Joshua Baru, MD 

Benjamin Mba, MD, MRCP
Stroger Hospital, Chicago, Illinois, United States

The Schwartz Center Rounds program provides a forum for an interdisciplinary and interdepartmental case-based discussion of the emotional and interpersonal underpinnings of healthcare providers. The following is a description of a recent Schwartz Center Rounds session at Cook County Hospital.

The case. A 23-year-old Indian man was driving with his 21-year-old wife when he got into an altercation about a parking space with another driver. After both cars stopped, the man got out of his car and approached the other driver, a woman, who in a panic attempted to drive away from the scene. She hit the man, and he was taken to Cook County Hospital’s trauma center for treatment. His condition on arrival was grave and his likelihood of survival very low.

His wife was white and non-religious. His parents were immigrants, Sikhs, and devoutly religious. The discussion focused on the experience of the staff caring for the patient in the midst of conflict between the patient’s wife, her family, and the patient’s parents.

The surgeon. The attending surgeon described her anguish in dealing with this divided family, whose anger at times seemed to spill over onto her. She tried her best to bridge these cultural and generational differences and soothe the conflict and discord by listening, making eye contact, and acting in a sympathetic manner. Her sense of failure to resolve the conflict in this case was a source of anguish and guilt for her.

The social worker. The social worker in the unit related similar feelings of failure, and even anger, over her inability to resolve the conflict between these families. In fact, her frustration was such that she could not contain her tears. She had arranged a family meeting to try to help, but, in retrospect, felt this may have been a mistake. The meeting had started out peacefully enough, until the wife’s father became angry because the patient’s mother had asked the wife to return a ring, a family heirloom, that the patient had given his wife. As the meeting devolved into screaming and hysterics, it became apparent that the mother was angry that the wife was the legal decision-maker for her son. After the meeting, the social worker expressed her anger at the father-in-law for undermining the meeting.  At the rounds, she expressed regret at having given vent to her emotions on a person in crisis. She described the support she gained from her colleague, who gave her a different perspective on the patient’s father-in-law, saying, “He was trying to help and stand up for his daughter. The whole family was experiencing pain, loss, and anger.”

The nurse. One of the intensive care nurses gave a nuanced view of the daily interactions around the patient. She described disparaging comments made by staff members about the patient and the family (e.g., “He should have stayed in the car” or “Look at him . . . of course [the other driver] was scared”). There was a degree of hostility expressed against the patient, and she worried this could affect his care. She described stressful moments: conflicts about who was to make decisions, emotional outbursts, and the patient’s wife feeling unwelcome in the room when his family was present. But, she also noted moments of respect and communion: the patient’s wife covering her hair in the room and asking the same of her friends.

The chaplain. The chaplain described finding herself in the unusual situation of being asked to pray for a miracle with a family that did not seem to understand the situation. The patient’s father insisted that his own life had been miraculously saved when he was cured of cancer and now was praying for a second miracle. She felt a conflict between trying to support the family and her own role and beliefs.

Audience comments and questions:
It is possible to isolate our emotions while caring for patients.
Can we keep our emotions from impacting the quality of the care that we provide?
When caregivers pass judgments (knowingly or unknowingly) can compassionate care still be provided?
How do healthcare professionals cope with their anger at difficult patients or families?
How do healthcare professionals bear the stress of daily encounters with tragedy?
What do we do with the guilt that we feel over situations that are beyond our control?

Acknowledgement

We would like to thank the Schwartz Center for Compassionate Care for their support of this activity and Dr. George Dunea for helping prepare the manuscript.

 


JOSHUA BARU, MD is an assistant professor at Rush University, chairman of the Stroger Hospital Bioethics Committee, and an attending physician for the Inpatient Palliative Care Service at Stroger Hospital.

BENJAMIN MBA, MD, MRCP, FACP, FHM is an assistant professor at Rush University, as well as firm chief and the associate program director in the Department of Medicine at Stroger Hospital.

The Schwartz Center for Compassionate Healthcare is a national nonprofit dedicated to strengthening the relationship between patients and caregivers. For more information visit: www.theschwartzcenter.org.