Creating a Culture: It's Okay to Not be Okay
This past Monday, February 11, marked the beginning of the Gold Humanism Honor Society’s Solidarity Week For Compassionate Patient Care. The week is sponsored through the Arnold Gold Humanism and Medicine Foundation, and is a “period of celebration, reflection, and connection between patients, caregivers, and the healthcare community as a whole.” It is about learning how to integrate humanism into patient care and “strengthen the bond between people who are patients and people who care for them.”
As osteopathic medical students at Pacific Northwest University of Health Sciences of this society, and as members of the GHHS, we’re encouraged to share stories about how humanism has played an important role in patient care.
The following story shares an experience that stood out to me more so than any other in medical school as a time where I truly experienced the potential of humanism in medicine. To me, it served as a reminder to stand beside my fellow healthcare colleagues and to create a culture that optimizes humanism, not only for our patients, but also for our fellow healthcare providers.
In the middle of an intrauterine device (IUD) placement, my obstetrics (OB) preceptor’s pager went off.
Tenaculum in one hand, applicator in the other, she ignored the beeping while she slid the IUD in the uterus. A quick cut of the strings and she wrapped up the visit with our patient. Two or three minutes elapsed and a nurse knocked at the door.
“Doctor,” she said, “please respond to the page. The hospital is trying to get ahold of you.”
She picked up the phone, dialed the number and waited. Then her face dropped.
“I see, I see,” she said. “We’ll try for a delivery. Give her some cytotec, type and screen her, do a stat H/H and we will be right over.”
At the time, I was on my second week of OB, and eager to get my first “hands on” delivery. This particular preceptor was not known to allow students to help out, so when I heard, “you can do this delivery all on your own,” I could hardly believe it.
Unfortunately that sentence, which brought me so much joy and excitement, was followed by “it’s a fetal demise, it’ll be good practice.”
My heart sunk. My stomach burned. I suddenly felt light headed. This would be my first hands-on delivery. This wasn’t how I dreamed it would go.
Anxious to seem eager, and too intimidated to appear weak and say no, I nodded and said, “Great, I appreciate the opportunity.”
In reality, I wanted to skip the next few hours of my life. I’d not yet seen a fetal demise, and I didn’t feel emotionally prepared to deliver the baby.
We arrived at the hospital to the sight of nurses scurrying about a very pale, incoherent patient. The doctor walked in and placed her hand on the patient’s abdomen. It was rock hard.
“What’s the H/H?” asked the doctor. “Do we have that back yet?”
The nurse refreshed Epic. Nothing. She called the lab, which had just processed the tube.
“Hb is 4.0.”
We urgently moved her to the operating room (OR) where we discovered a pale uterus and a placental abruption with concealed hemorrhage. As if the situation wasn’t complicated enough, I was not only witnessing my first fetal demise, but also my first massive transfusion, emergent c-section, and placental abruption.
I donned the scrubs, booties, mask, and bouffant as a million thoughts ran through my mind. Slowly those thoughts shifted from emotional to medical.
I suppressed the fears I had and started thinking about how we could best help this patient. I took a deep breath, scrubbed in, and helped my preceptor deliver the child from her mother’s womb. I help close the abdomen, and my preceptor started to lecture me about the risks of post-partum hemorrhage. We discussed important questions, labs, physical exam findings, etc. to follow once she’s out of the OR.
When I left the OR, I tried to remain medically focused. I started researching post-partum hemorrhage, disseminated intravascular coagulation (DIC), and placental abruption. I read through charts. I looked at old U.S. reports.
I avoided the huge elephant in the room.
After stuffing my face with a few giant cookies and milk from the doctors lounge, I went up to round on the patient. When I arrived to the intensive care unit (ICU), I wasn’t sure what to expect.
I certainly wasn’t expecting a pediatric nurse to be cradling a cold, stiff child in pajamas, a hat and blanket. I wasn’t expecting the adoptive family to be surrounding the mother. I wasn’t expecting the mother to be fully coherent, sobbing. The feeling I had before I went to the hospital came back. And it came rushing back quickly.
My heart sank. I felt light headed. My stomach churned with anxiety.
I tried to hold it back. I tentatively asked the patient a few questions and learned more about her complex history, but the nurse could sense that I was extremely uncomfortable. I held the baby. I talked with the adoptive family and mother, and offered my deepest sympathy — but in that moment I didn’t feel there for the patient, or for myself.
The family and mother bid farewell to the child, and the nurse and I cradled the child down to labor and delivery (L & D) unit. She would soon depart the hospital for further investigation and autopsy. As we walked down to the L & D unit, and the nurse looked at me.
“Tori,” she said, walking alongside me, “are you okay?” I held my breath as I answered.
“Yeah,” I said, fighting to hold it together. “Sad situation though.” She nodded and we finished our work in silence. When we got back to the nursery, she once again turned to me, taking my arm in her hand and looking me in the eyes. “I want you to know that it’s okay to not be okay,” she said.
In the midst of this complex delivery, my preceptor didn’t have time to sit down with me to un-package all that had happened. In our abrupt move to the OR, I never had the chance to share my fears of delivering a baby who didn’t make it. Although this preceptor ended up being one of the best preceptors I had in medical school, I felt emotionally abandoned.
Humans make mistakes. Humans don’t pay attention to every detail, nor are we capable of reading minds. Medical culture emphasizes the importance of taking advantage of exciting learning opportunities, but sometimes ignores the emotional turmoil we’ll be exposed to through those opportunities.
The nurse who took me by the arm? She was attempting to change the culture. She recognized my hesitation, acknowledged my fear, and allowed me to express what I was holding back. To have someone nearby that was willing to aid me in unpacking this difficult situation was crucial. I will forever be grateful to her.
In a few short months I will be a resident physician, and something like this will undoubtedly happen again. If not to me, then to somebody around me. When it does, I understand just how crucial it is that I be there for them; to tell them that “it’s okay to not be okay.”
Medicine is about caring for others. That care expands beyond our patients. If we can allow our colleagues to confide in us and learn to provide support, we will ultimately be doing our future patients a service. We can be those critical players in someone’s training, teaching them that “it’s okay to not be okay” and it’s important to acknowledge your emotions, your fears, and you’re humanistic qualities while caring for patients.
Osteopathic Medical Student - 4th Year (OMS IV)
Pacific Northwest University of Health Sciences