Student observations from Telluride West

I wrote this quote down on my pad during the Lewis Blackman video that was shown today because I’ve been guilty of this during rotations myself. Hellen Haskell, Lewis’ mother, was talking about the nurse taking care of her son and the fact that nursing notes ultimately revealed that she was indeed deeply concerned about the patient and his deteriorating clinical condition.

The truth is I don’t quite know how to act (maybe act is the wrong word) or rather what emotions to show around families. No one ever tells you to show a impassive face, to act as if everything is proceeding according to plan even when your team is struggling to figure out what is wrong, yet this is exactly what one learns observing the behavior of residents and attendings.

I suppose I always assumed that it was more comforting for families to feel like the providers had a handle on the situation. However, having heard from the patient and patient family perspective, I recognize how isolating and invalidated it can be to feel as if you are the only one concerned about your loved one’s care. While there is a time, a place, and an extent to which to share one’s emotions with patients and their families, honest communication throughout a patient’s stay can create a foundation of trust that can be critical in the terrible event an adverse outcome occurs.  (Neelaysh Vukkadala)

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We started the day with the Lewis Blackman story. It was a very sobering, raw look at what healthcare should not be. Everything that could go wrong did in this case. No one could see the forest for the trees. I felt sad as a provider, devastated as a parent and could not imagine the strength that Helen has to go on and share this with others.

The whole story reminded me of my mother in law (who had cancer). She had epigastric pain & went to the ER. She was told she was constipated from her pain meds-and they missed her massive MI. Mom walked into the ER but never walked out. She lived the rest of her days (2 months) in a nursing home since she could no longer care for herself due to the injury from the missed MI.  She ultimately died from heart failure shortly after her MI-not the cancer she had been battling. We thought she would be with us for about another year-but we got that time stolen from us. In our case, my husband and I talked and decided not to pursue legal action since we knew she likely did not have much time left. He approached someone who he was friends with in hospital administration and let him know about the missed MI. He told him that he didn’t plan to pursue any legal action but did want to talk about how this could be avoided in the future. The guy he thought was his friend suddenly did not take his calls anymore. How sad. There are far too many stories like this.  (Tanya Celia)

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Throughout the day, I couldn’t help but keep thinking about the importance of communication between the healthcare team and the patients that they serve. If there is no transparency, patients and their loved ones (even those well-versed with the medical system) feel like they are left in the dark — during the most stressful time of their lives, they have the added burden of trying to figure out what it is their doctors, nurses, and auxiliary team are actually doing. Lewis Blackman’s story is powerful in that it illustrates the importance of honesty. Watching the video left me with so many ‘if; statements. If the resident or intern working with the nurses had taken pause to discuss Lewis’s worsening condition, could this all have been avoided? What if the doctors and nurses had been more upfront about their lack of understanding of Lewis’s situation? What if Helen had been able to directly contact the attending, would he/she have listened to her pleas and ordered tests to reveal the ulcer? What if there had been a system implemented in the EMR to alert attendings when vital signs were out of whack? As an engineer by training, I believe we should create a framework so that even when humans make mistakes, the system in which we operate is able to provide a safety net to catch that one mistake that could mean life or death.  (Sunny Kung)

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As students of medicine, we are constantly learning: from understanding how to create a robust differential diagnosis, to figuring out ways to chart a patient’s progress through an electronic health record. We drink thousands of new words from a firehose every day, hoping to eventually master the mesmerizing and powerful medical language. With this constant influx of new information, it is easy to forget perhaps the most important facet of our patients’ care: a meaningful relationship founded upon trust. Regardless of the hours spent memorizing biochemistry textbooks, if we as health care professionals cannot find a way to communicate with our patients, we will fail to provide our patients with high quality care. (Serena Dasani)

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The general feeling I left the end of Monday with was discomfort. The idea that I will be taking the reins on patient care in three short years is a terrifying thought. I hope that I can draw on lessons from Telluride to remember to stay goal oriented, patient centered, and most of all scared in order to provide safe, quality care. (Alexandra Butz)

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The corridor faded as her trust weakened
Ending a life, hopes, and dreams
Learning to cope with how we failed her
Leaving her impressions fluid in the rigid system
Unavailable.
Rising and challenging us to remember the center
Instill our pledge in our actions
Demanding change to our discussions
Establishing humanity in our calling  (Natalie Elder)