Translator: Laura Pasquale Reviewer: Peter van de Ven
I'd like to start with a story.
Addison was an eight-year-old little boy.
He was as blond as could be,
he had a quirky sense of humor,
he loved to build, he loved Legos.
The other thing he loved was Spider-Man,
he loved all things Spider-Man.
Addison also was a very thin little boy,
he was pale, and he had a cough that literally wrecked his body.
I had never seen or heard anything like it in my life.
You see, Addison had cystic fibrosis,
and I was his brand-new, newly minted nursing student.
It was all new to me.
Addison had had a good day - I was so grateful for that -
he actually made it to the playroom,
he was able to build some battleships with Legos.
He also had all of his treatments for his lungs, for his respiratory system,
and he also was able to make it through
what I considered a mini-mountain of medication.
And he was able to take that with this special applesauce,
with a lot of extra cinnamon, that his mother had made for him.
And together, his mother and I helped him get through the day.
He had had a lot of activity that day,
and he was getting tired, so he needed to rest.
So he climbed into his bed,
we tucked him in with, of course, the Spider-Man comforter,
and he went off to sleep, drifted off to sleep.
And I thought to myself,
I was so happy for him, he had had a good day,
Addison had had a great day.
Of course, as the new nursing student, I thought,
"He had a good day: I had a good day!"
I breathed a sigh of relief.
That was, until his mother asked me the question.
She simply said to me and asked me, "Can we talk?"
Well, I have to tell you, my first thought was, "About what?"
I kept thinking to myself,
"There are a lot of people in this hospital
who know a lot more than I do."
I felt so unprepared.
I was trained as a "doer," you see.
I did not feel particularly comfortable or capable
when it came to these kinds of conversations.
But I have to tell you,
I had the good sense that day to sit down, and I basically listened.
And Addison's mother went on to tell me some wonderful stories about her son;
I felt so privileged to hear them.
She told me what she was worried about:
She was worried that the medications weren't as effective anymore,
that it took him longer and longer in the hospital to get better.
But she also shared with me her hopes.
Of course she hoped for a cure for cystic fibrosis,
and the thing she was most hopeful for
was that Addison's third-grade friends would always stick by him,
that they would always include him to birthday parties
and never leave him out.
That was what she hoped for the most.
That day I learned some very important lessons.
I learned, first of all,
how important it is to tell your stories,
to be listened to, and to be known.
I didn't really think that I was maybe the best person
to be doing this conversation or listening,
but I was called upon that day.
I learned that that day I was called upon to be present, not perfect.
Addison and his mother set me on a path that day
that really has been my entire career,
and that is to help foster these kinds of conversations
across what people feel is a divide, where we have to be perfect,
and to help healthcare people
to feel more confident and comfortable in these conversations.
So that is what I've dedicated myself to.
What I'd like to do now is to fast-forward a little bit
and share with you a time in my life when I was a patient.
And I want to invite every single one of you
here in the audience to think of a time when you were a patient
or someone in your life was a patient, and to go there with me.
It was a happy time in my life,
I was pregnant for the third time
and my husband and I were very, very hopeful
that this pregnancy was going to take.
You see, we had suffered two miscarriages before this,
but we still were hopeful that this one - "Yes! We're going to have a baby!"
So, with this news, I went to the clinician
and I'm hoping that I'm going to hear the baby's heartbeat.
It was very early and the clinician said,
"Look, it's OK, don't worry about it, it's really early.
We'll try again next week."
So, we tried again next week.
Now, this time, I didn't quite understand it,
but there was something wrong with the battery and the Doppler machine,
so they couldn't really hear the baby's heartbeat.
Again, I leave the office thinking, "uh-oh!"
and the fear is starting to creep up on me.
I go for the third the next week, for the third visit now,
and again, now I'm really getting myself kind of worked up and I'm worrying,
"Uh-oh, is this going to happen again to me, to my husband?"
I explained this to the clinician, I said,
"I'm worried. I really feel like I need to hear the baby's heartbeat,"
we didn't hear it that time.
I said, "I really think I need an ultrasound, I'm worried."
And she said, "Well, I'm not worried."
And I said, "But I am!"
And I said, "Please, I think I need this."
And she said, "Well, OK, we'll order up an ultrasound for you,
but I'm just going to put down 'because of maternal anxiety.'"
(Laughter)
I couldn't believe what I was hearing,
I thought, "Really? You really can't understand
why I would be nervous, why I would be anxious?"
But I said, "whatever," I just wanted the ultrasound.
So I find myself within a couple of hours in the ultrasound suite in that position,
you know, in the hospital gown, flat on my back,
and I am watching this radiology technician's face like a hawk.
(Laughter)
Right? You guys, you've been there, some of you.
And it's absolutely expressionless, I can't tell: good news, bad news?
But I have to tell you, the longer I'm not getting any good news,
just by virtue that I'm not getting good news,
I'm starting to think the worst.
So I say to her, I broke the silence, I said, "Can you tell me anything?
Can you see my baby's heartbeat? Is my baby OK?"
I'm kind of expecting, "Yeah, there's the heartbeat,
there's a little arm, there's a little leg,"
and there was none of that.
And then she said those fateful words,
she said, "Well, the doctor will call you with the results."
She said, "But there is one thing I can tell you."
I said, "Really? What? Anything!"
And she said to me, "I want you to know
that you did a really great job filling up your bladder for the test."
(Laughter)
And I thought to myself, "Really? Is this good news or bad news?"
And of course, honestly, I knew it was bad news.
Because I thought, "If the best thing that is happening about today
is that I could fill up my bladder, this is not good news."
And in fact, over the telephone, from a doctor who I didn't know,
I found out that I had had my third miscarriage.
Of course, I was heartbroken. I felt like a failure.
The next morning I found myself in an operating room.
"Now we're going to have the procedure."
I was very nervous about this, very fearful.
On the operating table, I see a semicircle of surgeons and nurses,
all in their surgical scrubs suits and their caps,
and I saw the clinician - the "maternal anxiety" clinician -
and I so had hoped that she would come over to me
and talk to me, maybe comfort me, tell me what to expect,
tell me maybe she was sorry for what I was going through.
But that didn't happen.
And I just felt at such a loss that I didn't have that opportunity
and I thought, "How sad for her that she wasn't able to do that, either."
And again, it was a "note to self"
about how important these conversations are.
But I have to tell you,
I had an anesthesiologist who was behind me,
I never did see the man's face, but he put his hand on my shoulder,
he squeezed my shoulder and he talked to me in this left ear,
and he said to me, "I will be with you the whole time.
I will watch over you."
And he said, "We'll get you through this."
Those words sustained me, I have to tell you.
The next thing I knew, I'm strapped down like this.
And I would say, "Hey, wait a second!
Wait until the patient is sedated before you do that!"
It was really scary. I felt very fearful.
There was a nurse on the left-hand side of me
who said, "Give me your hand."
You bet your life I took that hand and I squeezed it.
It was a little strange because she had a glove on,
you know, it felt a little plastic. (Laughter)
But you know, it was a human hand and it was warm.
That was the other thing I remember,
it was warm, and she squeezed it as hard as I was squeezing her.
And the next thing I knew, as soon as the medications did their work,
I drifted off and here I am, talking to you.
Those experiences really stayed with me.
What I'd like to do now, with that as backdrop,
is to talk to you about a philosophy that I have come to with my colleagues.
I like to think of it as the "one-room schoolhouse."
And in this one-room schoolhouse, we bring together physicians, nurses,
social workers, psychologists, chaplains, medical interpreters.
We bring them together with patients and with family members.
We leave our badges at the door, and we learn together
about these kinds of conversations, what matters.
I've learned from the families that, years later,
it isn't the medications or the surgeries, the treatments that they remember.
What they really remember is the words that we said to them,
our kindness that we extended, how we made them feel,
and the way we treated them.
That's what stays with people, the crucible of the whole experience.
So this is what we learn in the one-room schoolhouse.
I have learned through my own training,
as not only a nurse, but as a clinical psychologist.
I mentioned a lot of "doing,"
and so much of our experience and our training
is focused on the technical aspects of care, the clinical excellence -
which absolutely we all need, we all want, we expect that -
but the one-room schoolhouse is about the other half of the medical equation,
it's about the emotional standard of care.
I want to show you what happens inside this one-room schoolhouse.
On your right, my left, is one of our physicians,
one of our learners, and she is actually with two of our actors.
We work with actors; they are really coached
by our family members and our patients.
She is getting the opportunity, in a way, to try this on for size.
How to introduce herself.
A lot of times in the hospital, people would say, "Hi, I'm G.I.,"
"I'm renal.," "I'm cardiac."
You have to start with where they're at, you know.
Not really. You may be:
"I'm Dr. Elaine Meyer, I'm a clinical psychologist,
I work here in the pediatric intensive care unit."
You start with wherever the person is at.
The way you introduce yourself,
sitting down -
When you sit down, even if you only have five minutes,
it seems so much better; it's of higher quality.
This doesn't have to be about a healthcare conversation.
This is a conversation in life that's important, right?
Just sit down. Lean into it.
As you can see, she's touching this person.
There's something happening here.
This could be any kind of a difficult conversation:
it could be about a new diagnosis;
it could be that maybe they're hearing about a miscarriage;
they could be hearing about a medical error,
where this clinician might be apologizing to them or talking to them
about we're going to do to make this right,
to help make the situation whole again.
So this is the kind of thing that happens inside of the one-room schoolhouse.
The other thing in the one-room schoolhouse,
is that practice makes better, practice doesn't make perfect,
especially in this art form of conversation like this.
Again, being called upon to be present, not perfect.
You all know these guys, right?
This is one of the best mnemonics because everybody knows The Wizard of Oz.
What are the ingredients of these kinds of difficult conversations?
What I'd like to do is share with you a way that I like to think about that.
Remember the lion? He was after courage.
So, what I would say to you is,
"Never, ever underestimate the power of your courage,
your leadership, your willingness to go there
with a patient, with a loved one."
This is not just about healthcare conversations, this is in life.
Carl Rogers, the great psychotherapist,
teaches us that one anxious person in the room is enough.
Do you know what that means?
That you have to be that calm, non-anxious person, or try to be.
Again, just as I did with Addison's mother,
I sat down and I listened, I did the best I could.
What about Scarecrow? What was he after?
Remember what he wanted? Brains.
This would be the information that you have to share, the knowledge,
your clinical experience, your wisdom.
Very important.
If you were newly diagnosed with prostate cancer or diabetes,
you certainly would want a clinician in front of you
who could explain what was happening, in terms that you could understand it,
that wouldn't scare or frighten you,
that would help you feel like,
"I can get through this, we can get through this."
Just a little example: I work with a lot of kids
and sometimes we may say things like, "We're going to put you on a stretcher."
Well, the kid may say, "Ouch! Stretch? I don't want to be stretched!"
This is the Scarecrow part that we learn about: our word choice.
Instead of saying to that child "I'm going to put you on a stretcher,"
I may say something like,
"We're going to put you on a little bed that has wheels,
and then we'll be able to take you where you need to go."
So, that's the brains, the word choice.
And what about Tin Man? Remember what he went to Oz for?
Heart. The heart is the little kindnesses that we can extend every day,
the compassion, the mercy that we can show people,
especially people who are hurting, or suffering, or ill.
Maya Angelou, the great American poet, teaches us that in order to survive,
a human being needs to live in a home furnished with hope.
So many of these conversations are about hope.
They're about learning to ask questions like, "What's on your mind?
What's worrying you? How can I be helpful? What are you hoping for?"
You get the idea.
What I'd like to do is share with you just a really brief story
about how this all came together for what I would call
"a very reluctant learner" to the one-room schoolhouse.
This was a clinician who didn't want to have these conversations at all.
He had joined the Emergency Medical Transport Team,
so he just thought, "I'm going to bypass having these conversations altogether.
I'm not with people very long."
Well, it was a good plan, but it didn't quite work that way.
After he had spent some time with us in the one-room schoolhouse,
he was called on an emergency transport
to an emergency room with a 14-day-old baby girl.
The rest of the team rushed over to the baby girl,
and out of the corner of his eye
he saw the father at the foot of the baby's bed,
and he was saying, "Come on, little lady. Come on, little lady."
The mother was in the corner of the room, crying, alone.
Effortlessly, he found himself walking in that direction.
He said, "I just couldn't believe that I felt like I could do this."
And then the next thing he did was,
he knelt down next to the mother and took her hand.
He didn't sit. He didn't stoop. He knelt.
He realized that this was sacred space,
and he went on to explain to that family what was happening to their baby girl,
who, unfortunately, had severe dehydration and was having a cardiac arrest.
It was extremely scary.
That family thanked him and the team afterwards,
and he said, "Well, I didn't do anything. The team did everything."
And they said, "Oh no, you helped us through this."
So many times people naturally devalue the conversations that we have
and think it's all about the procedures and the actions,
and he learned that day that it was really about being present, not perfect,
and to going there with the patient.
So, coming full circle here, what I'd like to do
is to share with you a piece of my inspiration:
that's a lot younger me and that's my little boy,
and all I have to do is think about him
and all the people who helped bring him into the world,
and I've got my inspiration to know why these conversations matter
and to keep having them in my world, in my work.
And I encourage every single one of you
who's sitting in these seats today or listening to this
to dig deep, find your taproot, find your inspiration,
so that you, too, can have these kinds of conversations
with people you're taking care of and that you love.
And I'd like to give and close with this last message for you:
"Once upon a time, you wanted to change the world."
And I want to tell you that you still can, one conversation at a time.
Thank you.
(Applause)