Q & A: Staying Compassionate with Patients Suffering from Medical Issues Related to Alcoholism

QUESTION:

I am wondering what your thoughts are on the following scenario: A patient comes to us with medical issues, but is also suffering from alcoholism. He has been hospitalized many times in the past for medical issues, most related to his chronic alcoholism. The patient has gone through detoxification many times at our facility, and when he is discharged he begins drinking again. The patient becomes combative during detoxification and is very verbally abusive toward the team caring for him. How do we ensure that we are not becoming angry and judgmental of this man and instead remain compassionate and caring for this human being who has entrusted us to care for him?

ANSWER:

Michael-Trout-150x150This is a tough one. You may be vomited upon, swung at, cursed at by a (momentarily, at least) raving lunatic. You don’t deserve this sort of treatment. The patient is being his own worst enemy. He is not participating in or cooperating with his own treatment. It’s maddening. How easy is it to have compassion for people whose own chronic behavior is the cause of their suffering and the suffering of countless others? In these instances, for many of us, judgment comes far more easily.

It may or may not help to know this, but each time you try to engage with this patient you join a very large group of friends, partners, and family members who have nearly caused themselves head injury from ramming into this same wall, over and over.

You have already taken an enormously important first step, in naming the problem. You didn’t name it “disrespect” or “rudeness,” even though those labels seem to apply. You named the problem alcoholism, and as soon as you used that word, answers began to emerge. Whether we like it or not (and certainly alcoholics don’t like it, and routinely deny it), alcoholics tend to have a few characteristics in common:

  • They drink. (Hmmm….)
  • They say they don’t drink. (or at least not excessively)
  • When they have been drinking, they treat most people around them (including those they love) with utter disregard for human courtesy, much less love or respect.
  • They neglect their health, eat badly, forget to eat or to take certain meds, yell, neglect many of their responsibilities, and act badly even toward people they really love.
  • They manage to avoid seeing the writing on the wall.
  • They drink. (Did we already say that?)

We mentioned “they drink” twice because it turns out that an obvious-but-elusive truth is contained therein. Quite naturally (but irrationally, as it turns out), we sometimes expect people to not be who they are. In an Al-Anon meeting, it is commonplace for new members to go on about the drinking and drinking-related behaviors of their partners. Usually everyone is quiet for a while, until finally one of the more seasoned members states the obvious: “Yup, drunks drink.”

For some, this is truly a revelation: not that their partners do indeed drink, but that the person living with this behavior is everlastingly surprised and reactive to the fact. Sometimes this is a moment of genuine healing, when a person decides to stop being surprised. This is not a moment of condoning the drinking (or the ensuing vomiting, missing work, or yelling), but a moment of deciding to stop being surprised and stop reacting.

We in health care are not spared this challenge. Alcoholism tends to come with certain features in addition to the drinking itself (see list above). Those features are as inevitable (and resistant to rational discourse, or health care education, impatience, irritation, or demand) as the drinking itself. These folks are going to be resistant, depressed, and withdrawn, and they’re going to be Olympic gold medal champs at denial. And, as if we needed this to be more confusing and confounding, they will also occasionally be incredibly charming, compliant, and articulate. At these moments, we are at great risk of imagining that the other characteristics we saw just a few hours ago are not inherent and therefore may not return. We think: This person can be all of the things we want him to be! At that moment, we just fell into the trap that the patient’s partner, family member, or friend has likely fallen into a hundred times.

So what’s the answer for the clinician caring for this person? Acceptance of our inability to make the patient behave better is a terrific first step. This can happen when we stop to wonder: Why is my patient acting this way? And then it dawns on us: She’s acting this way because that’s the nature of the illness she has. Hemophiliacs bleed. Alcoholics drink (and deny and argue and neglect their responsibilities and resist our care). At that moment of acceptance, we stop feeling obligated to take on the impossible work of changing the person’s behavior, and our frustration can ease.

From there, it gets easier. We’re less triggered, and we can focus on the few things we can do: to be attuned and compassionate, to hold, and to show genuine interest. We can accept this person for exactly who he is—a person suffering from alcoholism—rather than who we want or need him to be.

This doesn’t mean we start liking the behaviors being exhibited, and we may still find ourselves susceptible to irritation, dismay, and even disgust. But there’s an opening now, through which compassion might find its way into your heart and to your patient’s experience of you. While this won’t cure him, it might make you both able to cope just a little better and open the possibility of genuine human connection.

 ~ Michael Trout

If you have a question about how to stay therapeutic in difficult circumstances, click here or go to the navigation bar and send it our way!

A Therapeutic Sighting: Let Us Love One Another

This past Sunday, was heartbreaking for our world. On Friday, innocent children in Connecticut were murdered and our hearts shattered for them, for their families, and for all the innocents in the world whose lives are taken every day. We wonder and we struggle with why, and what we are to do in the face of such senseless hate and rage.

Today we came across this simple story in our local newspaper entitled, Let us Love One Another. This writer describes her interaction with a stranger, an elderly man with “watery, gray eyes, tired from travel, or perhaps from life.” She was unable to look away … he was alone, and she saw him.

So, what are we to do? May we see and connect and hold each other. We think it matters.

Click here for this beautiful story of healing through connection.

Q & A: Feeling Dismissed

QUESTION:

I find it very stressful to care for patients who do not trust my opinion. How can I stay present with people when I feel they’re outright dismissing me?

ANSWER: 

Michael-Trout-150x150As always, we begin with wonder. Why am I not getting through? Why is this patient so dismissive of my opinion? When we wonder without indignation, we often stumble across the obvious. Perhaps this person has been seriously led astray by someone wearing a uniform much like mine. Perhaps this person doesn’t want to know what I’m saying because it would lead to unpleasant conclusions—that the patient could have prevented this illness, for example. Perhaps this person feels so powerless because of his illness that he just cannot relinquish the little power he has left in order to listen and attend to what I have to say.

We don’t have to know the answers, but if we do the wondering part, even without an answer, we allow ourselves to shift gears, stop competing with the patient, and focus on being accepting and available. We intentionally release our own inner struggle (dismissing feels like rejection, and for most of us rejection triggers us) and, therefore become more able to be attuned and present to the patient.

If we are then able to follow, there is a chance we will learn what the person’s roadblock to learning and accepting our guidance is really all about. So we notice that we’re not getting through—that we’re being dismissed—and instead of plowing on, we slow down or we stop. We pay attention to the signals the patient is giving us and, with a genuinely curious attitude, we try to follow those signals. We change our position (we sit instead of stand, we talk more slowly, we make better eye contact, we make sure we’re looking at the right person in the room as we speak) and we try to follow the signals. Maybe we make a guess—”I’m wondering if you’ve heard all of this before?” Maybe we try reversing roles—”Tell me about your perspective on this illness and on what will make you better.”

If we can be present and attuned and we can wonder and follow, there is a possibility that the patient will feel held, rather than lectured to or left to experience her own impotence in the face of all of our wisdom. If we get lucky and this happens, we may notice a slight increase in the patient’s openness to what we have to say.

 ~ Michael Trout

If you have a question about how to stay therapeutic in difficult circumstances, click here or go to the navigation bar and send it our way!

A Therapeutic Sighting: Police Chief Calls for Humane Treatment

 

 

 

 

Janee Harteau was sworn in as Minneapolis police chief on December 3, 2012. On that day, this is what she said:

“As your chief, I will be asking every officer to use one same guiding principle during each encounter, no matter how big or small. It’s a very simple question: ‘Did my actions reflect how I would want one of my family members to be treated?’ The answer should be yes.”

We think this is a beautiful example of a strong leader working to create a culture in which every person—even those who are expressing overt anger—is seen as a person deserving of humane, respectful treatment.

Commentary/Research: The Difference Between Hospitality and Health Care

This is Mary’s recent response on the Patient Experience Champions:

I greatly appreciate Dr. Gallan’s blog post on the clear distinction between the goals people have when engaging in the hotel and resort industries vs. being a patient in a health care setting. He makes the important point that “while hospitality employees are highly trained and skilled, they do not approach the training and demands that are placed on health care providers such as nurses and physicians. Health care providers are entrusted with our very lives, and are treating patients’ physical conditions and sense of dignity.” This important distinction means that health care leaders must understand that to achieve extraordinary, compassionate, and knowledgeable patient care, they must invest in creating the cultures, the support, and the development required for clinicians to knowledgeably render moment-of-truth, authentic, therapeutic interactions with persons who are vulnerable (potentially suffering) and focused on “survival, wellness, and treatment.” My co-author, Michael Trout and I have described a therapeutic methodology to support clinicians in our book, See me as a Person. We believe we must advocate for the respect and dignity of the patients we serve as well as advocate for the respect and dignity that clinical professionals deserve in providing complex, compassionate care to those experiencing illness, trauma, loss. Their work goes beyond customer service. Thank you, Dr. Gallan, for putting voice to this important phenomenon.

For Dr. Gallan’s entire post, click here.