. At this rate, I may have a flickering tic in my eye by sundown. Also, I am doing the unconscious eating that everyone I know is doing, whole packages of Oreos for us sugar freaks, whole bags of chips for the salty-fats crowd, oat-bags of dip, whole sides of beef: no little dog is safe in the midst of our voracious appetite for numbness. I absolve everyone: It’s okay for now. We need ballast.

Because we’re all doomed. It’s hopeless.

Oh, wait, never mind.

But what do we do, what do we do?

We have to figure this out—oh wait, never mind. Figure out is not a good slogan (altho certain very tall people in your household and classrooms always insisted that this was the golden path to glory.) (I will not name names.)

Where do we start?

Well, that one I can answer. We start here, where our butts are. We get up and feed the dogs—I said feed them, not eat them.

We can say a little prayer even if we are not believers: “Help” is a great prayer. “Help me, help me, I am a completely doomed human,” is even better. When my then six-year-old son got his head stuck in the bars of a chair at the dining table of some friends we were visiting, he went unnoticed for a time, and then a tiny voice piped up and said, “I need help with me.” The friends had this calligraphied and framed for us. I say it at least once a month.

I’ll tell you a great praise prayer for the believers, and then one for the Nons.

I have a friend who is a hopeless alcoholic of the worst sort, like me, who somehow like me has put a few years between those cool refreshing beers we had with breakfast, just to get all the flies going in one direction. She went to some sort of “meeting,” and met up with a woman who had had most of her tongue removed during surgery for an aggressive oral cancer. She shared during the meeting that the cancer had returned and she needed another round of chemo. Everyone looked on in dismay, but she flipped her wrist dismissively. “Oh, I’m not worried,” she said. “God’s got it.”

God’s got it. This is so not me. I’m more of a Rube Goldberg machine of herky jerky attempts at control, domination, and, most importantly, assigning blame. But then the pain and isolation of feeling like the Wizard of Oz gets my attention and eventually, I give up. I surrender. I lay down my weapons, and breathe, maybe not like the Dalai Lama, but less like a sturgeon on a dock.

And for the Nons: a dear friend once got a call from a world-famous screenwriter, who, in the throes of grandiosity, had lost or was losing almost everything precious to him. He recounted a litany of troubles and obsessions, from the distant wife to the scary child to the lack of prospects, and then demanded that my friend gave him one good reason to stay here on this vale of tears.

My friend listened attentively, which is pretty much all we have to offer, and then said, “Mornings are nice.”

That’s a gorgeous prayer.

“i thank You God for most this amazing day:” cummings wrote, “for the leaping greenly spirits of trees and a blue true dream of sky; and for everything which is natural which is infinite which is yes.”

So that’s where we start—here, now, damaged, scared, grateful, surrounded by our beloved, by sad strangers, with lots of poor people to care for, a world to save, a bracing cup of coffee, walks begging to be taken, lonely people to check in with, Oreos and Cheetos to get through, (someone’s got to do it,) a whole new day before us, that we can screw up or not. Sigh. Here we go.

__________

Anne Lamott’s Facebook post, because they’re wise words that I need. Maybe you do too.

Theologian Miroslav Volf makes a surprising case for one candidate

Posted October 7, 2016 by heysonnie
Categories: Blogroll, Presidential Election

Tags: , , , ,

Excerpt:

I want to get to these issues. But first, make your best case for the candidate you think Christians should vote for.

The best case to be made for Hillary Clinton is that on balance she better represents the convictions and character that should concern Christian citizens. No candidate is perfect. There are certainly areas where Secretary Clinton’s policies and record might give Christians pause. But she takes the threat posed by climate change seriously. Her policies, such as paid family leave, would actually strengthen American families. She is committed to a just and welcoming approach to immigration that does not unduly compromise the legitimate good of security. She supports major reforms to America’s overly retributive and racially biased criminal justice system. And, perhaps most importantly, she has demonstrated much deeper commitment to supporting the disadvantaged and the vulnerable than her opponent has, his grandiose rhetoric notwithstanding.

The second best case for voting for Secretary Clinton is Donald Trump. Mr. Trump is an exceedingly poor candidate whose public life has not demonstrated a single one of the moral virtues that are important for a political leader to have. Braggadocio is not the same thing as courage. His policy proposals, such as they are, range from half-baked to obviously incompatible with deep Christian convictions, such as the importance of welcoming the needy stranger, care for the nonhuman creation and pursuing peace.

Source: Theologian Miroslav Volf makes a surprising case for one candidate

#Orlando #Pulse #Heroes

Posted June 13, 2016 by heysonnie
Categories: Blogroll

Tags: , , , ,

Yesterday morning I was still in bed, lying next to my wife as she slept. As is my habit, I grabbed my iPad to check the news. The headlines read something like “20 Dead in Nightclub Shootings,” [a few hours later we learned that the number was 50] and these early articles neglected to mention that the bar, the patrons, the bartenders, were queer people. But they knew… and I knew. 

Queer people have magical powers. Among those is invisibility. Sometimes we make ourselves invisible for various reasons (including basic survival), and sometimes it’s other people, and society in general, who can’t / don’t / won’t see us. But one of the things about this magical power is the ability to see levels of reality that haven’t been fully expressed. We frequently can see through others’ invisibility — and through attempts to make us and our lives invisible. Thus, I read through the invisibility cloak cast by the New York Times and other media in their earliest submissions. So did some of my friends in their posts: “Please, God — don’t let this be at a gay bar!” even while, on some level, knowing that it was.

Once upon a time, a long time ago in a world far away, I was a bartender. I worked in a place much like Pulse. The weekend clientele was 75% gay men, 20% lesbians, and a few straight people. Mostly the latter were there with friends, and a few others who just liked the music and the vibe. But there were the occasional ones who were motivated by less-noble factors. Often the bartenders would notice, sometimes a patron would point out someone acting odd, and sometimes it would be a bouncer who knew that this person needed to go. A quiet-ish conversation between bouncer and customer, an arm in the person’s elbow to escort them to the door, and they were gone. And the party continued.

Knowing from my own experience that bouncers are strong, mostly silent heroes, it didn’t surprise me when I read that one of them had knocked down a wall or partition. Behind this wall was an employees-only area — and an exit to the outside, to safety. Unnamed in the story, maybe this was Kimberly “K.J.” Morse — one of those who died. (Or maybe not.)

I hated that the media was already turning to the evil, to the perpetrator, focusing on the “terrorism” (by which they meant a dark-skinned “radical Jihadist” because those are the only terrorists, right?) aspect of the story. That, and guns and other angles can and will be the subject of other conversations. But just then I wanted to know something different. I wanted to see hope. I wanted to see humanity. I needed to see the heroes.

By then I was up, flipping through the TV channels.

There was this guy, the guy in the hat on the left. He was interviewed (I think on CNN, but I was in a channel-flipping blur, so I can’t be sure), and he talked about escaping, running to safety — but then he saw someone else bleeding, so he stepped out of his safety zone to help carry this person to the back of a pickup truck to be taken to the hospital. All the ambulances were full.


NY Daily News photo gallery

Next I heard a story about a man who came to the scene to see if he could find news about his brother. He managed to get closer, inside the crime tape barrier, nearer to where there was still an “active shooter” situation. Even while searching for his loved one, he too helped to transport a messy, bleeding person away from the scene.

Then I heard this hero’s story:

Other heroes and sheroes include the many people who stood in line in the hot sun for hours so that they could donate much-needed blood. Some of these were people visiting DisneyWorld; some were Muslims during their Ramadan fasting time. No one did it for the accolades.

It took some hunting behind the story that the media was intent on telling, the story of the bad guy. But I loved these stories of ordinary people, queer and not, who found themselves in ugly, extraordinary circumstances and stepped up — some even in the face of danger.

In the introduction to David Copperfield, Charles Dickens wrote, “Whether I shall turn out to be the hero of my own life, or whether that station will be held by anybody else, these pages must show.” Even in our times when it often seems like darkness prevails, there are stories of light — stories of ordinary people who do the right thing, thus becoming our heroes, and the heroes of their own lives.

An Open Letter to the Rev. Laura Mariko Cheifetz

Posted May 12, 2016 by heysonnie
Categories: Blogroll

My friend Rocky wrote an open letter that I really like. In this spirit, I’m doing the same thing… Sorta. 

Dear Laura,

I love they way you think. You challenge me. As a result, I think that little by little I become a better person. Thank you.

Love,
Sonnie

p.s. I also love your sense of humor.

Happy are they who lead from the back pews

Posted March 18, 2015 by heysonnie
Categories: Blogroll

Tags: , , ,

blessed

Blessed are those whose names are unknown.

The voiceless ones

who were quiet, so their stories were never heard;
who were overwhelmed, so they couldn’t find the words;
who felt like others had more important songs to sing;
who shared their stories in less-public arenas.

Blessed are those who showed up.

The ones who did the countless behind-the-scenes work

who made the coffee and baked the cookies;
who folded the bulletins and served as ushers;
who stuffed envelopes and licked stamps;
and did all the other Martha chores
that those in the spotlight never even knew about.

Blessed are those who remained in the shadows.

Those who just couldn’t…

who lived in insurmountable unsafe places;
whose closet doors were nailed shut;
who yearned to live in the light;
who were isolated;
whose participation was a financial contribution
…or a prayer.

Blessed are those who moved on.

Those who needed to be elsewhere 

who were battered by the church;
in order to survive;
in order to more fully live;
so that they could find happiness.

Blessed are those who died on the journey.

Those who we knew
and those who we never got a chance to know.

And blessed are YOU.

Those who come next

the leaders (and the followers)
of this generation and beyond,
who find the next liberations
and who work for them to become reality.