confessions of an eclectic pragmatist

Healthcare's 99%

My mother-in-law, Hilda, has ovarian cancer. I am stunned, my whole family is stunned. This independent and lively woman has gone from working and playing full-time to being a full-time patient and all of us are getting an up-close and personal look at the patient and family experience, and it is not always pretty.

Ninety-nine percent of the people in the system are exceptional. Sure, a small number of people have clearly chosen the wrong field or need a break, but the real disappointment is the system itself - the lack of systems really. I will post soon on specific issues that we have and continue to experience, but today I want to honour some of the 99% (in order of appearance, not importance).

To Floyd, MD - when you arrived in the ER exam room, you introduced yourself in this way, "Hello, I'm Floyd, your resident physician - I'm going to take care of you tonight". And in this humble but competent way, with no title to create distance, you did care for Hilda. When you entered the room and saw she was crying, you didn't avoid an uncomfortable discussion but asked what was causing her to cry. She told you she was thinking about her family (she knew something major was wrong) and told you about her sons and their wives, her husband, and her special dog. You didn't brush this off, but asked more details and then moved into the clinical reason you came back into the room. In total, I think this interaction took 2 minutes. We will never ever forget it.

To Kevin, MD  - you hardly knew us when you had to break the news that Hilda had cancer, likely ovarian. You were kind and compassionate in delivering very hard news. Thank you for being honest and kind.

To Tammy, LPN - you started your shift by introducing yourself with clarity and humour, "I'm Tammy, Yan (the RN) is the boss, but I'm the bossy one!". You noticed Hilda's Stuart McLean book on her bedside table and used this common interest to anchor a connection. You came in early for your shift to talk to Hilda and shared personal stories about your life and your family in a way that made Hilda feel much less alone.

To Elena, MD - from the moment Hilda met you, she loved you. You sat with her for 20 minutes and gave her the straight goods about ovarian cancer treatment. You don't mind my endless lists of questions and you always answer honestly, but with compassion and hope. As you said, in your business, you can't deal in platitudes, but you do deal in hugs. I've never asked a doctor I didn't know well to hug me - truth be told, not sure I have ever asked a doctor to hug me. But I felt compelled to ask you the other day and when you did hug me, it was real - a maximum dose of human compassion that increased my confidence in your medical skills

To Doreen, housekeeping - on the day after Hilda was transferred to City Hospital, you stopped my husband in the hall and asked how she was doing. Another morning, you showed up fairly early to clean Hilda's room and explained that you noticed how early her family came to visit so thought it would be nice to clean her room first. You came to say goodbye when she was transferring to Royal University Hospital, stopping to chat and share your own battle with cancer. You hugged her and promised to stay in touch. Thank-you for understanding how to create value for patients and families in your work. You demonstrate how housekeeping staff play a vital role in caring for people.

To Laura, RN - when we arrived on the oncology ward at RUH, we were all overwhelmed and scared and it was so busy and felt crowded compared to City Hospital. When you showed up, one of Hilda's longtime customers and friends, you lit up the room by lifting Hilda's spirits. Thank you for honouring your friendship by providing caring service to Hilda, even though she wasn't technically "your" patient.

To Holly, RN - my husband and I think you are the perfect balance of competence and compassion. I never felt worried that you wouldn't do the right thing. When you weren't sure about something, your ego wasn't an issue and you asked for help. You believed us when we explained that Hilda's veins just weren't cooperating and needed an anesthesiologist's touch. But you also were so genuinely kind and caring and we so appreciate it.

To Joanne, EMT - when you came to transfer Hilda on her second admission, you were so clearly aware of our fragile situation and you advocated for us. You took charge of the transfer situation by teaming up with me and I so appreciated your respect and collegiality before knowing what I do for a living. When we were holding in the RUH emerg hallway, you kept on top of the bed situation and took it upon yourself to clean the room that came available so that Hilda could have some privacy in a very hard situation. That seems like a lot, but then you also remembered us and took some time the next day when you were back in RUH emerg to come and see how we were doing and express your regret that we were approaching a god-awful number of hours waiting for an inpatient bed. Thank you for remembering.

There are many more, Yan and Donna and Shirley and Vivian and Alfeo and Danny and Marichu and Jeff and Brian and Joel and Anita and more and more every day. What is key, as I read back over these experiences, are the exceptional moments when people transcend their professional roles. When they bring all that they are - their interests and passions, their compassion and humour, their challenges and struggles - to be fully present in the caring experience. This, to me, is the key value in our often flawed and ailing system - I hope we don't mistake it for waste or create systems of care that impede the flow of such powerful human connections, but more on that next time...