Cultivating connections

FigurePatients and families come to healthcare professionals for safe care, effective treatment, and the hope of healing. They come in anticipation of the care we can give. This is the reason healthcare professionals are referred to as "caregivers" and medical "providers." Physicians, nurses, technicians, and therapists are trained to perform interventions and make medical decisions that treat illnesses and diseases, relieve suffering, and give care to patients and families with compassion and careful attention. Simone Weil, a writer, philosopher, social activist, and brave soul wrote passionately about the importance of attention: "Attention is the rarest and purest form of generosity."1 She described "the capacity to pay attention to an afflicted person" as a rare and difficult thing: "It is nearly a miracle. It is a miracle."2 The therapeutic relationship, unlike a business or social relationship, is one in which we recognize and give attention to the uniqueness of each individual and their circumstances.3 This kind of generous attention helps us establish relationships and communicate genuine care. It's an intentional act for the benefit of another person, truly an uncommon, beautiful, and rare gift. Giving attention requires us to set aside our own agendas and approach each person bravely with an open heart. Protection versus disconnection In healthcare, there's no shortage of affliction or suffering, but the pace and increasing demands on limited staff and resources make the capacity for attention as scarce as it has ever been. I recall one special nurse on the verge of tears and compassion fatigue describing the way he used to enter each patient room fully present for the patient and every person in that space. However, it wasn't long before he realized that he needed a way to keep his own thoughts, emotions, and responses in check to reserve emotional energy for the rest of the patients under his care. He imagined putting on a shell to protect himself from exposure to the situations he encountered. It allowed him to perform the tasks needed for the patients he was assigned without expending too much emotional energy. He put on the shell when he entered the patient room and took it off at the door on his way to the next room. But after a while, there came a day when he no longer had the strength to put it on and take it off and put it on and take it off...and he just left the shell on. At first, the shell protected him. It kept him from getting too close or too involved in the situation. It took less willpower to focus on the tasks at hand, but there was an unintended cost: it disconnected him from the joy of relationships with his patients. It disconnected him from the aspect of his work that brought him the most joy. Paying attention, connecting with, and caring deeply for his patients and families was difficult but deeply satisfying, and it turned out to be the very thing that gave him strength. When staff and providers are weary or discouraged, and patients are demanding, frustrated, and scared, our first inclination may be to protect ourselves rather than lean into the difficult reality of the environment in which we work. We mistakenly think this is the self-care we need to continue to diagnose, treat, and solve problems. But when the patient becomes a problem, and the problem becomes the focus, we compromise our capacity to relate well or notice what matters most to the patient. And we may work very hard to address the problem, but we fail in our calling by misplacing our attention. Ask questions, make connections Every day in Patient Relations, we encounter stories of angry, emotional, and confused people. Already this morning, four different people have called to convey some kind of problem related to their healthcare experience. Three people called yesterday. It was a dozen last week. Our work is to understand the situation, determine what happened, and find out how we can help to regain their trust. Their healthcare experiences didn't go as expected, and these people are reporting their problems to bring them to someone's attention. They want someone to listen to their hardship and take it to heart. Success or failure hinges on our ability to notice what's said, what's needed, and how best respond to correct their issues. Being patient, asking the right questions, and connecting well are critical steps. "The love of our neighbor in all its fullness simply means being able to say, 'What are you going through?'"2—Simone Weil Several years ago, I came to know a certain man through his many complaints. It seemed no encounter with our facility went without a follow-up call and "feedback." I generally spoke to him by telephone and, based on his distinctive voice, pictured him as someone who looked a bit like John Wayne in a green beret. That was my story. But I was forever changed by what happened the day a charge nurse called me to ask if I could pay a visit to this patient's hospital room. Apparently, he'd been firing his care team left and right, and at this point, the medical-surgical unit had run out of staff (and patience) to respond to his incessant call lights and crotchety comments. It was only when I met the charge nurse at the nurses' station that I realized who I was about to visit, and I prayed for strength. As I entered the room, it was quiet, except for a certified nursing assistant who gingerly closed the door to his bathroom and cast a sideways glance at me as if to say, "Good luck!" In the bed lay a man with a grizzled beard and scruffy hair. He didn't resemble the movie star I'd imagined until he spoke. Sure enough, it was him. I introduced myself and asked if I could pull up a chair. When he began to explain his frustrations with the "lazy staff who never respond to the call light," I was struck by how he felt as if they were "writing him off" and the only way to get a response for the alarms that kept beeping was to lose his temper. He said they made him wait to use the restroom and prioritized other things first. He felt that no one took him seriously. When I asked him to tell me more about the problems with his care, he was silent and seemed frustrated by my asking, as though he'd already made it clear. After the pause, he stated, "You know, I served in Vietnam...." I thought to myself: "Okay, maybe he wasn't a Green Beret, but close enough." He continued, "In the military, they train you to perform CPR so that when you come across a fellow soldier, you can resuscitate them—solo. They teach you not to stop for 20 minutes." I felt myself lean toward him, interested in what he might say next. Apparently, when he was in Vietnam, he came across an unconscious, wounded soldier, and started CPR. He was alone with no one else to help, and he was exhausted at only 13 minutes. The soldier was still cold and bluish gray; no sign of life, and no one around to witness if he quit early. It was tempting, but he kept going and suddenly "at 17 minutes that soldier spit up water into my mouth." I imagined with him as he retold how startling this was and how he held that soldier, watched his color return, and thought to himself: "What if I had given up on minute 13?" This crotchety man looked me in the eyes and said, "When they don't answer my call light, I feel like they are giving up on me." And then I understood. We talked a little longer than I had planned. Mostly I thanked him for his service and for trusting me with the deeply personal story he shared. As I prepared to leave his room to follow up with the care team, he thanked me for listening to him and, with his whole face, he smiled. I can still see that man with a voice like John Wayne and his story of performing CPR on a young soldier; it was so much better than the story I made up about him. I was glad I had the time to give him my attention. Of course, the charge nurse and care team were all a bit surprised. Yes, some were skeptical and thought this man had played me, but we had no further complaints from him the remainder of his stay, nor since that time. I attributed this to their attentiveness to him. I also think he knew his story had resonated with me. Perhaps his behavior changed a little bit too because, in the telling, he had called up a better version of himself. Regardless, this experience impacted how I listen to patients and family members today. How tired or discouraged do I have to be before I stop caring or being anything but generous with my attention for a person in pain? I want to be brave enough to sit with a person in their suffering—looking, listening, and connecting with them—and refusing to be taken out or, worse, become calloused by the circumstances or their behaviors toward me. Now think about the patients you encounter. Do you know their names? Do you know what they do for work or leisure? Have you asked about the important people in their lives: who they need at this time, or who needs them? We must be more ambitious in asking questions. Where are you from? How did you get your name? What should I know about you (or your parent or spouse, if you're speaking to a patient's family member) that I won't find in the medical record? In the context of creating memorable and positive patient experiences, patient stories are too important to leave to intuition or assumption. Noticing, making eye contact, asking these questions, and remembering the answers is more than good customer service, and it accomplishes more than making small talk; it opens the door to relationships and new ways of seeing each person and situation. The healing power of connections My personal experience working in a healthcare organization has opened my eyes to the power of personal stories. But what truly opened my heart to the miracle of attention and the therapeutic relationship was the experience of observing my son receive treatment when he was referred to specialists in a hospital hundreds of miles from home with unfamiliar caregivers. Especially at those first appointments, it was immeasurably comforting to observe them gather the pieces of his story and consistently remember the information among caregivers and specialists. They got his name right, asked about his interests, commented on the T-shirt he wore from the all-star football game, and remembered he was a university student and what he was studying. Over the years they've proven themselves to be clinically excellent in the ways they've managed his care and guided his treatment journey. They've been honest and forthright about his condition and what they believed could be done to improve the quality of life he's living. I genuinely believe that because they know his story, they see him, and they care for him. "Healing goes beyond dealing with a health problem or crisis. It touches every aspect of life, facilitating a continuous movement towards wholeness and peace. In order to support the healing of others, we must also be on the path ourselves."4—JoEllen Koerner Tapping into personal stories gives us an opportunity to understand what makes patients behave or respond a certain way. It helps us make sense of our own journeys, too. None of us are exempt from hardships or struggles. I believe humans are relational and meant to be in community. When we share our stories and help each other with the interpretation, we cultivate connections that are healing. We create a more complete history that's far more than a checklist and narrative of fact-telling. When we draw out stories and cultivate connections, we touch hearts. Moreover, we tap into greater joy and purpose as caregivers when we intentionally listen to, honor, and respect the humanity of each person interesting and worthy of our attention. People are really interesting, after all. And relationships with other people do matter. As caregivers, deliberately attuning to people where they are, noticing and being curious about what we learn, remembering and following through are all practices that help us build effective relationships. Cultivating such connections happens in moments when we are present with each other, generously offering attention, neither denying their pain nor diminishing the effort it takes to be present, listening with curiosity and responding with compassion. Yes, this kind of attention is a rare gift, but when we dare to offer it, we fulfill our highest calling as caregivers.