Perspective Journal of Patient Experience 2016, Vol. 3(1) 26 ª The Author(s) 2016 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/2374373516636740 jpejournal.sagepub.com
Quiet Lessons Jennifer Ramsey, MD, MS1
Mrs Barnes is a chronically ill woman in her 50s who came to our intensive care unit after a bowel resection became complicated by infections. Her infections caused life-threatening dysfunction of multiple organ systems: she was on a ventilator, vasopressors, dialysis, and nutrition was administered through her vein. Every organ system that modern medicine can support artificially was being supported in her case. Upon my assuming her care as we transitioned from one attending physician to the next, her white blood cell (WBC) count was 33 000; the newest source of infection was unclear. Her husband was at her bedside daily, usually calmly reading a book. He was a polite, pleasant gentleman, and was very loving toward her. The first few days of caring for her, we searched for the source of infection. Line changes, a surgical consult, imaging studies, and cultures drawn from everywhere possible helped define the source of infection and effective treatment. By Friday, her WBC count was within normal range. She continued to need all of the same forms of artificial support, but we had made progress. As I gave Mr Barnes the daily update that Friday, he seemed thankful to hear her WBC count was now normal. I said something like, ‘‘For the first time this week, I feel she is making progress towards recovery. Finally, the ‘big picture’ is that she is getting better.’’ Despite my reassuring words, I sensed remaining tension in him I did not understand. Without knowing what was bothering him, I couldn’t know how to provide him with relief. I asked, ‘‘What questions do you have?’’ He said he didn’t have any more questions, and that I had explained the situation well. I nodded, didn’t move from the bedside and maintained eye contact with him. He, as well, kept eye contact with me.
After a moment, he said, ‘‘It’s just hard to see her blood pressure drop. I know the nurses fix it with the medications, but it’s just really hard to see it drop.’’ ‘‘Mr Barnes, it has to be so hard to sit at her bedside and see the minute-to-minute changes her body makes.’’ He confirmed that it was difficult. I asked, ‘‘Perhaps even agonizing?’’ Finally, the tension left his face. Finally, I understood his plight and, importantly, he knew I understood. ‘‘Yes, it truly is agonizing. I read my book to try to distract myself from looking at the monitor.’’ I affirmed that witnessing the minute-to-minute changes in a sick patient absolutely can be agonizing, and that I was sorry he was having to experience this. I then restated that, despite those minute-to-minute set backs he was seeing, ‘‘the bird’s-eye view’’ was that she was finally making progress, that the ‘‘big picture’’ was that she was better. His eyes filled with tears, and he expressed a deep relief with hearing this. I learned an incredible lesson from Mr Barnes. His pleasant and calm nature had blinded me to the anxiety he was experiencing. I had incorrectly interpreted his reading books as a way of passing time; I had no insight into the fact that he was using books as tools to help deal with his anxiety. His hearing ‘‘the big picture’’ update was not enough. Only when starting the daily update from his emotional place was I finally able to provide him the relief that was rightfully his that day.
Author Biography Jennifer Ramsey, MD, MS, is board certified in critical care, pulmonary and palliative medicine. She practices at the Cleveland Clinic.
1
Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
Corresponding Author: Jennifer Ramsey, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, L 22, Cleveland, OH 44195, USA. Email:
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