It began with unbearable pain — an alarming development for a woman seven months pregnant.
And before too long, Dr. Rana Awdish was losing her grip on life.
While Awdish did not die, she did endure a long, tough recovery from the medical crisis that cost her the life of her unborn child.
And, as a physician who cared for patients in the intensive care unit, she learned profound lessons about how doctors and nurses practice medicine.
Awdish is with the Department of Pulmonary and Critical Care Medicine at Henry Ford Health System. She joined Stateside to discuss her memoir, In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope.
Listen above for the full conversation, or read highlights below.
On her revelations
“What surprised me the most was really how poorly trained we are to give bad news well. I knew the people caring for me. They are tremendously skilled and I really respect the work that they do and that we all do, but what I realized was hard was telling me things about my kidneys failing, or when the baby had died. Those things were actually hard for my providers to do well. And I recognized I similarly had trouble giving bad news well and really focusing on the emotional needs of my patients. They did an unbelievable job with the clinical care, and I believe I survived something that was truly unsurvivable, but I was left with this feeling of, ‘Gosh, we don’t always say things in a way that promotes healing.’ We can actually be adversaries to our patients in many ways.”
“When I sat with all of the events that happened and really looked at them in retrospect, I realized how much suffering was happening for providers — myself included. When I lost patients that I wanted more than anything to help, there was no place to go with that. I didn’t feel I could talk about it in a way that would promote my own healing; it’s just not our culture. We move onto the next patient, whether it’s in the next ICU bed or in the next clinical encounter. It’s just what we do.”
On a disconnect between patients and providers
“Medical training really is so focused on the disease itself — it’s something we’re enamored by. We chase it. And you’ll still hear a physician say, ‘This is a really good case,’ when it’s something catastrophic for the person who is suffering with it. And our orientation is really to the disease itself. We are looking for it in patients without always an understanding of how it impacts them, how their course of their life is changed by these diagnoses.”
On limited coping mechanisms
“[Dark humor] was the only coping mechanism that I think was modeled to me in all of my training, and to me it’s sad that that was all that we had. We had that ability to joke about something, and this sort of graveyard humor that sometimes happens in healthcare. But I really think it’s a sign of a deeper level of distress that people don’t necessarily know what to do with and that’s what’s socially sanctioned within medicine is that joking. And I’d like to see where we can get past that and talk really honestly about our feelings in a more constructive way.”
On what can change
“I think that whole paradigm that we’ve set up where it is a war on cancer, it is a battle to be fought — even that language can be harmful not just for the patients, who then feel that if they’re not ‘fighting,’ that they’re giving up, but also for the physician because if they’re in a war against something, that’s the only paradigm then is to win or lose. And I think we have to reframe the language. We have to begin to think about it in terms of truly partnering and walking alongside our patients in the same direction through the illness rather than fighting against something.”
“We believe that true healing happens in the context of a relationship and that we must cultivate that connection with our patients, that we have to listen generously. We have to know what matters to our patients. We have to empathize when emotion enters the conversation, which I think traditionally physicians aren’t as well trained to do — we stay in the cognitive channel much more than we do the emotional channel. We try to align with patient goals, which of course means knowing what matters to our patients, know what their values are. And then respect those values, so never put forth a treatment plan that isn’t in alignment with that the patient would want for their life. There’s so much that medicine can offer these days, but if it isn’t in the context of what our patients want, it’s relatively meaningless; we’re doing it for ourselves then.”
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* Stateside originally aired this story on Nov. 29, 2017.