Virtue and Suffering: Where the Personal and Professional Collide

By Lauren Rissman

A distraught, exhausted mother asked through her tears, “Doctor, what would you do?” The palliative care, neurology and pediatric intensive care team sat in silence in the cold glow of fluorescent light. At that moment, I felt a zap of pain to my heart. It was sharp, followed by a lingering ache. It was visceral and unforgettable.

The mother asked again. As a team, we discussed with her the uncertainties in prognostication. Sometimes kids get better, and sometimes they don’t. After a cardiac arrest, it can take weeks for kids to regain function, if at all. This question was not mine to answer, but rather use it as a stepping block to evaluate a family’s hopes and expectations for their child and their future, as a family.

“He loves The Lion King,” she explained. Though her son had a traumatic brain injury and was receiving multiple sedating medications, she thought it was important for The Lion King to be playing in the background, so her son could enjoy it. But, within 10 minutes of the opening credits, he had had another episode. She described the episode as arm stiffening, and then demonstrated what she had observed. One arm, over her right ear, reached for the sky. Her left arm hung down by her side, fingers pointing to the ground. She arched her back and turned her head. She paused and then began to cry. “I don’t want him to be in pain,” she explained.Read More »

“I Shall Be Released.” Restorative Justice Techniques Can Address Healthcare Burnout & Attrition

by Jay Behel

Burnout, provider dissatisfaction, and attrition remain at near-epidemic proportions among healthcare providers. A 2017 survey found that 39% of physicians reported significant burnout, and nearly a third of physicians were contemplating leaving practice in a 2012 survey.  Nurses seemed to be faring better in a survey released earlier this year with only 15% reporting burnout. However, 41% reported feeling disengaged from their work.

The myriad wellness programs launched to address these problems have disproportionately focused on private, individual aspects of wellbeing like diet, fatigue, and exercise offering similarly individual solutions like yoga and meditation.

Missing from the strategy to help healthcare providers is a coherent plan to address the systemic, communal factors underpinning the crisis, namely the disengagement and isolation fostered by our mechanized and monetized healthcare environment.

While they’re often reserved for use in criminal justice settings, community-building and conflict resolution practices rooted in the philosophy of restorative justice offer a remedy for the alienation of the contemporary healthcare provider and, perhaps, our entire healthcare system.

I began looking for ways to introduce RJ practices at Rush Medical College in Chicago after attending a training in California.  While the whole experience had a powerful impact on how I think about my work as a healthcare leader, I was most struck by the flexibility of the circle practices—their ability to make space for the silly and the serious, for simple connection and complex problem-solving.  I was also impressed by the speed and apparent ease with which participants, myself included, made themselves vulnerable and voiced hard truths.

Following this experience, I brought training to our campus, and our student leaders subsequently held a series of restorative justice circles to address tensions over a curricular transition. Participating students expressed their needs and, ultimately, reaffirmed their commitment to respect and care for one another. After the circles, the number of students reporting peer conflict and incivility dropped.  Moreover, several students noted that the experience of sitting in circle completely changed their sense of the learning environment and their place in it. One student noted: “I feel that I have gained social capital knowing that there is a community of peers I can reach out to whenever I need support.“

Rooted in indigenous traditions, restorative justice (RJ) is a theory that emphasizes building community and repairing harm through cooperative processes that include all stakeholders.  RJ practices convene groups of people to engage in meaningful dialogue about substantive issues that impact community and individual functioning. These processes can help a group identify and gain mutual understanding of both the personal and collective sources of disconnection, create the conditions that incentivize growth, and build or rebuild trust.

One essential RJ practice is the community-building circle.  A circle is usually convened around a desire to both build connections and address tensions and conflicts disrupting the group’s ability to fully function as a community. Guided by a trained circle-keeper and structured around the use of a talking piece, community-building circles provide safe, inclusive space for the revelation of issues both large and small, personal and universal.

More fundamentally for the healthcare space, RJ, particularly circle practices foster the personal connection and humanistic values that brought most people to the field in the first place. Healthcare institutions in New Zealand and Australia are leading the way in employing restorative practices.

Integrating these practices certainly requires an up-front commitment of time and money, and RJ-driven culture change takes time and inevitably involves some moments of painful self-examination at both the personal and institutional levels.

Nevertheless, the pay-off over time, in reduced attrition, increased provider satisfaction, and better patient care, would greatly outstrip the initial investment. And, in an industry that has become so focused on efficiency and metrics, RJ may be key to building capacity.

While these practices alone cannot repair our fractured healthcare landscape, they do offer a roadmap by which providers can navigate the terrain with their souls intact.

 

Jay Behel, PhD, is Associate Dean of Student Affairs and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Rush Medical College in Chicago.  He is a Public Voices Fellow with the OpEd Project.

Speaking of Addiction…

By Meaghan P. Ruddy

When we speak of addiction, there is a lot we can say. We can talk about stigmatization, how stigma is a mark, a signifier of something often associated with shame and disgrace, which in turn are responses to things deemed problematic by dominant cultural narratives. We could focus on historical usages of stigmatizing practices, how we come to know disgrace and feel shame by observing how others, particularly those who are in helper roles, respond to our marks, and how all of this negatively impacts healthcare. And we could, as we often do, speak about it from the safe, professional distance of the theoretical.

But there is a simpler truth here.

It is the truth expressed by the civil rights movement, the equity in marriage movement, and women’s suffrage. It is the truth that fuels both political correctness and the fight against it. It is the truth that language matters.

Think about it. If it didn’t matter, we would never take offense, never laugh at a joke, never tear up at a well-delivered line in a film or speech. No one would bristle at terms with historically racist or fascist overtones.

Yet, we do.

Healthcare has made some progress but our work is far from over. The person-first language movement has done a lot of good; even the CDC-recommended terms of use for people with disabilities. Even the word healthcare is a relatively new and welcome reframing away from the silos implied by medical care, rehabilitation, nursing care, etc. The harsh terminology that was once part and parcel of “clinical-speak,” handicapped, gomer, diabetic, depressive, has largely been abated or is at least on the way out. There has been wide-spread recognition that these are people first, conditions second.

Except. Except for one challenging, and unfortunately swiftly growing population.

Addict.

Drug-seeker.

Yeah, but c’mon, someone might say. They are seeking drugs. They’re a huge problem! They should know better.Read More »

“You will be alright” – A Doctor’s Reflection on the Power of Hope

By Mahboobeh Mahdavinia

Alanna and Anthony are not yet ten years old, but they have been to the emergency room more times than most adults. Every few months since they were babies, their parents have raced them to the hospital for asthma attacks, superinfections of their severe eczema, or food allergy reactions. They each have been intubated twice in their precious few years of life.

But for the last year, Alanna and Anthony have not had to come to the ER in crisis. Instead, their parents have brought them to see me in my allergy clinic for scheduled medication shots and follow-up visits. I consider Alanna and Anthony a success story, or at least the start of one. But most hospitals would not – and neither would insurance companies.

The truth is, Alanna and Anthony have missed multiple appointments, and consequently missed almost half of their shots. Other patients I see have similar spotty records. Administrators who oversee my clinic have pointed out the large cost of no-show appointments. When inconsistent patients do come, their appointments often go overtime, creating conflicts with nursing and staff schedules. Some other hospitals and  clinic administrators would almost surely have come up with plans for dismissing Alanna and Anthony from the practice. However, we have all come to the agreement that we should do whatever it takes for them to stay as long as they choose. Read More »

“The Homeless Situation” – Reflections of a Neighbor and Doctor

by Suzanne Minor, MD, FAAP

The subject of the email read “MDC Commissioners Meeting to Address the Homeless,” the body asking me to attend the Commissioners Meeting to describe my challenges in dealing with the “homeless situation in our area” in order to force the Homeless Trust to allocate dollars to target the Miami homeless populations.  Common scenes in the nearby downtown Miami waterfront public park included all manner of dogs and owners frolicking in their respective packs, designer-clad joggers and boot campers, tourists snapping photos, parents hovering near toddlers, and men and women rolling out blankets or spreading out cardboard for the night.  This email started me to seriously reflect on the homeless living in the park.

I’ve lived in this area for 10 years now.  There are more homeless now than when we moved in, displaced to the local park by museum construction.  At first, it was awkward as the pristine park felt overrun with this new population.  For a time, I even avoided the park in the evenings, not wanting to be reminded of the poor after working to provide healthcare for them in the face of great obstacles in my professional life throughout the day.  Looking at the homeless in the park was painful, bringing up feelings of helplessness, hopelessness, failure – providing health care for the poor of Miami was so difficult.  For any patients in the county safety net system, subspecialty appointments might take 6-12 months patients and if homeless, those patients might not get the appointment notification at the shelter address they gave until after the appointment was actually scheduled.  Just to see me as a walk-in patient required them to spend hours in the waiting room to be fit in to the day’s census.  Work was like constantly climbing a steep hill without the necessary gear or support.  And seeing those patients at night reminded me of this defeat and wore at my reserves.Read More »

The Power is Yours: An Exhortation from an Undocumented Medical Student

By Sumbul Siddiqui

My parents immigrated to the United States when I was 4 years old, hoping to give their children a better life. I was raised in Georgia with my three younger siblings, two of whom were born here. Georgia has a policy called 287(g), in which some counties are proud to work together with ICE agents to detain immigrants.

My first encounter with ICE officers was probably when I was 14 years old, just about to enter the 9th grade. I remember this moment very well, because the night before I had watched this scary movie called Saw. So, I was terrified that someone was going to kidnap me. I checked my closet and slept with the lights on that night. No one came for me, but my mom was taken. Two ICE officers entered our home that morning. I only heard bits and pieces because my mom had closed my bedroom door and told me to go back to sleep. Eavesdropping, I heard them tell my mom to go with them, and she would return back to her family soon. That took 3 months. She was taken to the Atlanta Detention Center, and then transferred to an Alabama detention center.

I don’t remember much of what happened during that time, but I do remember visiting my mom in the Atlanta Detention Center. We were only allowed to see her for a brief moment. She was wearing an orange jumpsuit – crying. Her handcuffs were taken off so she could talk to us through the glass window. I told her that everything was going to be okay even though I had no idea what was going on – or really, a clue about our immigration system. When my mom returned, I started high school, and I didn’t think much about immigration again.

Fast forward to my sophomore year in college. They come for my dad. Within just a few months, they come for my brother. My dad was gone for 2 years, and my brother was gone for 7 months. They were both in two different detention centers. Sometimes, I had to figure out who to visit – whether I would drive an hour up from Atlanta to see my father or 3 hours down to see my brother.Read More »

The Poetry of Dianne Silvestri, MD

Dianne Silvestri, MD, a retired academic physician, is author of the chapbook Necessary Sentiments. Her poems have appeared in Barrow Street, Naugatuck River Review, Poetry South, The Worcester Review, The Healing Muse, New Limestone Review, Zingara Poetry Review, The Main Street Rag, American Journal of Nursing, JAMA Oncology, and elsewhere. She is Copy-Editor of the journal Dermatitis and is founder and leader of Natick’s Morse Poetry Group in Massachusetts.