The only thing worse than a little knowledge may be a lot of knowledge. We clinicians rue the arrival of web-based medical “information” and advice which gives patients and their families the feeling they know as much—or more—than their care providers. Our pricey education, the depth of our decades of experience, the vaunted reputation of our ivory towers and even our own successes mean little to a family member who confidently contradicts our plans, stating summarily, “But I know him (the patient) or “I know my body.” Hear those words and admit it: you’ve been trumped. Better yet, prepare to learn.
In Osman Bhatty’s “Clinical Flashback” (Intima, Fall 2014), the writer admits, “By now it dawned on me what was really going on here.” (Reading this line I was reminded of a statement sometimes credited to R. Buckminster Fuller, neo-futurist architect, systems theorist, author, and inventor: “What seems to be important at the moment is not what is really going on.”) Mr. Bhatty is open to unscheduled and almost invisible lessons, even in the midst of the chaos and exhaustion of fourth-year medical school. May he ever remain so inclined to realize the possibility that his patients and their families will not always act, think, feel, and die just like all the rest of those he cares for—and cares about—in his long and successful career.
In my piece, “Watching,” I describe my reaction to my patient’s family during her last, agonizing hours. I intuited and judged, incorrectly, their seeming callousness by my own standards. How could they, I wondered, waste precious waning moments of the patient’s life while they watched a basketball game on the television? Over the course of 38 years of ER, acute care, and hospice and palliative care nursing I’d become familiar, a self-appointed expert, with the classic stages of grief, death and dying, and how patients and their loved ones should behave. Occasionally I might be faced with someone of a religion, culture, or ethnicity I was unfamiliar with but I quickly added those beliefs and actions into my unassailable belief system. It was only after my own attachment morphed into honest sadness for the patient and her family that I began to empathize with the discomfort that forced them to momentarily look away, to catch their psychic breath, to steel themselves against the impending, wrenching end. Forced by the white entrapment of a snowstorm, I was witness and eventual participant in their journey. I learned, like Mr. Bhatty, what was really going on.
Thom Schwarz has been a registered nurse since 1979, a hospice nurse for the past seven years, working for HV Hospice, Inc., Poughkeepsie, NY. He is also a writer: his work has been published in Journal of the American Medical Association, American Journal of Nursing, The New York Times, Newsweek and more. His piece, "Watching" appears in the Spring 2015 Intima.
© 2015 Intima: A Journal of Narrative Medicine