“Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity.”
– Pema Chödrön
Compassionate medicine is when a provider connects on a deeper, more intimate level with their patients. It’s not just laying a stethoscope on them it’s also laying your hand on their back and asking how they are doing mentally not just physically. Most chronic diseases are the result of stress and our bodies’ reaction to that stress. The secreting stress hormones can result in long-term damage to the body. A healthy mind lends to a healthy body. When my patients come to me for whatever reason, I always ask them about their level of stress and how they are coping with it. I don’t think the majority of practitioners do that. Most of the patients’ lives are spent at home not at the medical office. It’s important to know what is happening in their lives personally so you can help the patient cope and manage their disease at home not just in the medical office. Harvard, MIT and Berkley medical schools are now teaching compassion as a course for their medical students. It’s sad to think we have to teach compassion now in medical school. I am glad they are doing it, as compassion is as much a part of a patient’s healing process as the medicine itself. In fact, compassion may be more likely to help a patient heal than not having it.
“Your heart failure patient is ready in room one, and he is a difficult one, good luck,” said the staff member to me. I took a deep breath and I looked at his chart to see his name and study his case before I entered the room so I would be prepared. I opened the door and there sat an 85 year old man with a disgruntled look on his face and his wife who appeared very meek and mild sitting in the chair. I noticed his hand on her leg, and I thought there is hope here. I asked the patient, “How are you feeling today Mr. B? He replied,” I feel like hell, I’m tired of living like this. I’m tire of going from office to office and no one doing anything. I just assume die. That is how I feel!” His wife looks down as if she is apologizing silently to me. I look Mr. B in the eyes and I said, I understand Mr. B it has to be frustrating.” His anger grew and he shouted, ”How do you know?” I answered, “Mr. B you are the reason I’m in medicine. My Grandfather suffered from congestive heart failure and diabetes too. I started giving him his insulin shots and nitroglycerin paste when I was in third grade. I wanted desperately to save him. So, I went to PA school to learn medicine and try to save him but he passed away the day I graduated from the Medical College of Georgia. It was as if he held on long enough to see me finish and then he let go.” Mr. B looked up at me and said, “Sweetie I am sure he was so proud of you.” I asked him to stand up and come sit on the table so I could examine him. I fought back my tears, thinking about Papa. I think Mr. B knew that. He finally got seated we looked at each other in the eyes and I wrapped my arms around him and gave him a hug and said, “You are going to be okay. Now look at your ankles and how swollen they are. We need to up your Lasix.” I noticed a tattoo. I asked if he was a Veteran and he said, ”yes.” I then thought this poor man with all this anger must have been badly affected by the war. Who wouldn’t be affected? I finished my exam and he sat back in the chair next to his wife and put his hand right back on her leg as if those few minutes away from her were too much. Very touching to see him love her so much. I asked if he has ever had counseling from the war and he looked up and said, “No! I’m not going to either, I’m not wasting my time and I just soon go ahead and die anyway.” Well that wasn’t exactly the response I was looking for but I knew he had a big heart but he was scared and that made him mad. I said, “Come on Mr. B I want you to see something and tell me what you think.” He agreed. We walked down the hall and I took him to our wellness room, which was empty at he time, thank goodness. It has 4 big blue comfortable chairs, white walls with a nature scene and blue curtains and a dimly lit lamp. It feels cozy I have to say many of our patients feel comfortable in there. I asked Mr. B to have a seat and tell me if he thinks the chairs are comfortable. He asked his wife to sit first because she was tired and then he sat down next to her. He leaned back and I sat in the other chair across from him. I looked at him and said out of the blue, “My first spinal tap in PA school was at Ft. Gordon in Augusta. I trained there and saw a lot of soldiers with a lot of trauma. The toll the war takes on a soldier is traumatic. You have to get it out and clear your mind so you can relax and enjoy your time with your wife.” I looked at his wife and tears came rolling down her cheeks. I asked him to just sit there for a bit and I would be back. I left the door open so he could see the flow of the clinic and feel at ease sitting there watching the hustle and bustle. I came back and handed him an appointment card for the next day to see our wellness counselor, Linda. He said, “What is this?” I told him what it was and he went silent. I said “at least let your wife come if you refuse, okay?” He smiled.
Medicine is not just the application of science and technology to the patient but it is also just as much about compassion. You have to have respect for the patient’s suffering. You have to take time to talk to them and listen. Touching them with your hands and not just a stethoscope adds a human touch that they can connect with. So often do clinicians loose sight of compassion and de humanize medicine to the “heart failure guy in room one.” He is more than his disease. He is a Veteran soldier, a husband, a father and a grandfather that is exhausted from his disease. It takes more than pills to treat this patient. It takes a provider that will sit with him and listen and feel his pain with him. It’s a shared humanity. I learn so much from him.