The Kindness of Strangers
It matters as much as any prescription
This is a column I wrote for Emergency Medicine News last January. I thought you, dear readers, might enjoy it! Kindness is an essential part of the art of medicine. But it’s only possible if you actually care about the people you treat.
Life in Emergistan
The Kindness of Strangers
The words we say are often as important or even more important than the physical actions we perform for our patients. We are always looking for the best new device, the coolest decision rule, and the latest research, and simple words seem so mundane to our modern medical minds.
But words have the power of hope or despair. The people who come to us are often on the edge of their ability to cope, terrified of things we so dismissively take for granted.
Fever, fracture, bleeding, pneumonia; these are part of our everyday lingo. These things alone barely budge our blunted heart rates. But for those who have them or whose precious loved ones are afflicted, each word we speak is a potential terror because patients and loved ones alike expect the worst each time we walk into the room. They have heard these words from family and friends or on the internet, cast always in the grimmest manner.
I recall the time I told a sweet old lady I was calling the hospitalist. “You're calling hospice?” she cried, her eyes wide. “No, ma'am. Sorry. Hospitalist. The person who admits you to the hospital.” Her relief was visible. I've been very purposeful in my enunciation of that word since then. (Even more so because apparently my voice is in a register almost nobody can understand, causing no end of misery in drive-throughs.)
I often think about what I say to patients and the way I speak to them. It is a rare medical educator who teaches us the value of our words, even rarer is one who teaches us to use them like the instruments or prescriptions they are, not only for clarity of communication but for comfort.
I have stockpiled certain phrases to help me connect with patients and put them at ease. It requires the ability to read their expressions, to know what they'll tolerate. This takes time, experimentation, and practice.
Humor and Tenderness
When I am about to anesthetize an adult's wound, they sometimes say, “Will this hurt?” I say, “I've done this thousands of times, and I've never felt a thing!” Tensions drop immediately, and they smile.
A man with a facial laceration I repaired asked, “How do I look?” If I know he can take it, I'll say, “Well, your modeling career is over, but you'll be OK.” This is usually followed by a chuckle.
Of course, some of the words I've used are more tender than that. I have found one can never go wrong by complimenting an older couple on the long years of their marriage. Or saying to a parent, “Your child is beautiful!” Although once, while traveling by train in Japan, I tried to say that to a woman holding an infant, but I think I actually said, “Your baby is delicious.” Both words started with similar vowel sounds to my ear. The ugly American indeed.
Many times, I have told a woman with a facial wound, “I have never known any woman of substance without scars.” My own dear wife is the shining example of the admixture of wound and wonder.
I have also found that telling nervous parents they're doing a great job can be wonderfully calming, almost as much as giving them my parental credentials: “My wife and I have four children, and I've seen this in my own kids many times. It's OK.”
When I talk to the children or caretakers of those with dementia? I say, “This is really hard, but you're doing the best you can. And you can't do everything. Remember to rest.” Their thoughts are constantly accusatory, their minds bathed in guilt over the past or things they can't control, poisoned by hard words from their parents' failing thoughts. They need to hear positive words and be reminded that they have done all that is possible.
Hang in There
Among the hardest words are the discussions during cardiac arrest. This is when I tell loved ones what is going on and ask them if they want to be in the room. I explain what's happening in simple terms. Heart not beating. No pulse. No breathing. And critically, no suffering. “I don't think he'll survive. Do you want to hold his hand when we stop?” (They usually do.)
Hard words, delivered with my own heart and mind racing beneath what I hope is a calm exterior. Delivered between watching the team and the monitor and running through possible etiologies and interventions. Words as part of the cardiac arrest algorithm.
I once worked in a Catholic hospital where there were the words of a prayer for the dead attached by a small chain to the code cart. I nearly cried the first time I saw that.
I'll close with one of my favorite words. My great-grandfather Leap was named Friend. I've always loved his name. So much that I have come to address many of my patients and their family members that way. “How are you, friend? What can I do for you, friend? I'm sorry to hear that, my friend.” It's a bit casual perhaps. So am I. But I think it builds a connection. And we need that to do our best work.
We can't bill for words the way we can for medicines or procedures. Thank goodness for that. But having a repertoire of funny, soothing things has gone a long way toward easing the pain and building the trust of those in my charge in the daily chaos of my work.
So, hang in there, friends. You're doing the very best you can, and don't you forget it!
Thank you for reminding us why we do what we do. It’s so easy to forget the power of kindness in a hectic ER.
Beautiful words. Thank you so much, Friend.