How many talks on patient quality and safety have I seen where numbers are quoted (18% of GDP, 3rd leading cause of death, 26th in mortality) but stories are left out? Numbers have their place, to help policymakers and advocates for health system redesign (like me) to make a rational argument for change. I’ve been compelled by these numbers for years now, and in fact, I’ve decided to make a whole career out of making those numbers move toward equity. But it’s been a long time since I reflected on the stories that originally brought my attention to the world of patient safety and quality. Reflecting on that this week, I think I’ve missed those stories.
A story has a particular power to compel, because it reaches out and reminds you that you’re human. I think we humans derive much of our meaning from life by seeing ourselves as part of a story. We are the hero, battling some adversity, striving toward some goal. Reaching that goal or not decides whether our life is a triumph or a tragedy. Surely all of us in health care can relate to that. We’re all here to be one of the ultimate heroes in a story, since nurses, doctors, and all health care workers are so revered by society (as an aside, perhaps these expectations are why we’re so shaken by our mistakes).
But our patients and their families are in their own story, too. Their goal probably had a lot to do with their loved one, who has been harmed (however inadvertently) by our system. They’re in a story that has suddenly become a tragedy. The anecdotes we’ve heard this week remind us that, like it or not, we healthcare providers are playing a role in that story when we walk into their lives. A huge role. We have to watch what we say, how we move, and how we act and interact, because every little thing we do or say will change their story in a momentous way. We have an awful responsibility of sculpting what they take from this moment and how it will affect the story of the rest of their lives.
This all got me thinking about all the time I spent in student theater in high school and college. One of my best directors taught us “acting is re-acting.” He meant that, when we’re up there on stage, we’re not supposed to simply recite our lines as best as we can all alone then wait for the next cue, solitarily. We take energy from our fellow actors’ performance to fuel ours, and we give it right back to them when its their time to speak. It requires a certain amount of vulnerability. We’re all reacting to each other and creating something in between us that the audience perceives as a genuine interaction. In fact, if you do your job well enough, the audience gets pulled right into the acting-and-reacting and everyone feels something together. Everyone becomes part of the same story. This is when everything goes as best as it possibly can – there’s a flow, and it feels good. You can’t get there every night, but sometimes you do. At a certain point it goes beyond artifice: it is akin to genuine empathy, and beautiful to experience (and behold) when it happens. It is the dynamic creation of a meaningful story.
In our interactions with patients after a significant event, we need to strive for this flow. It’s our job to let the patient and their family know that we understand that their story is meaningful, and that we know how much we are affecting that meaning by how we act today. We should let ourselves be drawn into their stories, and embrace our role as meaning-makers and significant actors. We cannot forget that this is not another day for them like it might be for us. This may be the climax, or turning point, or sometimes just the beginning, of their story.
I felt this sort of dynamic empathy in all the stories we’ve heard this week. It’s a feeling I think I haven’t felt as often as I’d like in my clinical career. But it is vital to making sure that we capture the moment when a horrible mistake happens. Like it or not, in those moments we are center stage with the spotlight on us in front of the most important audience of our lives – our patients. We are in their story now.
before i decide what to do with the rest of my day,
i realize i am a part of someone’s story,
and that stops me,
not unlike when curtains unveil
a stark proscenium
and, for a moment, the decorous crowd
becomes even more hushed – even into silence.
it’s my turn to act,
and i look around and see
the rest of my production,
the director sweating in the wings,
and the stagehands quietly reminding me my cue
(as they always do,
that diligent crew),
where i stand on the boards?
where my blocking was spiked?
the important things.
i am talking – at that hushed crowd,
who are expecting a story
to tell to their friends over a sidecar
and from the incandescence of the spotlight
i reach out to them and join them
if they’ll join me