Why I Cried On Rounds

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Wow friends, I’m inspired.  You know that’s the case because I sit here less than 24 hours after my last post, writing again.

Today I learned about Public Narrative during the ICCH conference workshop entitled, “How to Become an Effective Advocate for Humanism in Your Healthcare Organization”.  The process was developed by Marshall Ganz, at Harvard.  Here is the course description (MLD-355M Public Narrative: Self, Us, Now):

Questions of what I am called to do, what is my community called to do, and what we are called to do now are at least as old as the three questions posed by the first century Jerusalem sage, Rabbi Hillel:

If I am not for myself, who will be for me?

When I am for myself alone, what am I?

if not now, when?

This course offers students an opportunity to develop their capacity to lead by asking themselves these questions at a time in their lives when it really matters. . . and learning how to ask them of others. Public narrative is the leadership practice of translating values into action. To lead is to accept responsibility for enabling others to achieve shared purpose in the face of uncertainty. Public narrative is a discursive process through which individuals, communities, and nations learn to make choices, construct identity, and inspire action. Responding to challenges with agency requires courage that is grounded in our capacity to access hope over fear; empathy over alienation; and self-worth over self-doubt. We can use public narrative to link our own calling to that of our community to a call to action. It is learning how to tell a story of self, a story of us, and a story of now. Because it engages the “head” and the “heart” narrative can instruct and inspire – teaching us not only why we should act, but moving us to act. Based on a pedagogy of reflective practice, this course offers students the opportunity to work in groups to learn to tell their own public narrative.

See also this video, where Ganz describes the central tenets himself.

In our introductory workshop today, we were invited to try writing our own narrative, and provide/receive feedback from a fellow participant.  My responses to the exercise prompts are below.  Just want to share.

  1. What is the change you want to make in the world:  Your Story of Now?

I wish to improve all of our relationships:  To foster meaningful personal connections in all realms, in an increasingly disconnected (yet deceptively ‘connected’) world.  This includes doctor-patient, doctor-administration, parent-child, teacher-learner, political opponent, colleague, friend, spouse relationships and more.  We all desperately need deep connection now more than ever.

  1. Why are you called to make this change: What specific experiences have shaped your Story of Self?

I am a Boundary Spanner.  From early in life I have repeatedly and consistently found myself in Middle Spaces, serving as liaison between divergent perspectives, such as family members, Chinese and American culture, conventional and alternative medicine, patients and physicians, physicians and our leaders.  I have an easy ability to take perspectives, withhold judgment, and communicate to connect.  I am perfectly positioned to do this work—I live at the intersection of each of these relationships and others, and I am comfortable serving as a bridge.

  1. What personal story can you tell that will help others understand why you want to make that change? What is the challenge?  The choice?  The Outcome?

In my fourth year of medical school, I rotated on nephrology consults.  Hospital care teams called us to evaluate their patients who had new kidney failure in the hospital, to advise on potential causes and make recommendations for treatment.  I had become confident in my knowledge in renal pathophysiology and collegial communication skills.  On this day we were consulted on a patient in the intensive care unit.  I was taken aback when I saw the man—a Vietnamese man close to my dad’s age.  He was gravely ill, intubated, swollen and jaundiced.  I met his daughter, who looked about my age.  Her hair was jet black and straight, cut like a schoolgirl’s.  She wore a modest t-shirt tucked into high-waisted jeans that looked about a decade behind the current fashion trends.  She did not speak English, so our encounter was brief.  But I remember being struck by the utter confusion and fear in her countenance.  She looked like a deer in the headlights.

I conducted the usual chart review, lab analysis, and physical exam.  I thought through the usual causes of acute kidney failure in critically ill patients, and then the concurrent conditions that made treatment a fine balance of volume, pressure, and perfusion (sepsis, heart failure, kidney failure).  But this case, though medically typical, was emotionally fraught for me.  I saw my own family in this patient and his daughter.  What if my dad had fallen critically ill when he arrived in the US back in the 1970s?  Who could have advocated for him, and how could his care team know what they needed in order to care well for him?  My heart went out to this man, likely about do die, and his daughter, apparently alone to manage everything for him and herself.  I related in a way that surprised and scared me, and I felt vaguely uncomfortable.

So when I overheard the ICU and nephrology consult residents making offhand fun of his monosyllabic last name, as so many people had done to my name growing up, I lost it.  I started crying right there in the unit, or maybe when our team rounded, I don’t remember.  I felt embarrassed and also angry.  How unfair.  These residents had not even known what they had done, they had no idea that I reacted to their words and attitude, which I imagine they would have defended as benign.  I was too embarrassed to say why I was so upset—felt it was selfish, unimportant.  I worried they would think I was being hypersensitive, over-reactive.  I also worried, I realize now, that I would hurt their feelings if I told them how much their passing, offhand remarks had hurt me.  It was too much, and I could not voice any of it.

So my team, perplexed and taken by surprise even more than I, just sat.  They were confused, concerned; they did not know what to do, had no skills at their fingertips to make it safe for me to open up and share.  I don’t remember any gestures of support or reassuring touch.  They sat, like deer in headlights.

My choice was to speak up or not.  To bring attention to what might today, I suppose, be labelled a microaggression?  I chose not to speak.  The outcome is that I regret.  I regret that nobody had any way of consoling me, even as they did not know what was happening.  I regret that I did not have the courage or language to describe my experience, that I did not advocate for myself and future Asian immigrant patients.  I liked our attending.  He was a decent and caring man.  But he had no idea what to do.  If he had briefly halted rounds and taken me aside privately, or asked to sit down later, I might have shared my story then.  But he did not.  I pulled myself together, we completed rounds, and nobody ever brought it up again that I remember, myself included.  He wrote a very generous letter of recommendation for me for residency.

My challenge today was to make sense of this sudden and profound emotional hijack, after marveling briefly that this was the only story that emerged to tell.  I had not thought about this incident in many years already.  My pair/share workshop partner pointed out, insightfully, that once again I found myself in the Middle Space, spanning the boundary between the modern American healthcare system and an East Asian immigrant family unit, both personally familiar to me, and mutually unintelligible to the people on either side.  “I’m not surprised that you’re trying to do something with this story,” she said.  Yes.  My calling is to foster awareness, respect, and mutual understanding between all people.

This is why I get Hippie Zealot Conference High, because insights like this hit me every time I commune with my meeting tribes.  Can’t wait to see what happens tomorrow.

1 thought on “Why I Cried On Rounds

  1. Pingback: November 23:  Range Makes Me Better | Healing Through Connection

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