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Title: Teaching and Learning Moments To be frank,
Year: 2015
Abstract: Teaching and Learning Moments To be frank, some days I long for times gone by, when the doctor was utterly, unconditionally trusted and respected. This was one of those days. I usually arrive at the hospital well before anyone else, before the nurses’ shift starts and the doctors, interns, and students make their appearance. I have found that this quiet time, early in the morning, is the best for working on manuscripts or catching up on my reading. One morning, however, my most relaxed hour was interrupted by loud shouting. I had no choice but to leave my sacred coffee ceremony and investigate. The voices were coming from Room 7 in the intensive care unit, where we treat patients who are unstable or need ventilation support. Entering the room, I saw a man in his 40s whom I had never seen before. He was standing threateningly in front of two nurses, who in contrast were very silent. Later, when I told my chief nurse how much I admired her equanimity, she told me that being calm had nothing to do with her silence. She was simply stunned. The man was angrily waving his finger in front of the nurses’ noses and shouting incessantly. When I approached, his rage turned to me. He indicated that if I didn’t comply “immediately” he would break my ribs and worse. “She is in terrible pain, don’t you see!” his loud voice and aggression resounded throughout the silent ward. “Give her morphine, NOW!” I had not seen him before, but the patient, who I assumed was his mother, I knew very well. She had advanced breast cancer that, after years, had stopped responding to treatment and had become extensively metastatic. She was stuporotic on arrival to the hospital, and our team and her family knew that she would not survive this admission. After a couple of days, her family came to me with a peculiar request. They wanted her intubated, ventilated, and kept alive “at all costs.” Eventually, I understood their request. The patient’s granddaughter was to be married in three days’ time. If the patient died now, the family would be in mourning. The wedding would have to be postponed at the last minute. Unusual as the indication for intubation was, I could understand the impossible situation. I complied, and the patient remained alive. Today was the morning after the wedding. After all we did for the family, was this man’s outburst their way of saying thank you? I was about to shout my exasperation, frustration, and sheer disappointment back at him but stopped at the last minute. I always teach my students that the three things that matter most in medicine are curiosity and observation, being methodical, and being able to see a situation from the other person’s point of view. Was I trying to see this situation from his point of view? It was his mother, after all, and he truly believed that she was suffering horribly. Now that the pressing need had passed, he was asking us, in the only way he knew how, to end her suffering. He may even have been feeling guilty about causing her this anguish. Instead of shouting back at him all our hurt feelings, I carefully explained that she was unconscious and not in pain and that we would do everything we could to make her comfortable. Or did I? I admit that my instinctive response was far removed from the ideals that I preach to my students. Angry at his overt ingratitude and afraid of being physically attacked, I summoned the police, and the incident was over. However, I remained uneasy for a long time after the incident. My uneasiness led to reflection, and reflection led to the recognition that, disruptive as the incident had been, I could understand the man’s behavior now, although I failed to do so in real time. In the end, my understanding begot tolerance and forgiveness. Would I be able to curb my instinctive anger and act more compassionately the next time I was faced with an irate family member? I believe so. In caring for our patients and their families, we often encounter raw nerves and vulnerability, which may take many forms. This incident was an extreme example, but it taught me the ubiquitous importance of Rule 1 in communication: Being able to really see a situation from the other person’s point of view—to grasp the scene as he or she does—is the first step towards expressing empathy, building a relationship, and resolving any conflict. Ami Schattner, MD A. Schattner is a visiting scholar, Ethox Center, University of Oxford, Oxford, England, and professor of medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel; e-mail: Wise After the Fact
Appears in Collections:Academic Medicine 2015

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