how to resuscitate a beating heart

The Covid-19 pandemic has challenged health care providers in ways we never anticipated. From the shortage of PPE, to the lack of ventilators, to the failure of leadership at the highest levels, we have witnessed defeat every step of the way. We thought our health care system was infallible only to discover gaping insufficiencies in our knowledge and preparedness. Now we question our ability to deliver care as we confront another massive surge in hospitalizations when we are facing a shortage of trained ICU nurses and techs. Who are already exhausted. Who are already beyond overworked. Who are totally tapped out. This is a problem because, let me assure you, we need them.

Look at this:

caixinglobal.com

The ICU staff is responsible for settng up this kind of equipment. For making sure all the wires and tubes are connected properly. For adjusting IVs, and administering meds. For knowing when the patient is in trouble, and when to summon help. Not many people are trained or adept at this kind of work under the best of circumstances...when they are well rested, and fed, and focused. But many of them are not. The influx of Covid-19 patients means they are rushed. They have to skip meals. They have to work multiple shifts without a break. There is no one they can call in to take over for them. I know I couldn't, which is why I want to remind all nurses that I believe:

"You're braver than you believe,

and stronger than you seem,

and smarter than you think."

~Christopher Robin~

Believe me, I know what it's like to be just that tired and hungry and frantic. I remember falling asleep at the nurses' station as my pen trailed on off the page while I was writing orders. I recall pilfering crackers and jello that were meant for patients in the middle of the night. I dozed off during lectures and on rounds. Trust me...you do not want your doctors and nurses to be exhausted, anxious, and frustrated if you end up in the ICU because you picked up Covid somewhere...

...which is why we should all continue to isolate as much as possible. We should wear a mask whenever we venture out and keep it on wherever we go, government mandate or not. We should wash our hands long, hard, and often. We should assure our family and friends we love them and miss seeing them. We should exercise compassion. We should use our brains. We should take every precaution to protect our family, friends, and neighbors. Our children. And our nurses, because:

"America's nurses are the beating heart

of our medical system."

~Barack Obama~

jan

who we remember and why it matters

I practiced family medicine for over thirty years. I cared for thousands of patients with everything from common colds and itchy rashes, to life-threatening chest pain and end-stage cancer. From birth to death. From morning to night. Like all health care providers do.

We record our patients’ stories. We invade their privacy and probe their bodies. We formulate a differential diagnosis and subject them to sometimes painful testing and treatment. Through it all, we provide encouragement. We embody hope. We offer solace. We confront suffering. We celebrate healing.

"The best way to find yourself

is to lose yourself in the service of others."

~Mahatma Gandhi~

It’s no wonder, then, that we carry their stories with us. That, years later, we still remember people we encountered only briefly, not because their stories were particularly gruesome or traumatic or heartbreaking (although many were), nor because their recovery was so extraordinary (sometimes miraculous), but because we took our time with them. We learned from them and we used what they taught us for the rest of our careers. Or, perhaps, we failed them, and still can’t forgive ourselves.

Trust me…for any but the most trivial office encounter, patients remember us, too. How we dressed. If our hands were cold. The smell of cigarette smoke on our breath. Whether or not we made eye contact. They read the expression on our faces and our body language. They sensed when we were hurried. They knew if we were listening.

"Give whatever you are doing
and whoever you are with
the gift of your attention."
~Jim Rohn~

I remember certain patients because I was touched by the suffering they endured, or by the strength they demonstrated, or by wisdom they embraced. I hope they remember me because of the time I spent with them, the compassion I felt, and the knowledge I shared.

Which patients do you remember?

“There is no such thing
as an ordinary human.”
~Stephen Moffat~

How do they remember you?

"I've learned that people will forget
what you said,
people will forget what you did,
but people will never forget
how you made them feel."
~Maya Angelou~

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how to make peace with what you imagine

 

November 14, 2020

Last week I was reading some of the metaphysical stuff I love when I came across a statement that caught my attention. It came out of a study that posited the best predictor of impending death is not the actual state of your health, but an unprovoked preoccupation with thoughts about death, even among people who are feeling fine. It concerned me because I've been thinking a lot about death recently. Who hasn't been? Every day we are confronted with its cruel reality. You can’t turn on the news without thinking about the thousands who have crossed this threshold in just the past few months. Souls who had never given death a thought.

"If I'm going to die, the best way to prepare

is to quiet my mind and open my heart.

If I'm going to live, the best way to prepare

is to quiet my mind and open my heart."

~Ram Dass~

My preoccupation with death went farther than that, though. For reasons I didn't understand, I pulled out my files on "green" burial. I found myself making a mental note of what of music I would select if my family and friends held a service of some kind for me. I searched for poetry I thought reflected my beliefs (hint: it doesn't have anything to do with heaven or hell). 

"The sun sets and the moon sets,

but they are not gone."

~Rumi~

But it went even deeper than that. I went really metaphysical with death itself. Not the burial, nor the corruption of the body, but the concept and nature of the afterlife. I reflected on issues I usually avoid, and tackled the contradictory teachings that have always left me confused and frustrated. I'm happy to say that I found the answers to some of the questions I have spent a lifetime seeking in all the wrong places. Something I can believe in. A portal to eternity.

"In the depth of your hopes and desires

lies your silent knowledge of the beyond;

and like seeds dreaming beneath the snow

your heart dreams of spring.

Trust the dreams, for in them is hidden

the gate to eternity...

And when you have reached the mountaintop,

then shall you begin to climb.

And when the earth shall claim your limbs,

then shall you truly dance."

~Kahlil Gibran~

It worried me when I came across the study that predicted my impending demise, but I'm feeling better about it, now. I realize that this unusual preoccupation with death has less to do with me than it has to do with my children and grandchildren, and with the friends I will eventually leave behind. Eventually, being the operative word. I want them to know that I no longer dread aging, or fear death. That they don't have to worry about me. That I am at peace with what I imagine will become of me. Which is the best I think we can do...imagine it. Like this:

jan

empty-handed and broken-hearted

 

I learned something new today. This is reason to celebrate because some people like to joke about my incipient dementia. At least, I think they’re joking.

I was contemplating the theme for this post, “primum non nocere,” and its English translation—“First do no harm.”—when I learned that this saying has nothing to do with the Hippocratic Oath. I'd forgotten that. When I graduated from medical school, I took the Hippocratic Oath, so I should have known. It actually comes from Hippocrates’ writings in “Epidemics”: “The physician must…do no harm.” These words are the bedrock of medical ethics and practice even today.

In fact, many of the traditions that influence the way we practice modern medicine were passed down to us by men like Hippocrates. Not because women were excluded from the practice of the healing arts in ancient Greece. On the contrary, way back then, women were highly respected as physicians and healers. Even Plato held them in esteem. Though they were few in number, patients sought them out. They were regarded as the “wise women” of the community. Their “soft hands” were considered to be “healing hands”.

“Have a heart that never hardens,

a temper that never tires,

a touch that never hurts."

~Charles Dickens~

 

But as the science of medicine advanced, the feminine ethic lost credibility. Its wisdom and power to heal were disdained in favor of dispassionate technical expertise—testing, procedures, and proofs. Today speed and efficiency reign, and reimbursement issues drive the system. Over time, tradition has suffered, and as a result, patient care has suffered.

 

Unfortunately, one of the time-honored traditions that did survive is the one that expressly prohibits the physician from entering into a personal relationship of any description with a patient. This, of course, is an impossibility. It disavows the emotional intimacy that is the inevitable fruit of shared suffering. It contradicts the compassionate physician’s experience and denies him a powerful tool.

Today, the physician is taught that it is unprofessional to share his personal experience, insight, beliefs, or values with the patient. This rule of non-engagement was hammered into our heads during training when we were still easily moved to empathy, at a time when connectedness with other human beings was still something to be desired and defended.

“The good physician treats the disease.

The great physician treats the patient

who has the disease.”

~William Osler~

 

Sadly, this means that patients may know more about their hairdresser or mechanic than they know about their doctor—the person they trust with their health, with their children’s health, with their lives. This can be troubling for patients. They may have little choice when it comes to selecting a physician, and except for the credentials displayed on the walls in his office, they may know nothing at all about him. They worry about it and they should. Is he competent? Is he caring? What motivated him to undertake years of grueling study and training? What sustains him? What is it like for his family? How does he manage it all?

 

This precedent distances us from our patients at times in their lives when what they may need from us more than anything else—more than another prescription or another test or another procedure—is our presence with them, our strength, our compassion and support especially at times of serious illness and suffering. At times when fear and grief cut deep. At times when they may need to understand that nothing more can be done for them…or for someone they love—a friend, a spouse, or a child.

When our patients need us the most—that is, when there is little hope for recovery—we are trained to turn their care over to the nurses, their family, their pastor, or to hospice. We leave the patient’s bedside the way we approached it—as a stranger. We lose sight of the greatest gifts we can offer as healers—our time and attention. Our presence. Our touch.

“Some patients,

though conscious that their condition is perilous,

recover their health simply through their contentment

with the goodness of the physician.”

~Hippocrates (460-400 BC)~

 

We leave the bedside empty-handed, and sometimes broken-hearted.

 

“Tell me your story,

show me your wounds,

and I’ll show you what Love sees

when Love looks at you.

Hand me the pieces,

broken and bruised,

and I’ll show you what Love sees

when Love sees you.”

~from “When Love Sees You”~

~lyrics by Mac Powell~

jan