Bedside Manner will be hosting Palliative Care Grand Rounds for the first time on June 2, 2010. Please submit interesting or enlightening blog posts by May 26th to Julie Rosen, Executive Director, The Kenneth B. Schwartz Center (jarosen (at ) partners.org).
We will include all submissions but are particularly interested in posts that examine the impact of communication on patient care. We look forward to hearing from you!
Monday, May 24, 2010
Thursday, May 20, 2010
Defying the Odds
The fact that Jason Crigler was standing in front of a room filled with caregivers today was nothing short of a miracle. He and his sister Marjorie were presenting the story of his against-all-odds recovery from a devastating cerebral hemorrhage he suffered while performing music onstage at a NYC nightclub in August 2004.
The occasion was Schwartz Center Rounds at New England Sinai Hospital in Stoughton, MA. It was a little different than typical Rounds, in that a patient and a family member were presenting. More typical is a presentation by a multidisciplinary panel of caregivers presenting a patient case that was challenging for psychosocial reasons – as opposed to clinical ones.
Jason and Marjorie showed a couple of short video clips of Jason during his stint at a rehabilitation hospital in Boston. He couldn’t move or talk and his hands were frozen into claw-like positions - his face immobile. Yet there he was yesterday, looking like nothing had ever happened, except for some slight vestigial contraction in the fingers of his hands.
He and Marjorie spoke about the four most important components of the compassionate care they received during Jason’s hospitalization. Here they are:
1. Personalized care: Jason said that he responded better to caregivers who treated him as an individual. One speech therapist asked him to write a paper on what it was like to produce a record- which proved to be a very effective exercise because it tapped into his passion.
2. A positive attitude by his caregivers: Jason said he didn’t want people to paint an unrealistically rosy picture, but he wanted them to emphasize the things he was able to do, and to build on that.
3. An ability to think large and act small: Marjorie said that Jason’s stroke affected many parts of his body, large and small, including his teeth and his eyes. In the hospital, he was sweating a lot so the nurses would put a fan on him, which would then dry up his eyes, which wouldn’t close after the stroke. A vision specialist prescribed an ointment that solved the dryness. Marjorie said that she was thankful that caregivers had large goals for Jason – that he would stabilize and recover – but that they didn’t forget the small things.
4. A balance of intelligence and intuition: Marjorie told a story about a nurse at the rehab hospital who sensed that something was not right with Jason at one point and sent him off to an acute care hospital to be checked out. It turns out a shunt in his brain had become infected. Afterwards, when Marjorie asked the nurse how she knew something was amiss, the nurse said it was a hunch.
Back in November, we featured a short documentary about Jason at the Schwartz Center’s annual dinner and afterward he came up on stage and sang a song with his wife Monica. It was very moving. You can see the song he performed today in the documentary.
Friday, May 14, 2010
A Tough Case at Schwartz Center Rounds
What do caregivers do when a young patient with a history of psychiatric illness refuses nutritional and medical intervention, claiming she is experiencing intense esophageal pain? Do they strong-arm her into compliance? Concede to patient autonomy? Get the legal department involved?
Such a case was recently discussed at Schwartz Center Rounds sessions at which caregivers from multiple disciplines discuss cases that were difficult for psychosocial reasons, not clinical. This one was a doozy, and caused caregivers much consternation about the right thing to do.
Read it and tell me if you think they made the right choice.
Such a case was recently discussed at Schwartz Center Rounds sessions at which caregivers from multiple disciplines discuss cases that were difficult for psychosocial reasons, not clinical. This one was a doozy, and caused caregivers much consternation about the right thing to do.
Read it and tell me if you think they made the right choice.
Friday, May 7, 2010
Separation of Church and Hospital
Can doctors pray with patients? Is it appropriate for a nurse to talk with a dying woman about her spiritual crisis? In healthcare facilities, should spiritual and religious matters be the realm solely of chaplains?
Yes, yes and no, according to a group of a dozen caregivers who gathered together Wednesday night in a Massachusetts General Hospital conference room overlooking the Charles River. The diverse group of caregivers included a neonatologist (who unpretentiously called herself a ‘baby doctor’), several nurses, a few social workers and an ER doctor. All were graduates of the Schwartz Center’s Clinical Pastoral Education (CPE) Program which teaches clinical caregivers how to minister to patients spiritual and religious needs, in addition to their medical ones.
The 20-week program, which takes place at Massachusetts General Hospital and Yale-New Haven Medical Center (although that site has been on hiatus this year), has graduated 50 clinicians who are all doing their part to change the culture of health care – a culture that generally frowns upon mixing medicine and spirituality. The graduates spoke about the many ways CPE has transformed their lives and their work with patients and the ripple effect of the program.
A few examples:
• One therapist now weaves questions about spirituality into her interviews with clients. “It feels like an aspect I can’t leave out of diagnostic evaluations and treatment plans,” she commented.
• A psychologist at a rehab facility said that the program was responsible for her switching careers and becoming a chaplain and starting a palliative care program at her facility. Like others, she said CPE gave her the self-awareness, confidence and language to speak with patients about spiritual matters.
• A nurse who works with patients with lung cancer said that sadly, most of her patients will die of their disease. CPE helped her see that “there’s a powerful healing process going on parallel to the treatment process….CPE teaches that witnessing, listening and validating the meaning in patient’s lives” is as important as healing their bodies, she said.
• Several grads have started programs at their institutions including “Nurture the Nurse” retreats; “Tea and Empathy” gatherings for hospital staff; prayer circles after patients die; and reflective sessions for residents working on the Pediatric Intensive Care Unit.
It was a very inspiring evening.
Yes, yes and no, according to a group of a dozen caregivers who gathered together Wednesday night in a Massachusetts General Hospital conference room overlooking the Charles River. The diverse group of caregivers included a neonatologist (who unpretentiously called herself a ‘baby doctor’), several nurses, a few social workers and an ER doctor. All were graduates of the Schwartz Center’s Clinical Pastoral Education (CPE) Program which teaches clinical caregivers how to minister to patients spiritual and religious needs, in addition to their medical ones.
The 20-week program, which takes place at Massachusetts General Hospital and Yale-New Haven Medical Center (although that site has been on hiatus this year), has graduated 50 clinicians who are all doing their part to change the culture of health care – a culture that generally frowns upon mixing medicine and spirituality. The graduates spoke about the many ways CPE has transformed their lives and their work with patients and the ripple effect of the program.
A few examples:
• One therapist now weaves questions about spirituality into her interviews with clients. “It feels like an aspect I can’t leave out of diagnostic evaluations and treatment plans,” she commented.
• A psychologist at a rehab facility said that the program was responsible for her switching careers and becoming a chaplain and starting a palliative care program at her facility. Like others, she said CPE gave her the self-awareness, confidence and language to speak with patients about spiritual matters.
• A nurse who works with patients with lung cancer said that sadly, most of her patients will die of their disease. CPE helped her see that “there’s a powerful healing process going on parallel to the treatment process….CPE teaches that witnessing, listening and validating the meaning in patient’s lives” is as important as healing their bodies, she said.
• Several grads have started programs at their institutions including “Nurture the Nurse” retreats; “Tea and Empathy” gatherings for hospital staff; prayer circles after patients die; and reflective sessions for residents working on the Pediatric Intensive Care Unit.
It was a very inspiring evening.
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