Quiet Conversation During A Storm

“We all saw it, but everyone silently walked away, and no one has talked about it since,” said a resident, referring to a particularly graphic code. I wish this recollection felt unfamiliar to me, but instead, it resonated with my own experience as a physician at several different hospitals. In medicine, we often keep our most important stories to ourselves.

I vividly recall the moment I first felt overtly disconnected from the emotions I was supposed to feel, after the eighth code on the same patient in the same night. Following a failed liver transplant and multiply relapsed leukemia, he was admitted with severe thrombocytopenia. With each resuscitation, his ribs cracked and his heart restarted, but he also began to bleed from his mouth, then his tear ducts, and finally, his ears. When he died early that morning, I had a story to share and to process, but I didn’t. I went home and slept.

When I enrolled in business school, our first orientation activity was to share a story that defined us. In a few hours, I learned more about my fellow students than I ever knew about co-residents and attendings with whom I’d worked hundreds of hours. For the first time, I shared the fragile side of my work openly. And I realized that confronting adversity not only changes our patients, it changes us, too. Sharing my story sparked a series of self-reflections that restored my own voice; I could now make better sense of what had happened to me. This process ultimately led me to pursue a career in palliative care, supporting others as they sculpt meaning from adversity.

In the midst of the COVID-19 pandemic, the number of important, yet untold stories has only multiplied. Our work has become tougher. Many of the medical therapies I had previously marveled at feel woefully inadequate. And now, my only connection with patients is often behind the armor of personal protective equipment or by telephone with their loved ones. Similarly, it is harder than ever to connect with colleagues -- the banter in the team room is muffled behind masks and stifled by social distancing.

Telling stories makes us human, and telling important stories helps us heal. “But, there’s no time. I don’t know how to find a safe space. I’ve never done this before.” Even amidst a busy clinical environment, I want to share some practical tips to get started:

• Change the setting. Find ten minutes to go to the cafeteria or outdoors as a team. Storytelling happens more organically when we are outside of our work spaces. People are more likely to speak up about something more sensitive outside of the team room and when they won’t be interrupted.
• Choose big talk. Instead of asking colleagues about their educational history when you first meet, give them a chance to tell you an important story about themselves. Try starting with, “What idea or experience has inspired you lately?” or “When were you last proud of someone else?”
• Create a safe space with your words. Others are more likely to share openly if you model the behavior you hope to encourage. After a tough clinical encounter for the team, starting by sharing – honestly – how you are feeling. “I’ve been thinking a lot about what I’ve learned about myself by taking care of such sick patients.” Others are more likely to engage in reflection if you do.
• Expect intermittent progress. Ten minutes of meaningful conversation at a time is likely to lead to follow-up conversations that lead to storytelling and deeper connections. Insights develop at different paces and in different circumstances. Enjoy the journey of getting to know yourself and your colleagues better.