A short time ago I was telephoned unexpectedly by the daughter of a friend, who felt I should know that her father had suffered a stroke and was in a critical condition in hospital.
Visiting a friend after a stroke offers a short sharp lesson in the power of relationship in recovery, and the poignancy of small gestures. The four-man London ward my friend was in represented the spectrum of British society: A venerable Lord lay next to a plasterer, their ranks levelled by drips and valves. Opposite them were a man from the arts and a contractor; all equally vulnerable to the ministrations of the nurses. These men all had visitors. In ways quiet or ribald, wives, friends and children bent over their beloved, offering succour, hoping to help, looking more or less helpless.
Around them doctors consulted and nurses wafted in and out, each with their own background, their own character, their own ideas about care and compassion. Between the staff and the family the conversations were smooth or stilted, anxious or open, kind or abrupt. In the patchwork of those interactions lay the potential for healing for the men they attended.
When, as in stroke, the prognosis is so broad and so dependent on human variables, the communication between patient, family, doctors, nurses and the hospital itself becomes a net of trust. A strong net will promote cooperation, share responsibilities and information, and affirm the importance of the person on the bed. This will buoy the patient, inspiring and encouraging their internal will to recover. If the net is weak or broken, hesitation, distrust and disaffection will infect the air the patient breathes, hampering their ability to rest, thrive, or even survive.
In a healthcare system that is overstretched beyond sustainability, how do those relationships get managed? If doctors are overtired and nurses are ill-equipped, what bandwidth do they have for a patient who can’t communicate or a spouse who is terrified? The system at this point is radiating stress. I saw innumerable acts of kindness and generosity alternate with suspicious attitudes, clipped rebuttals, and outright belligerence.
In a case in which the next of kin was a young girl, terrified for her father’s life, overawed by the responsibility of attending to paperwork and confused by the jargon, she had enough work managing her own feelings, never mind the flow of information.
Attending to the ill is a beehive of small tasks. Matters of medication, nourishment, personal hygiene and comfort are taken care of by many hands and many minds, operating within areas of expertise vastly differentiated by levels of education and training, with little overlap. In an efficient hospital situation there is enough communication between skill sets that the whole human machine runs smoothly, the patient feels cared for, and the family can focus on loving support. In a place where resources are stretched and doctors and nurses are overworked, things start to fray at the edges.
Over the weekend, the budget only allowed for one physiotherapist on duty. The first priority of this individual was to attend to the most urgent cases: positioning people who were partly paralysed to ensure they could breathe. When there was extra time they might be able to work with recovering patients on mobility. In the case of my friend, a large man, two strong attendants were required to help him move. In a previous visit to another hospital, an overly confident young female nurse had insisted she would be able to support him. When she found she couldn’t, he fell to the floor. So on this weekend he lay in bed, unable to move and unmovable, frustrated and uncomfortable, and worse, not being offered treatment that would have helped him recover sooner and prevented the risks presented by immobility.
All of this was painful to watch. At the same time, getting pain relief administered on a timely basis required the skills of a negotiator, something beyond the patient and his daughter in that moment. One began to understand the outrage of Shirley Maclaine in Terms of Endearment, when she screams at the nurses to “Give my daughter the shot”.
What was happening in that scene was a breakdown in communication between people highly sensitised to the emotion of a situation – the patient’s family – and people, of necessity, inured to it – the medical team who have to maintain a professional detachment. The two sides, those who are emotionally overwhelmed and those who can’t afford to be, face one another over a divide without the time or resources to bridge it.
In this case, I was able to stand somewhere in between the daughter, whose emotion rendered her less likely to be heard, and the nurses, who became defensive if they were heatedly questioned. There were two different languages being spoken: that of distressed youth and that of uniformed authority. Reassuring one that she was being heard and that her father’s needs and therefore hers, would be met. Meeting the other on a level of calm, informed conversation led to understanding, a resolution and the relief of suffering.
Having the sense to listen and the language to mediate means that the emotional needs of parties are met so that work can go ahead on the agreement and the action. In this instance, it was the work of recovery, but the dynamics are universal.
The work of mediation at ASM is the resolution of conflict in a manner which leaves all parties feeling heard, attended and engaged. If you would like to find out if mediation or counselling might help you, please contact Elizabeth or her team members at ASM
By Elizabeth Richards – Counsellor, Psychotherapist, Civil/Commercial and Family Mediator and Fluent French speaker