Experiencing an uninvited gift

It’s been five years since she was told she was cancer free. Today she was told it was back, and the future was quite grim.

My job was to make sure she understood how to properly take the medication that would reduce the swelling around the tumor so radiation could start as soon as possible.

That was my job. Clinically speaking it wasn’t the most challenging or difficult issue of the day as I scanned her file. Then I went to speak with her.

It took mere minutes to make sure she understood how the new medication worked, how to fit it into her day with her other medications, how she might feel taking it. We reviewed her other drugs and medical conditions and I assessed her level of understanding to be high. Job done.

But what about the other part of my job? When she told me about the cancer returning, I looked into her eyes and could see the shock and the fear. What she needed in that moment was human connection, a hand on hers and someone to listen to her.

When I looked around for the time I needed all I saw was the impossibility. At least a dozen patients waiting for me to sign off on their medications, one waiting to learn how to use their new inhaler, and two patients nervously waiting for me to administer their injections. At the same moment I heard one of my technicians say I was wanted on the phone by a physician.

Time — I didn’t have it. I couldn’t take her into my office and be that presence for her.  So I spoke medication, touched briefly on the agony of the diagnosis, and resisted going too deep.  I know too well the fragility of emotion, and without the privacy to truly be present to her situation, she needed to keep from falling apart and make her way home.

But somehow I feel I have failed. There have been times when I have taken patients into the office who have been grief stricken, going through withdrawal, requiring in-depth discussion of an issue. But today, I was stretched too thin.

And so, I take it home with me.

I have had colleagues tell me to leave the job at the door. Walk away to my family and rest assured there will be more patients and problems tomorrow. I have learned that at times I can and must do it, and at other times I simply can’t. But perhaps it’s the “can’t” moments that make me a better professional, a better person. There are times when I experience humanity laid bare, a rawness of emotion, a fragility to life.

These experiences become a part of me whether I invite them in or not. In the end they are an univited gift.

Carlene Oleksyn is a pharmacist in Canada who blogs at An Examined Life. She can also be reached on Twitter @colekpharm.

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  • Anonymous

    Communication is the name of the game . :-)

    • http://twitter.com/colekpharm CarleneO

      Thanks for the comment.  It certainly is! 

  • http://twitter.com/mbmom Nancy Foster

    I think the injections and inhaler could have waited…the patient who shared her news of terminal illness told you because she was in acute distress and all the med instructions were not what she needed from you. Rx instructions can be found online…human caring and a kind word cannot.
    You failed the patient..shame :(

    • http://twitter.com/colekpharm CarleneO

      Thank you for your comments Nancy.  I had struggled with the decision on whether to share this post, and in essence share a moment of insecurity and imperfection as a professional.  On any given day I make split second decisions that I hope are the best for each patient I encounter.  I agree that I did not provide the best for that patient on an emotional level on that day. I listened to her, told her how very sorry I was but knew I could not stretch beyond that.  Perhaps the other patients who had already waited 20 to 30 minutes to see me could’ve waited longer.  Maybe it wasn’t the best choice, but that was why I wrote the post. I have made, and I’m certain I will continue to make, mistakes in my practice. But my mistakes do not define me nor keep me from continuing to do my best to engage my patients in an imperfect medical system.

      I would have to disagree with you on one issue however.  I would not have been doing my job as a health professional if I did not ensure that patient understood her medication before leaving that day. Yes, there is plenty of drug information online both good and bad. But that information is not patient specific. It does not tell a patient what to expect in their particular situation and what issues are relevant or not relevant to them. 

      While I cannot go into details for privacy reasons, the particular medication had not only complicated dosing nuances, but also has dozens of indications.  The patient would have found it difficult to navigate online information that referenced her particular situation.  As well, side effects listed online for this drug are extensive, serious and scary.  But dosed as it was for her, none of those side effects would apply.

      Health care is both an art and a science when it comes to meeting the needs of our patients.  I appreciate the comments, Nancy, and thanks again for engaging in the conversation. 

  • Anonymous

    It is so difficult to attend holistically to patients when there is so little time. Clearly, in this situation, your needs as the physician were not met either. This is where referring to a good Holistic Health Coach to take over makes sense. They can spend the time that you could not. You would feel comfort that she was cared for on an emotional level, making it much easier for you to move on. Health Coaching has been written into Health Care Reform, it is still currently being defined. There are some integrative clinics that are using a model where health coaches with their own private practice come in and use a room in the clinic. It is time to start tending the needs of both physician and patient.

    • http://twitter.com/bostongal1641 bostonmeg

      If I may add my two cents to your comment about handing the patient off to a Holistic Health Coach – I feel that this woman turned to this doctor because of a connection that they have and so handing her off might have made her feel even more lost and alone. 

      I think that this Dr should have told the patient how stretched she was for time right them and then gone out of her way to connect with the patient afterwards, setting up a time that was just for the patient in the schedule.  Even a phone call can be so helpful to the patient. 

      Just giving medication information and moving on is a disservice to the patient and actually causes emotional harm.  No one wants to treated as a chore to be gotten through. 

      • http://twitter.com/colekpharm CarleneO

        Thanks for the comments from you both.  Just to clarify, I am a pharmacist, not a physician. I practice in a setting where patients do not have access to holistic coaching.  While there is primary care and collaboration amongst health professionals happening, it is certainly not the norm.  It is quite traditional in the sense that a patient would be speaking to me after receiving the diagnosis from their physician. 

        I try and make it a habit to followup with patients who require it either by phone or with an appointment, although quite typically it is for more drug/disease related issues and for    solving health related problems or working on lifestyle issues. Although I have to admit this followup often occurs on my own time away from work.  I agree that this would have been a good moment for followup.

  • http://www.bryantsstatisticalconsulting.com Donald Tex Bryant

    In our lives there seem to be many whose needs we cannot meet because of time constraints.  Wouldn’t it be wonderful to have all the time we need for our loved ones–spouse, children, friends and so on?  The same can happen at work for professionals such as physicians and pharmacists.  There are ways to find more time to attend to these needs.  Perhaps another staff person, your assistant for instance, could have taken the time that you did not have.  Sometimes we can meet the needs of our patients and clients through surrogates, as long as this has been worked out through teamwork.

  • Jody Hoch

    Thank you for sharing something so personal and putting yourself out there. I appreciate what you are saying, so sad that we can’t have more time with our docs.
    My doc has a health care coach, but he makes me uncomfortable so I said no to his help. I just can’t take having yet another provider giving me conflicting advice contrary to another provider as I am a weight loss surgery patient so my dietary needs are very different from the norm. I just told him I would be getting that support from the bariatric practice, and I am.
    Providers can make life confusing when the PCP says do this, coach says do that, bariatric surgeon says yet other things, and the dietitian has yet other rules.

  • Anonymous

    From personal experience, when you can turn it off it is time to quit because you have hardened your heart to your humanity. Your humanity is what makes you good at your work and that is what patients really need from you.

    • http://twitter.com/colekpharm CarleneO

      Thanks for your comments Molly.  I agree that if you are untouched by your patients it is time to walk away.  The frustration of practicing in an imperfect medical system is an everyday experience.  I really feel it’s important for health professionals to let their human side be known.  I am not perfect, but I strive to continually improve my practice as I engage with my patients.  They are my greatest teacher.

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