Winter 2019 Selection: Compassionomics

I am super excited about this topic, I think it pairs topics in building physician resilience and improving patient care. Authors Trzeciak, Roberts and Mazzarelli have published several pieces on the topic, our discussion will focus on their book pictured below.

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I’ve included a short sampling from their paper in Medical Hypotheses which attempts to delineate the different factors that affect both patients and providers when considering compassion in healthcare, and conveniently in a compact table!Screen Shot 2019-11-25 at 8.13.05 PM.png

Check out the full article for more food for thought! (1)

  1. Trzeciak S, Roberts BW, Mazzarelli AJ. Compassionomics: Hypothesis and experimental approach. Med Hypotheses2017 Sep;107:92-97doi: 10.1016/j.mehy.2017.08.015. Epub 2017 Aug 12. PubMed PMID: 28915973.

A bit of poetry from the MICU

Limited time and demanding rotations leave minimal time for reflection.   Maybe you only have time for a new album on the way home, or you catch an old favorite on the radio.  Consider the following lyrics and and how they take on specific meaning  while you’re on you way home from the ICU.

Long Way from Home
By the Lumineers
Held on to hope like a noose, like a rope
God and medicine take no mercy on him
Poisoned his blood, and burned out his throat
Enough is enough, he’s a long way from home
Days of my youth wasted on a selfish fool
Who ran for the hills from the hand you were dealt
I flew far away, as far as I could go
Your time is running out
And I’m a long way from home
Laid up in bed, you were laid up in bed
Holding the pain like you’re holding your breath
I prayed you could sleep, sleep like a stone
You’re right next to me
But you’re a long way from home
Hospital gowns never fit like they should
We yelled at the nurse, didn’t do any good
More morphine, the last words you moaned
At last I was sure
That you weren’t far away from home
Source: LyricFind
Songwriters: Jeremy Fraites / Wesley Schultz . (3)

 

In an interview with Aquarian online publication, lead singer Wesley Schulz of The Lumineers describes the why this piece was particularly meaningful to him (2).

“Do you have any song on the album that holds a more significant meaning or has a little bit of a stronger hold in your heart?

Lately it’s been, “Long Way From Home.” That is a song about losing my dad. He died on 7/7/07 at 7:07am. It was a pretty bizarre coincidence. Only a few days ago it was nine years and I hadn’t really written much about it. I felt compelled to talk about him getting sick with cancer. He died from the same thing that took his mother’s life, so I think I was just trying to process that. It was a hard thing to do but I’ve been able to now play that live for people and it’s been really cathartic.

With this we use that line “long way from home” four different times but it means something different each time. On a lot of levels it was a really fulfilling song to write.””

With a bit more time, you could even reflect on a myriad of poetry inspired by medicine.  This one from Pablo Neruda caught my eye, and Ode to my Liver (1):

Modest,
organized
friend,
underground
worker,
let me give you
the wing of my song,
the thrust
of the air,
the soaring
of my ode:
it is born
of your invisible
machinery,
it flies
from your tireless
confined mill,
delicate
powerful
entrail,
ever alive and dark.
While
the heart resounds and attracts
the music of the mandolin,
there, inside,
you filter
and apportion,
you separate
and divide,
you multiply
and lubricate,
you raise
and gather
the threads and the grams
of life, the final
distillate,
the intimate essences.
Submerged
viscus,
measurer
of the blood,
you live
full of hands
and full of eyes,
measuring and transferring
in your hidden
alchemical
chamber.
Yellow
is the matrix
of your red hydraulic flow,
diver
of the most perilous
depths of man,
there forever hidden,
everlasting,
in the factory,
noiseless.
And every feeling
or impulse
grew in your machinery,
received some drop
of your tireless
elaboration,
to love you added
fire or melancholy,
let one tiny cell
be in error
or one fiber be worn
in your labor
and the pilot flies into the wrong sky,
the tenor collapses in a wheeze,
the astronomer loses a planet.
Up above, how
the bewitching eyes of the rose
and the lips
of the matinal carnation
sparkle!
How the maiden
in the river laughs!
And down below,
the filter and the balance,
the delicate chemistry
of the liver,
the storehouse
of the subtle changes:
no one
sees or celebrates it,
but, when it ages
or its mortar wastes away,
the eyes of the rose are gone,
the teeth of the carnation wilted
and the maiden silent in the river.
Austere portion
or the whole
of myself,
grandfather
of the heart,
generator
of energy:
I sing to you
and I fear you
as though you were judge,
meter,
implacable indicator,
and if I can not
surrender myself in shackles to austerity,
if the surfeit of
delicacies,
or the hereditary wine of my country
dared
to disturb my health
or the equilibrium of my poetry,
from you,
dark monarch,
giver of syrups and of poisons,
regulator of salts,
from you I hope for justice:
I love life: Do not betray me! Work on!
Do not arrest my song.

What ever your preference, consider the cathartic value of poetry or lyrics in your time-crunched reflections.

 

  1. Arrese M. The liver in poetry: Neruda’s ‘Ode to the Liver’. Wiley Online Library. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1478-3231.2008.01814.x. Published July 8, 2008. Accessed November 15, 2019.
  2.  Sariyan D. The Aquarian. The Aquarian. https://www.theaquarian.com/2016/07/27/an-interview-with-the-lumineers-wesley-schultz-unveils-the-stories-behind-the-bands-intimate-lyrics-and-irresistible-sing-a-long-songs/. Published January 3, 2018. Accessed November 15, 2019.
  3. ​The Lumineers – Long Way From Home. Genius. https://genius.com/The-lumineers-long-way-from-home-lyrics. Published April 8, 2016. Accessed November 15, 2019.

Featured Read: Finding Chicka

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“Bestselling author Mitch Albom returns to nonfiction for the first time in more than a decade in this poignant memoir that celebrates Chika, a young Haitian orphan whose short life would forever change his heart.

Chika Jeune was born three days before the devastating earthquake that decimated Haiti in 2010. She spent her infancy in a landscape of extreme poverty, and when her mother died giving birth to a baby brother, Chika was brought to The Have Faith Haiti Orphanage that Albom operates in Port Au Prince.

With no children of their own, the forty-plus children who live, play, and go to school at the orphanage have become family to Mitch and his wife, Janine. Chika’s arrival makes a quick impression. Brave and self-assured, even as a three-year-old, she delights the other kids and teachers. But at age five, Chika is suddenly diagnosed with something a doctor there says, “No one in Haiti can help you with.”

Mitch and Janine bring Chika to Detroit, hopeful that American medical care can soon return her to her homeland. Instead, Chika becomes a permanent part of their household, and their lives, as they embark on a two-year, around-the-world journey to find a cure. As Chika’s boundless optimism and humor teach Mitch the joys of caring for a child, he learns that a relationship built on love, no matter what blows it takes, can never be lost.

Told in hindsight, and through illuminating conversations with Chika herself, this is Albom at his most poignant and vulnerable. Finding Chika is a celebration of a girl, her adoptive guardians, and the incredible bond they formed—a devastatingly beautiful portrait of what it means to be a family, regardless of how it is made.” (1)

  1. Amazon. Finding Chicka. Amazon. https://www.amazon.com/gp/product/B07NWR1JRW?ref=dbs_p2d_P_R_popup_yes_pony_T1. Published 2010. Accessed October 18, 2019.

Featured Book: Compassionomics

Check out this recommended read, I’ve provided the electronic equivalent of a back cover blurb curtesy of Amazon.

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” A 34-year-old man fighting for his life in the Intensive Care Unit is on an artificial respirator for over a month. Could it be that his chance of getting off the respirator is not how much his nurses know, but rather how much they care?

A 75-year-old woman is heroically saved by a major trauma center only to be discharged and fatally struck by a car while walking home from the hospital. Could a lack of compassion from the hospital staff have been a factor in her death?

Compelling new research shows that health care is in the midst of a compassion crisis.
But the pivotal question is this: Does compassion really matter?

In Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference, physician scientists Stephen Trzeciak and Anthony Mazzarelli uncover the eye-opening data that compassion could be a wonder drug for the 21st century.

Now, for the first time ever, a rigorous review of the science – coupled with captivating stories from the front lines of medicine – demonstrates that human connection in health care matters in astonishing ways. Never before has all the evidence been synthesized together in one place.

You will see compelling evidence that:
– Compassion has vast benefits for patients across a wide variety of conditions
– Missed opportunities for compassion can have devastating health effects
– Compassion can help reverse the cost crisis in health care
– Compassion can be an antidote for burnout among health care providers
– 40 seconds of compassion can save a life

After seeing all the evidence, the answer is crystal clear: Compassion matters…in not only meaningful but measurable ways.” (1)

  1. Trzeciak S, Booker C, Mazzarelli A. Compassionomics: the revolutionary scientific evidence that caring makes a difference. Amazon. https://www.amazon.com/Compassionomics-Revolutionary-Scientific-Evidence-Difference/dp/1622181069. Published 2019. Accessed October 18, 2019.

When healthcare “happens” to patients

Recently I’ve had several patients that shared a similarity.  They seemed to be content with allowing their life, or at least their healthcare to “happen.”

What do I mean by “patients who allow healthcare happen to them?”  The very first thing I notice when I’m working with a patient who exercises no agency is that the work is hard and slow.  The work that the patient abdicates to the provider often feels heavier.  As the healthcare worker you’re not only now interfacing with someone who has a health problem and is consuming medical care, you are working with someone who has a problem that they think you can solve.  Many times providers will work with patients to understand what patients really want, to make most effective time of the patient encounter.  But have you ever come across those patients that don’t know what they want? Consider the screaming child in the middle of tantrum who can’t remember what the issue was to begin with and yet they will pout until something magical happens when they feel better. Do every feel like you’re negotiating with a child in a tantrum? Sometimes I come across patients that want you to help with EVERYTHING.  They can’t articulate it but deep down they want you to divine their purpose, so you cant fit a perfect intervention into their life, that is if they understood what their goals of care were.

I take my example to the extreme, but everyone has had a patient where life continues to ‘happen’ directly to the patient.  Many times the patient quite literally had a string of unexpected, uncontrolled things happen in their lives.  Some patients have been seriously disenfranchised by their circumstances such that learned helplessness has taken hold.  This type of patient reminds me of Santiago in the foreign market place.  He has just sold all of his worldly belongings and crossed into a brand new world when he is robbed and lost. Do you ever see a little bit of Santiago in your patients?  A lot of times these patient will get mad at you. I find this most frustrating.  The patient who cannot articulate what he or she wants is insistent that you fix “it,” what ever it is, RIGHT NOW.   I think in many ways Santiago had already made the grand gesture of embarking on a journey and now, robbed and lost, the world wants even more of him.  His adventure, which appeared to be “happening to” poor Santiago was cruel and unforgiving and left him feeling like he had no agency.

Now comes the question.  Santiago’s adventure didn’t stop in the market place, so what was the special sauce that move him forward? What do you offer your patients who act as though life is “happening to” them? How do you continue on the journey with those difficult patients but share the load?

Finding Inspiration in Purpose, Part I

One of the resounding themes of The Alchemist is Santiago’s journey, that in the end, leads him on a search for purpose.  Santiago has the benefit of reflection, of long hours in the fields with his sheep, or later in long expanses of time traveling the desert contemplating the meaning of his life’s events.  That’s a luxury that many residents, heck anyone who works in a busy emergency room might forego.

Being the quintessential emergency physician I was drawn to a quick top 10 list, pared town to 5 list, words of wisdom while on your journey to your purpose. They echo many of the lessons Santiago encounters over the course of the novel.

 

1. Letting discouragement overwhelm you.

Santiago took risk after risk by leaving his home town, selling his flock and traveling to a new country only to be robbed on arrival.  He didn’t let it stop his transformative journey and neither should you let failure dissuade you from your purpose.

2. Denying your current situation.

Santiago knew that he couldn’t stay at the Oasis without pursuing his purpose, even if that meant leaving Fatima.  Take stock, and honor your present.

3. Dwelling on the past.

Maybe if Santiago had fixated on the life set out for him by his family maybe he would have never lead to his adventures. Life takes courage folks. 

4. Procrastinating.

If Santiago had not realized his vision for the crystal merchant, he would have never made it to the caravan. Don’t let time be your enemy.

5.  Trying to get approval for your dream.

The Englishman was blinded by his end goal of transforming lesser elements to gold, his only validation came from accomplishing the seemingly impossible task.  What if he had taken a moment to enjoy the trek across the desert, enjoyed the stars.   Residency definitely feels like a trek across the desert, so maybe we should take a few moments to enjoy the stars.

  1. Davis A. 10 Mistakes To Avoid When Chasing Your Dream. Tiny Buddha. https://tinybuddha.com/blog/10-mistakes-to-avoid-when-chasing-your-dream/. Published January 21, 2016. Accessed September 7, 2019.

 

Adventure Reading

Do you ever feel like Santigo of the Alchemist, needing direction during the daily drudge?  Yearning for more adventure in your life?  Living that low budget resident life?   Outside magazine asked readers what inspired their “athletic, artistic, and environmental feats,”  many highlighting insight which might come in handy in the emergency department. Check out these summer reads, and even more, found at:

https://www.outsideonline.com/2176152/adventurers-books-changed-their-lives?utm_source=facebook&utm_campaign=facebookpost&utm_medium=social&fbclid=IwAR1ew3J5vGF7UXXmi1nVkhbMpu5nMhGkmvwoTMm8nff4UVM4bwMk4cvc4MM.

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‘Willpower: Rediscovering the Greatest Human Strength’ by Roy F. Baumeister

“When distance runner Alexi Pappas was assigned psychologist Baumeister’s book about self-control as summer reading in college, it changed the way she thought about her limits as an athlete. “The book gave me the words to identify some of the things I was feeling,” Pappas says. “It taught me that I have a certain amount of willpower that can be depleted but can also be replenished, which are both such important things to know and realize as an athlete trying to push boundaries and improve yet also have longevity. It also told me that it is okay and super important to sleep.”” (1)

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‘Thinking Fast and Slow’ by Daniel Kahneman

 

“In his job as host of the Dirtbag Diaries podcastFitz Cahall breaks down a lot of the one-dimensional conventions we have about the outdoors, from weekend warriors to environmental activism. The book that Cahall says colored a lot of his thinking, Thinking Fast and Slow, does the same, just on a different scale. “I think for me it basically comes down to this: there are a lot of obvious ways of looking at the world and at people, but they aren’t always the correct ones,” he says. “We are really good at tricking ourselves into following others and our own deep biases. Right now, I think it’s worth examining how we think, how we engage, and how we empathize with others. There are a lot of ideas in that book, but I think what’s important is that questioning our assumptions is more imperative than ever.”

Our Favorite Quote: “Our comforting conviction that the world makes sense rests on a secure foundation: our almost unlimited ability to ignore our ignorance.”” (1)

 

  1. Hansman H. 10 Adventurers on the Books that Changed Their Lives. Outside Online. https://www.outsideonline.com/2176152/adventurers-books-changed-their-lives?utm_source=facebook&utm_campaign=facebookpost&utm_medium=social&fbclid=IwAR1ew3J5vGF7UXXmi1nVkhbMpu5nMhGkmvwoTMm8nff4UVM4bwMk4cvc4MM. Published July 10, 2019. Accessed August 21, 2019.