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Patient Care

The Patient-Provider Experience: The Wrong Side of Healthcare

May 6, 2009 started like any other day. My son woke up first; he had just turned 2 in December and wasn’t really a morning person, so I hopped out of bed so my wife, Robin, could get a little more sleep. She was nearly 26 weeks pregnant and pretty tired. The night before she had felt ill with stomach cramps and nausea and planned to go to the doctor for a checkup. We didn’t think we had anything to worry about, as her first pregnancy had been fine; thus far so had this one. After breakfast I kissed them both and headed off to work.

My day was going to be a sad one—helping to close an EMS agency. A few thoughtful paramedics saw one of our rural counties without advanced life support services and started a rapid response program to serve the needs of the community. It was a great idea, but unfortunately the business plan failed. I needed to help audit the controlled substances so they could be returned to the pharmacy as the agency closed down. 

Rural Rensselaer County does not have very good cell coverage today—less so in 2009. As I drove from the Tsatsawassa firehouse back to Albany, my cell phone started going off with texts, missed calls, and voice mails. All the calls were from Robin. She was being sent to the hospital (not my hospital) for additional testing and ultrasound by the high-risk obstetrician. She sounded scared. She sounded alone. 

Thus began my journey from clinician to helpless observer. On our course through obstetrical bed rest to becoming parents in the neonatal ICU, I was but an overtrained bystander. I learned a lot in the next week before my second son was born at just short of 27 weeks' gestation. When we brought him home at 37 weeks gestational age, he technically still shouldn’t have been born. I learned even more in the 70 days before we were able to take that tiny baby home. 

Family

Nothing is more important. I called my boss to let her know what was happening, and her response was simple and succinct: “Take care of your family and don’t worry about anything else. We’ve got it covered.” That meant so much. Yes, the FMLA said that as my employer she had to give me time away, but when my boss greeted my call with understanding and took away any concerns about work I had, it made all the difference. My partners made significant sacrifices to cover my shifts while I focused on my soon-to-be two sons and my wife. I am forever grateful for that support. 

Empathy

Empathy comes from a German word, einfühlung, meaning “feeling in,” and is defined as the ability to sense other people's emotions, coupled with the ability to imagine what someone else might be thinking or feeling. From my fellow physicians to the nurses and staff in the ED, the fire, EMS, and law enforcement agencies I work with, and even to the staff at a competitor hospital, everyone was supportive with a compassionate empathy. They recognized the emotional roller coaster we were on and supported us through the experience. 

Compassion

Compassion is the feeling that arises when confronted with the suffering of another, followed by motivation to relieve that suffering. It is similar to empathy and equally important. From the moment my wife was admitted to the obstetric service through her stay in the NICU, my wife, son and I were treated with compassion by all members of the hospital staff, whether they knew our story or not. There is an ad on television now about the “caring gene,” and it likely resonates with many who are in emergency medicine and EMS. People in healthcare want to make others feel better—it is just what we do; it is how we are wired. As someone who has been on the other side, I can share with you that it really makes a difference. 

Education

One of the scary things that can happen in a neonate is fever. At just a few days of age, James had a fever. The fear was that he had bacteremia: bacteria in his bloodstream. Because the brain is not yet protected by the blood-brain barrier, meningitis is a real complication, so he needed a lumbar puncture (LP), a spinal tap. As an emergency physician I perform LPs and have discussions with families about why. I think I became a better doctor as I listened to the clinician explain to my nonmedical wife the process of the LP; I was impressed at her patience and the time she spent educating. Never underestimate the value of the few minutes you can spend educating a family member about the procedure you are performing.

Teamwork

Like many families with a child in the NICU, we had another child, Patrick. We were greeted each day, washed our hands, put on a gown, and went in to see the baby. Everyone was always glad to see Patrick and stepped in to welcome him. From the moment we walked into the NICU, we had the feeling everyone was working as a team to help us. From the clerical personnel to the unit cleaners, the physicians, nurse practitioners, and nurses, everyone worked together to make us feel welcome and comfortable. It was easy to see everyone had a role. These pieces fit together to take care of both the baby and the family.

Communication

One morning I got a call from hospital staff saying, “Your boy has a cut on his arm, but don’t worry, we’ve called plastic surgery.” Hmm. I pondered the call. My 1-kg baby has a cut on his arm...that’s unusual. Odd, in fact. In the entire 70 days, this was my only disappointment, and one that could have been solved with an explanation, apology, and clear communication. Frankly, I was more interested in making sure the same thing didn’t happen to a baby’s face. I was not concerned about the actual injury. We never did get a straight answer about what happened. And in spite of the plastic surgery consultation, my son still has a cool scar on his upper arm. 

Happy Ending

After 70 days we went home with a very small, yet normal baby. While we did have another four days in the hospital with some respiratory issues around Christmas, other than normal kid stuff, we have not been back. The Dailey family is lucky—our story ends well. Many do not. 

While this video from the Cleveland Clinic is perhaps overly dramatic, it reminds us all that we should always remember that we don’t know what others are facing each day. The images of the baby in the NICU sure bring back memories.

Remember, in EMS and sometimes in the ED, we are the first chapter of many in an experience with healthcare. At the New York City EMS academy at Fort Totten many years ago, an instructor told me to treat every patient as though they were family. Live by this. Treat your patients and colleagues with compassion and empathy, communicate with them, and support them as you would family. These may be their worst days, and you can make them better. Remember, no two experiences are the same. Never pretend they are. 

Thank you to the staff at the St. Peter’s Hospital NICU, my physician, nursing, administrative, and clerical partners in the Department of Emergency Medicine at Albany Medical Center, my chair, Dr. Mara McErlean, Dr. Sam Bosco, and the countless other people who supported us along the way. You helped the Dailey family through this difficult experience, and we are so grateful for your support. 

Michael W. Dailey, MD, is a professor at the Department of Emergency Medicine, Albany Medical College, N.Y. He is an EMS World editorial advisory board member and serves as EMS World's medical director for all continuing education activities.

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