On Healing 3/3/2008: A patient yearns for a caring touch

I took a couple of months off because of some health problems.

It all began last summer, when my normally slow heart rate suddenly dropped to dangerous levels. A pacemaker was implanted the next day, but within hours I was experiencing wild fluctuations in blood pressure, and extreme fatigue. The doctors thought it was temporary. It wasn’t.

Several months of consultations and evaluations left me feeling pretty isolated as I navigated a complex and often impersonal health-care system. Two doctors said my body was beginning to wear out. Neither one looked at me when he said it.

Sometimes care is as important as cure. In the operating room getting my pacemaker, I felt very alone and frightened. I needed care – so I asked if someone would make eye contact with me, perhaps smile and touch my face. Everyone was too busy to stop, and they couldn’t take their masks off anyway.

The vast majority of doctors are caring, dedicated people who are working way too hard to meet unreasonable demands and expectations. They feel stress about their schedules, responsibilities and liabilities. And many of them feel stress when they don’t have answers, or when they have to deliver bad news. I’m sure that the doctors who didn’t look at me cared very much; they just didn’t know what to do with what probably were very uncomfortable emotions of helplessness while delivering painful information.

Most medical training teaches doctors to be strong, independent, and to hide their vulnerability – essentially, to keep their masks on. Plus, most doctors today are pretty isolated in their work, with little time to talk to colleagues about medicine, let alone difficult emotions. The good news is that there are many new programs around the country that teach medical residents compassion for themselves and others.

Despite my reputation for compassion, in the midst of my fear and isolation the only thing I really cared about was whether someone was going to care about me. I needed someone to touch my hand or put an arm around me and ask – not tell me – what I was experiencing. I needed to be with more than a technically skilled doctor; I needed a caring, compassionate and feeling human being.

There were exceptions, of course. One of my doctors was so troubled by the lack of answers – the medical literature for 61-year-old quadriplegics is limited – that he called colleagues and searched journals to find any mention of my symptoms. And there was the integrative medicine specialist. When I told her what was happening, she closed her eyes and took a deep breath, as if to try to truly understand my experience. In that moment, I felt for the first time that someone understood what I was going through. Hippocrates would have been proud.

Throughout the medical system, doctor and patient typically share physical space while adopting predictable roles (knowledgeable doctor and compliant patient); points of discussion are usually confined to symptoms and treatments. Both may be feeling isolated, both may care very much about what’s happening in that room, but neither one speaks about it. Maybe both wear masks.

I never did get a diagnosis, but my symptoms are substantially diminished. So while I feel much better, I may well be dealing with this again in the future. If I do, I hope I have technically skilled doctors who will be able to ask me what it’s like, and then take their emotional masks off while they listen. It will be good for both of us.

New book and TV special. My column’s return to this page coincides with two events, both titled Learning From the Heart: Lessons on Living, Loving, and Listening. Both the book and the broadcast examine what makes us human: How is it, for example, that children who readily experience awe grow into adults who go through life so fast they often don’t even notice the world around them? And what can we ultimately do to find the kind of security and happiness most of us long for?

The 90-minute special will air tonight at 9 on WHYY TV12. It will be rebroadcast on March 15 at 5:30 p.m.

The book was released today and is available at area bookstores or via my Web site (www.drdangottlieb.com). I will be doing readings at the Free Library of Philadelphia, 1901 Vine St. (noon on Wednesday), and at the Barnes & Noble bookstores at 1311 Nixon Dr., Moorestown (2 p.m. March 15), and 301 Main St., Exton (2 p.m. March 16).

Emotional Side of Surgery

Therapist Dan Gottlieb offers these suggestions for improving your emotional state in the operating room:

For patients

Be aware: Acknowledge how you feel. You don’t need to pretend you are “strong” when you don’t feel that way.

Communicate: If you feel frightened or vulnerable, it is important to let the doctor know. Anxiety could interfere with your ability to understand what is being said.

Request: If you are anxious as details are discussed, ask the doctor to slow down. Feel free to request a few moments to collect your thoughts; additional questions or concerns may appear.

Connect: If you are afraid, ask your doctor if he or she understands how frightened you are.

For doctors

Breathe: Before entering the room, take a minute to catch your breath. Allow your body and mind to make a transition between patients.

Think: Be aware of how you feel about seeing the next patient, what you might need to say and what assumptions you might be making.

Listen: Please don’t simply reassure. It only takes a few seconds to try to understand what the other person might be experiencing.

Connect: Allow yourself to feel what the person said, and then respond. If the patient says that he or she is frightened, make eye contact and touch a hand or a shoulder. It means a lot.

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