Thursday, July 27, 2006

Empathy

Empathy is a very important to me. I feel that to be a competent caregiver both professionally and personally I must have empathy. To be a wife I must have empathy. To be mother to three boys with challenges, I must have empathy.

I want the people involved in the care and education of my boys to have empathy. My children are happy boys and are leading full lives; they are creative, funny, active and engaging. They do have difficulties with various issues and situations, some things are beyond their capabilities. Some things they will never master, but with the correct leadership and education I expect they will conquer their own world and continue to lead full and joyful lives. They don’t need sympathy or pity.

As a Nurse Practitioner I encounter many situations that require empathy. There are very few professions outside of the health care professions that are as intimate and invasive of the individual as our professions are. People come to us and trust that we will preserve their dignity and integrity. We are strangers and they often trust us with some of the most important and private issues in their lives. We have usually entered a care giving profession because we really do want to help people, the work is too hard and the hours are too long to want to be there for any other reason.

I am a Family Nurse Practitioner, I have for the last 9 years done Women’s Health Care. I have a varied professional background. I never dreamt I would do Women’s Health Care and OB. I was more interested in fast paced, adrenaline producing situations and complicated multiple diagnoses. My professional history includes time working in a Pediatric Burn ICU, Coronary ICU, Cardiovascular Surgery ICU and working as the Inpatient Coordinator for Heart and Lung Transplant programs at three different large transplant hospitals. Now I do pap smears and STD testing and colposcopy. How did I end up here? How did I end up loving this position as much if not more then the ones I have had in the past?

One thing that all my various positions have required of me is empathy. The ability to look at the patient’s situation and understand it. I don’t need to feel it to recognize what they are going through; I don’t even have to agree with it. I just have to understand it.

When a woman comes to me for her well woman exam or a problem she trusts me, a stranger, to invade her body and perform procedures that are quite foreign to her. I will be touching her in intimate and private areas, I will be asking her embarrassing questions and expecting her to answer with honesty. I will be bombarding her with information in a very short amount of time and I will be doing what is routine to me. If I am able to show empathy to her and acknowledge her fear and anxiety in my actions and words and gain her trust she will be more likely to be forthcoming with answers to questions that I am asking, she will be more receptive to information that I am giving her. She will have an uncomfortable exam instead of a painful and embarrassing one and she will trust me enough to come back. Maybe then the information that I have given her on health and safety issues will actually mean something to her.

I saw a woman in her mid forties; she had not had any kind of healthcare since her last child was born, 11 years ago. At that time she had a Bilateral Tubal Ligation and felt no need to continue routine exams since she didn’t need any birth control. She originally came in to the clinic that day at the insistence of her husband and daughter because of severe low back pain and bleeding from her vagina after intercourse for about two years but had now been constant for a few months. She was there with her sister because the pain in her low back was so severe that she couldn’t drive.

She was terrified. Her last pregnancy was a difficult one and her delivery was complicated and the whole experience had her convinced that she had no need to ever seek health care again. She filled out our medical history form and I felt that she had been quite honest in her responses to the probing questions. One thing that put up a red flag was that she had an abnormal pap smear 11 years ago. She never returned for follow-up. She had lost trust in the caregiver that performed the Pap smear and never went back.

With this information all before me, prior to even meeting this woman I knew it would be a challenge. She was the last patient on a day that had been long and was already running over an hour late. I was tired. In my mind I was asking the rhetorical question, why do they always wait until problems become so bad and then they are the last patient of the day?

I knocked and went in and introduced myself to the patient. She sat at the end of the exam table a tall, elegant and poised woman. She sat with at straight back and stiff limbs and when I offered my hand to her to shake, she gripped it firmly. She promptly told me that she didn’t want to be there. She then introduced me to her sister who brought her and wouldn’t let her leave. From there she proceeded to tell me that she had avoided healthcare professionals and she didn’t trust us and would rather die of blood loss that let anyone touch her again. What? Why was she here then? She came at the insistence of her family; she still had the ability to say no. Tension enveloped the room and I wanted to run, to go home and be with my family and spend the evening doing family things. I knew right then that my family would be having dinner without me that night.

I took a seat on the stool and asked her to just talk to me and let me know what was going on. I sat as she started and stopped a few times, I didn’t rush, and I didn’t interrupt except with a few utterances to let her know I really was listening. She finished her story and I sat a few more minutes, acknowledged how really hard it must have been for her to be in the clinic that evening and how scary it must be to know something is wrong and to have to rely on someone else to figure it all out. I let her know that I was very concerned, I asked her to allow me to examine her. She was not sure she could manage an exam that evening. I offered her the opportunity to make another appointment in the next few days to return after she had thought about what I had said and what my concerns were. I did tell her I would call her and check on her the next day and we would set up her appointment at that time. She agreed that that may be the best.

I left the room, started writing my note about our interaction and the plan when her sister came out and asked if there was still time to do her exam. By now it was an hour and forty minutes since the clinic had closed. I went in to find the patient a bit tearful and yet stoic and ready to do the exam. She has decided that if I was able to take the time to listen to her and allow her to make a few decisions that she was able to make the decision to be examined at that time.

It was a very difficult exam. It was painful and there was significant bleeding and I knew as soon as I put in the speculum that my news to her would not be good. I found a large lesion on her cervix and her cervix was hard and fixed in place and her pain increased dramatically with the exam. I finished what I was able to do and had her get dressed and then went back to talk to her.

I told her that I was certain that the lesion that I saw was an invasive cervical cancer. I offered at that point to work on securing grant money to do a colposcopy to rule in the cancer and then she would be able to obtain emergency Medicaid for treatment and I could then refer her to a Gyn Oncology clinic. Reluctantly she agreed to come the next week to my dysplasia clinic. I was very concerned that she wouldn’t show up and had the manager of the clinic call and assure her she had funding for her and to set up and then confirm her appointment.

The next Thursday as I was driving in to the clinic I felt quite anxious that she wouldn’t be there. I suddenly felt very invested in the well being of this patient. As I walked in the back door the assistant was walking with this woman to the counseling room. She was there and was the first patient of the day.

We did diagnose invasive squamous cell carcinoma of the cervix in the biopsies that I did that day. We were able to get her emergency Medicaid and she did get treatment and is now home and doing well and enjoying her family.

She sent me a card the other day. She thanked me and said that her family thanked me. She then added that the time I took to really understand what she felt was what changed her mind. She called it my “gift of empathy”.

7 comments:

samurai said...

\o/ awesome, simply awesome.

Praise be to God that he gave you these gifts.

BigMama said...

Thank you. Thank you for caring for women, for giving of yourself, for following God's call for your life. This was a joy to read.

~Alise

Intelinurse2B said...

As an aspiring NP and nursing student, this was a poinant example of how I want to practice healthcare. Thank you for sharing and inspiring.

Surgeon in my dreams said...

I am glad she sent the card, and when the day is long and everything has gone wrong, keep in mind there are many who feel the same way but never say it.

Anonymous said...

When I was young and poor and on Medicaid, I was diagnosed with cervical dysplasia at a clinic where the docs changed every month. The gyn who saw me took me on as a private patient to make sure I got the follow up I needed. Medicaid couldn't have paid her very much. Empathy is a wonderful thing, but especially when you are down and out it is so nice to be treated as a human being.

Mary Lu said...

Hey W-Mom,

Of all the things we caregivers have to do the most difficult for many healthcare professionals to do is be with our patients "in the moment." As you know from your years this isn't anything you can "teach." It is something that is just understood. In all my years of working in the field, I understood, that is must come from within the person.

Not everyone has it. But you described the best example of being in the moment and empathy I've heard in years.

God Bless Hon-- You did it right.

Anonymous said...

This is a beautiful story -- thank you so much for sharing it. It is people like you that show what human beings are capable of at our best.