Valerie Brooke, MD
Several years ago, I had the most challenging interaction I have ever had with a patient’s family member, and even today, the memory of that exchange releases a rush of cortisol into my bloodstream. This patient was admitted after she suffered a stroke, and her son was very involved in her care. On admission, I decided to stop a medication the patient had been taking, one I knew could be detrimental to her stroke recovery. Several days into her stay, the director of nursing came to my office and told me the patient’s son was furious. He found out his mother was not getting that particular medication any longer and he was demanding to see me. I asked the director to let him know I would be with him as soon as possible, but truthfully, I was not going to give in to his immediate demands, concerned this would set up a dysfunctional pattern of our interactions. He apparently was manically pacing up and down the hospital hallways, irate not only with me, but with all the hospital staff.
Later that afternoon I went to the patient’s room, knowing that she was done with her daily therapies, and hoped by that time her son had calmed down. He had not. He was inconsolable, argumentative, raising his voice, demanding that I restart the medication in question, no matter that I tried to explain to him the detrimental effect on his mom’s stroke recovery. My heart was racing, I was sweating, and trying unsuccessfully to reason with him. He would not listen, interrupted me, and behaved like a toddler having a tantrum. I acquiesced to restarting the medication in order to calm him down, effectively treating the family member and not the patient. He did have power of attorney for his mother, which meant he had the right to make medical decisions for her, no matter my education and strong recommendation that it wasn’t a smart choice.
I stressed over that case for weeks. Not just because of the intense interaction with the son, which was traumatic and adrenaline producing, but also because I wondered if I really did make the best decision for the patient by stopping this medication. I kept asking myself, “Did I harm the patient?” I have to admit that I had doubt, lots of doubt, in part due to the son’s vehement reaction, but also in part because I was a relatively new physician. Several days later the patient was transferred back to the acute hospital for a medical issue, and I followed along in the electronical chart. I noted with immense relief the physicians involved in her care were also recommending stopping this medication, but they too did what the son demanded. When they asked if the patient could return to rehab, I said no. I did not believe I could take adequate care of her if the son was involved in making medical decisions for her, and honestly, I also didn’t want any more interactions with her son.
Something has shifted within me during the last year of the COVID-19 shut down, affecting my ability to manage these occasional stressful patient and family interactions. I have used the isolation time to shelter myself in the sanctuary of my home, focusing on making healthy choices for my physical and emotional body, resting and recovering from feeling burned out from the practice of medicine during a pandemic. A prayer entitled, “Honoring Shelter,” written by Pixie Lighthorse in her book Prayers of Honoring Grief, beautifully captures the mantra I used to restore my energies during the last year.
“Help me detangle the nerves coating the outside of my skin…guide my hands to create a protective haven that allows me to nurture my body and emotions…help me build a temporary umbrella like this when I need to get away from the turbulent storm that frays my spirit.”
As awful and devastating as COVID-19 has been for so many, there has been an unexpected blessing in it for me. A re-awakening as to why I chose to become a physician, as well as a powerful recharging of my battery, so that the way I react to patients and families is slowly transforming. Similar to my experience last year, a nurse came to me several weeks ago and told me a patient’s mother wanted to talk to me, and the mom was really pissed off. This time I did not hesitate and went immediately to the patient’s room to see what the concern was. The mom wanted me to allow an intervention for her son that was commonly done at the main hospital, but was not done at the rehab hospital, as it would limit the patient’s mobility. When I explained that we didn’t even have that equipment in the building, she angrily pointed in the direction of the main hospital (a mere two blocks away) and suggested we go over there right now and get the equipment.
This time I calmly listened to her concerns, without any attempts to reason or interrupt. It took some time, and when she was finished, I validated her concerns and frustrations, telling her I understood she was trying to do what she believed was in the best interest of her loved one. I calmly explained my reasoning, and we then came to a compromise. Not what she was asking, and not exactly what I would have chosen, but we met in the middle. We talked some more about her son’s other medical issues and also a bit about their social lives outside of the hospital. The physical therapist came into the room and started working with the patient, and I continued to be present, just listening. After some time, the wife apologized to me for her angry reaction, telling me she was just very protective about her son. I told her there was no need to apologize, and I really meant it. I understood she was advocating for her loved one.
A year ago, I would not have had the ability to have that relatively calm and measured reaction. My heart would have raced, I would have resisted and gotten upset, responding much like the mother, pushing back with the same combative energy she was throwing at me. I imagine that I will have days I don’t react with such equanimity, days that my physical and emotional gas tank is partially empty, causing interactions that don’t go smoothly. I can honest say however, I now feel much better prepared for these rare interactions and I see the power in my resolving resistance.