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Previously, I outlined the distressing experience of being scolded by an Imperious Trio of doctor, nurse, and social worker in the Emergency Room when I arrived to fetch my wandering mother. Their presumptuous and bossy behavior only added to my trauma. In this post I describe the treatment I received from two other ER caregivers and how their individualized, compassionate care helped me feel like I could persevere and everything was going to be okay.
While I’m surrounded and hounded by the Imperious Trio, an ER nursing assistant helps my mother get dressed. The Trio finally departs. I’m a puddle of goo. This nursing assistant-- a far kinder and gentler caregiver-- figuratively scoops me up and asks if I need anything before we go.
Turning to greet this nurturing soul, I quickly come to my senses. I notice that my mother has only eaten half the sandwich served for lunch, and I know she’s still running on empty.
Desperately hoping I’m not being rude or breaking any rules, I tentatively ask, “Do you have a doggie bag or something for the rest of that sandwich?”
He smiles. “I’m sure I can come up with something.”
I’m so relieved. He reaches into a drawer and pulls out a quart-sized sealable plastic bag with BIO HAZARD emblazoned in red.
“Oh goody,” I say. “I’ll be feeding my mother bio hazardous waste!”
He chuckles, commiserating with my irreverence. Encouraged by this rapport, I go into full smart aleck mode, using humor to ameliorate my distress. “So, did you give my mother a good talking to THAT SHE’LL REMEMBER?” We share a hearty laugh and I’m pretty sure he won’t track down the social worker to give her more fodder for the case she’s building against us.
The nursing assitant also thinks to fetch one of the paramedics who brought my mother in, so I’ll know where to find her getaway car. The paramedic is also friendly and helpful. He calls up a map on a computer for me to study, as I am unfamiliar with the area. He points out the Jeep’s location and understands my intense curiosity about my mother’s route. When I see where the Jeep is, I know instantly how she got there. Five miles from home, she’d turned onto a busy road that, 50 miles later, dead-ended at the security checkpoint at this Satellite Development Facility. That chance destination is what returned her to us so quickly. The paramedic shares my delight at solving this mystery and marvels with me at our good fortune.
He then presents me with the car keys and registration, two details I’m sure I’d have overlooked. This proactive and organized care helps calm the chaos still reigning in my brain. I collect the keys and registration, my mother, and my wits, and I sign out of the ER. As we head for the parking lot, I’m still feeling a bit gooey, but I also feel emboldened by the kindness and understanding extended by the nursing assistant and paramedic. Their compassion and collaborative approach was the antidote to the judgmental thrashing I got from the Imperious Trio.
To the casual observer, the differences in care might not look like much, but to the distressed and perhaps traumatized family member, a little bit of quality care goes a long way. When hyper-aroused by trauma, we are hyper-sensitive to our interactions with others. It’s as if our brains are wide open and vulnerable to the effects of both assaults and balms. Insensitivity is deeply hurtful. Compassion is deeply healing.
Compassionate Care is Relationship-Centered Care
In recent decades, hospitals and health care practitioners have become increasingly relationship-centered in the way they provide care. Also referred to as “patient-and-family-centered care” and “relationship-based care,” this framework acknowledges that quality relationships are central to the delivery of quality health care. Relationship-centered care is also evidence-based. Research shows that modern drugs, disinfectants, surgeries, and therapeutic relationships are all powerful medicine.
Granted, when it comes to providing relationship-centered care, some caregivers receive better training and support than others. And regardless of training or support-- or education, status, or pay-- some caregivers come by relationship-centered care more naturally than others. Indeed, compared to their imperious colleagues, our ER nursing assistant and paramedic had a far greater knack for approaching me with compassion and seeing me as a competent human being. They knew how to build rapport and connect. In less than a minute each, they formed a therapeutic relationship with me. They saw me as my smart, funny, competent self and treated me like a collaborative partner. Contrast this to being seen as a misguided, bumbling idiot and being bossed around like a clueless inferior. Guess who bolstered my ability to manage this new frontier of my mother’s care.
After all, one doesn’t inspire folks to do better by making them feel worse! Unfortunately, not every caregiver gets this memo. And in spite of the proliferation of relationship-centered care during the past few decades, I’ve heard way too many stories from families about insensitive or domineering health care practitioners. That day in the ER, I got to experience this firsthand.
It was as if I’d stepped back in time, when it was standard for hospitals to harbor a culture of looking down one’s nose at the patients and families. Copping this attitude is all too easy, especially in understaffed ERs and intensive care units, where stressed caregivers are looking at patients who are in poor condition-- perhaps incoherent, inattentive, or unsensible-- and seeing them as incompetent, difficult, even crazy. Patients, as well as their family members, are also likely to be overwhelmed with painful emotions such as anxiety, sadness, and anger, and as a result, they can be challenging to interact with. But these agitated states are natural responses to the distress of hospitalization-- and what preceded it. Patients and families aren’t trying to be difficult or delusional; they are experiencing trauma and struggling to cope, When caregivers are mindful of this emotional landscape, it’s far easier for them to provide care with compassion rather than condescension.
Seeing patients and families as incompetent is another trap. Indeed, they often do appear dazed and confused. But again, it helps to remember that "dazed and confused" are natural responses to the stress of hospitalization and the unfamiliar world of medical terminology, conditions, treatments, and equipment. It is normal for patients and families to need information repeated, plus plenty of time to form coherent questions. Rather than heaping judgment and lectures on families, effective caregivers are collaborative partners to families navigating the new terrain. Being met with bossiness only exacerbates distress, as what happened to me. In hindsight, I can totally see why I played the PhD card. I was trying to prove that I was competent. I wanted to assert that I’d been doing a stellar job of care coordination for the past five years. I wanted to believe that even with this new monkey wrench in the works, our team would be back on track by nightfall.
Relationship-Centered Care Inspires Resilience
And when I say “by nightfall,” I actually continued to blunder along, searching for new bearings until nightfall. In fact, if any of the Imperious Trio had been spying on me after we left the ER, they would’ve called in the hounds. Here’s what happened:
For my entire life, my mother, when guided to the passenger side of vehicular transportation, has never, ever, ever needed any supervision whatsoever to open the door, climb in, shut the door, and put on her seat belt.
“Here’s my car,” I explain. “Go ahead and get in while I make a phone call. It’s warm and out of the wind too.” I add this enticement as insurance.
I turn my back and wander 20 feet away to phone my sister and cement our plan for her to pick up the Monday Caregiver and meet me at the satellite facility. I give her the easy directions: “Just go to the end of the road! Hahahaha!”! As I seal the deal, I walk back to the car and to my horror, I notice that it’s empty. My mother is not in the passenger seat. She is not in the back seat. She isn’t standing outside the car. She is not even in the parking lot!
“Oh my god,” I exclaim to my sister. “You’re not going to believe this, but I lost her! Again! Crap, what a dork move! I’m an incompetent fool! Lock me up and throw away the key!!!”
We both dissolve into hysterical laughter.
Okay, think like a demented person! The parking lot isn’t that big. My car is the sixth one in from the circular drive and a mere 100 feet from the ER entrance. As I make my way to the gigantic doors, I frantically peer around the other cars and cast my glance far and wide. There are paths between other buildings. A glade of fir trees. Traffic speeds by on Broadway.
She’s had probably 5 minutes to make a clean getaway. At least I’m certain she’s on foot this time!
As I walk into the lobby, still on the phone with my sister for emotional support and dark humor, the guard at the entrance to the bowels of the ER motions with his hand for me to look around the corner to my left. Praise be, there she is! Perhaps I’ll be spared a lengthy incarceration in a correctional facility… or a psychiatric ward. I’m not sure which.
“There you are!” chirps my mother, unaware of her talent for giving me heart attacks.
Adrenaline coursing through my veins for a second time today, I take her by the hand while sharing the glad tidings with my sister. As we exit, I wave and call out to anyone who might understand the implications of what just happened, “Okay, I get it! She wanders. I’m ramping up care. I’m figuring this out!”
But it's another lesson that makes the biggest impression on me: the significant effect of compassion and collaboration in the ER. The caring connection I got from both the nursing assistant and the paramedic is what fueled my second search, my success, and my aplomb.
I carefully, mindfully escort my mother to the car, strap her in, and lock the door.
In the next installment, I describe our hip-hop trip to collect the Jeep, my conversation with the satellite facility security guard, and the immediate aftermath for our family.
