Life at the intersection of health and mental health: Business as usual

Let me start by saying I am not particularly proud of my actions here. But the story I am going to share with you made me think a great deal about the issue of staff burnout, staff coping strategies for dealing with people who are very ill and the problem with focusing on task and not people.  At the end of the day I became much more sensitive to how hard it is for staff to cope with interactions with people who are very ill, and much more compassionate around the issues of staff burnout when faced with daily emotionally painful situations.

As I write this I am completing my first week after my first chemo treatment. Let me just say it has not been a good week. I am trying to work each day to support my resilience but the side effects of the chemo make it challenging to walk to my front gate, let alone do anything else. I am very lucky to have a supportive family and co workers who surround me with love and care. Not all consumers of mental health services we serve are so lucky.

I have been thinking a bit about one of the three hospital/cancer center visits I had to make this week as a routine follow up to my chemo. This Cancer Center visit started as I heard my name being called and I went through the opened door into the work area. I stopped to try and figure out where I was supposed to go. There was no one standing there waiting for me within 10 feet of me. No one looking at me. No one calling my name. I waited for more than a minute and then said out loud to the four or five staff across the room, "am I supposed to go somewhere?" A woman over in a corner said "over here" and pointed at the scale. She did not greet me by name, she did not introduce herself, she did not make eye contact.

If you know me at all, you know this is not going to end well. 

I asked her in as sympathetic a voice as I could muster if she was having a bad day. She replied sharply, "no." That’s it, "no." After my weight was recorded, she pointed at a room. I went in and, wondering what to do next, I eventually sat down at a chair, not on the table. Without any explanation she inserted the thermometer. At this point I said something like, "Well, you are not winning my vote for most compassionate and helpful staff member this month."

I was mad. I am not a thing, I am a person. And, by the way, I had spent the last 24 hours throwing up, dealing with insomnia, severe joint pain, diarrhea, and exhaustion like being hit with a mac truck. I spent the hour trip to the facility holding a throw-up bucket between my knees. Walking from the car to the treatment room was about all I could accomplish that day.

Her response to my statement was "I am sorry you think so" delivered in a brusk "I really do not give a d**n" voice. While she took my blood pressure I asked her why I was there that day as I had no clue. I was just doing - barely - what I was told to do with no energy for much more. She replied with scorn and incredulity that I was there to see the doctor. I asked why and she said, "I have no idea." And she clearly could not care less. Well I had had enough. I was sick and sore, tired and scared and I just was not going to be treated like a thing by some twenty-something person who thought I was of no value. So I told her she was really bad at this and she left the room in a fury.  I was left to sit in the room for 15- 20 minutes while someone figured out what to do next.

Nope I am not proud of what I did. I may have been sick and scared but that is no reason I could not treat that staff member with courtesy.

Eventually the Nurse Practitioner – not the doctor I was there to see – came in. Turns out I was there to talk through my symptoms, get a blood test to check my levels and make sure nothing out of the ordinary was happening in my body as it dealt the with poisons running through my systems.

I explained to the NP that the assistant/tech/whoever had been really rude and unfeeling and I was scared and sick. She corrected me firmly saying other patients like this person and implying I was wrong and out of line. I said, ok everyone has a bad day and I walked through in detail why I was upset ending with “I want to be treated like a person not a thing, I am sick and scared and exhausted. I need to be treated like a person not a thing.”

As I think about this interchange I think a lot about how really I am a bunch of procedures for people sometimes. I am no different that the fifty or a hundred people they see that day. I am just one more. But when anyone becomes a routine procedure with no humanity in the interchange, I think the whole healthcare system fails.

If I had accepted that interchange and not fought against it, I would have left understanding that what I think, what is going on with me does not matter. And then I would not work to communicate my symptoms and other issues these people need to know to treat my illness. If they are not treating me as a real person - they are at least supposed to be treating my illness. And they cannot do it if I am shut down because I got the message that I do not matter.

This is an issue that is rampant in many of our behavioral healthcare systems as well. I think consumers of behavioral healthcare are even more at risk of being treated as a dehumanized thing - a set of procedures, checklists and deliverables - than in general healthcare because we are often already seen as broken and somehow sub human.

As I continued to think about this series of interchanges, I wondered about this young woman – let’s call her "Rose." Rose works in an environment where every patient she sees is facing death. My chances with chemo have gone from one in three to one in nine. Better odds, but really, not the best if we are being honest. I would think if you were Rose you could go two ways here - you could be transformed as a person and embrace the gift you are giving people or you could shut down and push people away because it is just too hard. And I bet it is a choice someone like Rose has to make every day. With my luck I caught her on a day where she shut down. With her luck she got a kick ass advocate who was sick, scared and exhausted.

So how do we go from a system where we treat patient interaction as 'business as usual" to one where we can be present intellectually, emotionally and spiritually in the interchange? We talk a lot about patient-centered care. But the skills needed to be present are not remarked on. The simple kindness of communication and respect is most often ignored. I am glad I can view my white blood cell count online (one of the things this cancer center talks about in touting that it is "patient centered") but really I would rather be addressed by name, be greeted at the door and have someone like "Rose" tell me her name and explain what she is doing.

So how did it all end that day? At the end of the session with the nurse practitioner I said again that Rose had really upset me by treating me as a thing not a person. The NP said that next time I see Rose she was sure everything would be better and that what I had experienced would not happen again. When the nurse attached to my doctor came in to draw blood, I repeated my concern to this, a new person in the mix who is actually supposed to care about my overall treatment. She ignored my statement, talked cheerily over me talking, drew the blood and left. Business as usual. Sigh.