Teachable moments through death
Monday, July 08, 2019
"So how can we possibly incorporate some of the contemplative care practices we learned at ‘Being With Dying’ into real-life clinical practice? There's absolutely no time," he bemoaned. He was the director of medical education at a large teaching hospital. He also worked there as an attending MD — with outstanding teaching accolades.
I had given him a call after attending one of the earlier iterations of this professional training program for clinicians. We both lived and practiced in the same city; he had participated in the program prior to me. "Let's see," I said as he challenged me with an invite to participate in ICU rounds.
At the appointed time, I arrived at his office and we raced up the stairs taking two at a time. Once in the ICU, with the chief resident and three other doctors at his side, my colleague did the usual do.
Zooming in and out of critically ill patients’ rooms — a nod here, a few words with families there, greeting mostly unconscious patients, mini-briefings with staff, some new orders. It had been a quite a while since I'd been on ICU rounds — nothing had changed.
Then, a few minutes for a "huddle" with the group. We scooted off to the side, gathered close and he asked his mentees for their reports.
The chief resident noted he'd had two deaths the night before, one autopsy that morning and gave a quick update on each person on his patient roster. My colleague asked if there was anything else — there wasn’t — before dismissing them. No one but the chief resident had spoken the entire time. I was aghast.
We charged back down the stairs to his office where he immediately proclaimed, "So, you see, there's no time."
I asked if he wanted my input — there certainly was time and he’d missed it. He was all ears. So, I proceeded:
What if you had paused for even five minutes and did the following?
First, given empathy to the chief resident who looked exhausted and had dealt with death three times in the last 12 hours? Maybe start by saying "that's a lot" and then wait for his reply.
Might that have triggered some discussion or even emotions? The other three doctors may have engaged in some way. To have been heard and seen at the human level could have been helpful and healing for them.
What ripples would such an intervention generate? Instead of trudging forth through the rest of the day, perhaps these four physicians (plus you and I) would have felt tended to and been transformed in some tiny way. Such care might have influenced all of our forthcoming interactions — and beyond.
He seemed astounded, then agreed.
Not long after this experience, this doctor decided to become palliative care certified and, upon doing so, went off to steer head a new palliative program elsewhere. I am certain, once there, he incorporated many of the tools we learned at that "Being With Dying" training.
A challenge for all of us as providers: to be mindful and make the most of the myriad of teachable moments in our practice. They are there, there IS time and the education is invaluable. Lives are changed.
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