TY - JOUR
AU1 - Longmaid, H. Esterbrook
AB - Critical conversations can arise at any moment in care settings. How we respond can powerfully affect the patient's perception of being heard and supported and may influence the patient's capacity to trust us. Our capacity to respond, often with little time to reflect, prepare, and anticipate the interaction, is governed not by whether we have memorized a script designed to show caring or compassion, but our ability to acknowledge and address, by both verbal and nonverbal means, the patient's vulnerability and need for support, even if we cannot offer any other hope than our presence. We can only do this if we are truly able to acknowledge, access, and engage the human values that are universally needed in such settings1: a genuine desire to care and comfort, to respect, to support, and to validate the patient's circumstances and experience. As physicians, we may have difficulty accessing some of these, as to do so requires us to acknowledge and address our own vulnerability and sense of helplessness in such conversations. The door of the MRI scanning room opened, and I turned from viewing the images on the operator's console to face Jim. Earlier that day, Dr James Bates, chaired Harvard professor and widely admired clinician and mentor, called me with a simple but profoundly weighted request: “Hi, Brook. I wonder if you might be able to do a brain MRI. I just lost vision in my right eye.” A robust, compact man in his 70s, Jim had quietly battled metastatic prostate cancer for years while continuing his remarkable clinical and administrative leadership at the hospital. Whenever possible, he graciously accommodated numerous requests from generations of former residents and staff to serve as visiting professor nationally and internationally. Not having seen Jim for many years, I was humbled—I was honored—that he called me. I was also intimidated: he could have asked anyone in the Harvard medical system. Images of Jim's brain scrolled across the MR control console. I tensed, bracing myself to perform my diagnostic duty: trying not to think of the man, the mentor, the remarkable physician and humanist lying quietly on the MR table. Focus. As I sat reviewing the images, memories of Jim's influence on my professional development shouldered their way into my focus. With his warm smile and firm hand gently squeezing my arm, Jim encouraged me to extend my diagnostic range, my capacity to see the patient beyond the images, my responsibility to provide hope in the darkest of moments. I kept this lesson close as years turned into decades. It was now my turn to provide him with hope, or at least the truth, in the gentlest way I could find. Focus. How many times had I performed this task? Muscle memory guiding my index finger, I moved the mouse scroll wheel in automatic, methodical manner. Now the familiar, usually quiet mouse click pierced the silence, punctuating each new image of Jim's brain, and my focus faltered. Focus. Multiple large, dural-based metastatic masses compressed his brain and right optic nerve. Their size and number startled me. I wondered why Jim was not more significantly compromised by the volume and location of his intracranial metastases, and I knew that his symptoms would soon ominously progress. I felt the support of the many hands of fellow colleagues and trainees on my shoulders as I turned to face Jim exiting the scan room. Tears of hundreds wet my cheeks as our eyes met. I tried to speak, but I could not find the language I needed for this moment. We shook hands, and Jim placed his left hand on our joined right hands. Our grip continued, neither one of us willing to let this sacred moment end. I wondered which of us was being consoled. “I know,” Jim said gently. “I know. Thank you.” He squeezed my arm one last time. Our ability to acknowledge, and respond to, our patients' needs at such a critical moment will depend on our ability as caregivers to access our own humanness.2In this one last, such critical moment, I learned why Jim chose me. Back to top Article Information Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. References 1. http://charterforhealthcarevalues.org/. Accessed February 2, 2013 2. Browning DM. To show our humanness: relational and communicative competence in pediatric palliative care. Bioeth Forum. 2003;18(3/4):23-28Google Scholar
TI - One Last Teaching Moment
JF - JAMA
DO - 10.1001/jama.2013.1803
DA - 2013-04-24
UR - https://www.deepdyve.com/lp/american-medical-association/one-last-teaching-moment-EnA3U1qX0v
SP - 1695
EP - 1695
VL - 309
IS - 16
DP - DeepDyve
ER -