It can show gentleness and compassion or carelessness and
incompetence.
By Caitlin Kelly
Oct. 8, 2018
Oct. 8, 2018
It started, as it does for thousands of women every year,
with a routine mammogram, and its routine process of having my breasts — like a
lump of dough — manipulated by another woman’s hands and placed, albeit gently,
into tight compression. It’s never comfortable, but you get used to it because
you have to.
Unlike previous years, though, my next step was a biopsy,
for which I lay face down, my left breast dangling through a hole in the table.
Several hands reached for what’s normally a private and hidden body part and
moved it with practiced ease, compressing it again into position for the
radiologist’s needles, first a local anesthetic and then the probes needed to
withdraw tissue for sampling.
I was fearful of the procedure and of its result and, to my
embarrassment, wept quietly during the hour. A nurse gently patted my right
shoulder and the male radiologist, seated to my left and working below me,
stroked my left wrist to comfort me. I was deeply grateful for their
compassion, even as they performed what were for them routine procedures.
The following weeks gave me a diagnosis with a 98 percent
survival rate: ductal carcinoma in situ, a condition that is not even considered
a cancer by some. The diagnosis began a disorienting parade of more unfamiliar
people touching my body, from routine blood drawing to a transvaginal probe (to
determine my baseline uterine condition because estrogen inhibiting drugs can
cause uterine cancer), to injecting a tiny electromagnetic wave device into my
breast to guide the surgeon to the tumor’s exact location.
At midlife — apart from four orthopedic surgeries, three of
them minor — I’ve been healthy, so my body had never before been so intimately
and medically handled. Having someone puncture your breast isn’t quite like
getting a cortisone knee injection.
Some of the procedures, some done with a local anesthetic,
were uncomfortable, some downright painful. The thoughtfulness with which I was
touched — all at suburban New York hospitals — made a real difference in my
ability to stay calm and lie still as needed. My anxiety, even as a middle-aged
adult, wasn’t just an annoyance to be ignored or dismissed.
And, as someone from a family that shows little physical
affection, it was also surprising, pleasantly so, to be hugged by my surgeon
when she delivered good post-op news and by a phlebotomist whose technique
drawing my blood without the usual tourniquet was so deft I felt nothing.
Touch during medical procedures can be soothing or
traumatizing. It can be gently and compassionately administered; alternatively,
it can be roughly, carelessly or even, at worst, incompetently handled.
“Many patients feel that being touched is important to
getting better,” said the historian Paul Stepansky, author of “In
the Hands of Doctors: Touch and Trust in Medical Care.” His father was a
small-town general practitioner in Pennsylvania, and Mr. Stepansky saw
firsthand the effect of those personal relationships. “Medicine then was all
about touching, and patients welcomed their touch,” he said. “It was integral
to doctoring, and partly because physicians were part of the community,
medicine was about the laying on of hands.”
Now, in an era of electronic medical records, when
physicians can spend most of an appointment staring into a computer screen,
physical connection between doctor and patient may prove even more important. “Touch
promotes trust,” says Mr. Stepansky, “not just talking or ordering studies.”
Others have passionately argued the case, like Dr. Abraham
Verghese’s push for more human touch in medicine. Dr. Verghese is a
professor at the School of Medicine at Stanford University. His 2011 TED Talk
in Edinburgh urged the audience to rethink clinical medical practice: “When we
shorten the physical exam, we’re losing a ritual that I believe is transformative,
transcendent and at the heart of the physician patient relationship.”
A physician’s role, he said in his talk, is “to touch,
comfort, diagnose and bring about treatment.”
Patients with a chronic illness may spend decades,
literally, in dozens of medical hands. Natasha Walsh, a political consultant in
Alexandria, Va., who has Crohn’s disease, said she has experienced care both
comforting and cold.
“I know there are patients who bristle at being ‘manhandled’
or poked and prodded, and after being sick for 20 years, that doesn’t bother me
at all,” she said. “I have doctors who I’ve had a long relationship with who I
feel comfortable enough to hug or be otherwise chummy with, so in those cases I
absolutely feel comforted by their touch, just as I would a friend’s.”
Once, in the intensive care unit at Washington Hospital
Center, “after a bowel resection gone horribly wrong, I’d gone completely
septic and I had been in a medical coma for about a week and woke up and had no
muscle tone at all,” Ms. Walsh recalled. “I could barely roll over. So one of
the male nurses would wheel my gurney to the CT scan or M.R.I. rooms and had to
physically pick me up and roll me into position, and I remember thinking how
overwhelmed with gratitude I was for his strength and how gently he handled
me.”
Yet she gave up on another local physician, a GI specialist,
“because he never once physically examined me. He was almost too clinical.”
Part of patients’ challenge is not knowing how every
physician, nurse and medical technician will treat them, even as we’re in pain
and already anxious, feeling vulnerable. And survivors of sexual abuse or
assault can cringe at the lightest of touch.
“It should be a two-way conversation about what you’re
comfortable with,” said Susan Finlayson, a registered nurse and senior vice
president of operations for Mercy Medical Center, a 178-bed
university-affiliated Catholic hospital, founded by the Sisters of Mercy, in
Baltimore.
Ms. Finlayson knows their local population well, one that is
poor and underserved, and trains staff members to treat them with dignity.
“When nurses come in here to work, we talk a lot about our values — treating
the mind, body and soul,” she said. “Patients arrive because something very
tough is happening in their life, so from day one we make sure that every new
group we orient here understands that and offers them patient-centered care.”
While patients need and deserve gentle, thoughtful
treatment, “health care is evolving, and gotten more businesslike,” she said.
“We’re pressured to do more and more and to give better value at lower cost.
It’s easy to get caught in that to-do list. It’s easy for staff to get burned
out.”
As patients also navigate the additional obstacles of who
accepts their medical insurance, they can end up being treated less than
ideally. Can they expect consistently kind and compassionate care wherever they
end up? “In theory, yes,” said Ms. Finlayson. “In practice, no. There’s so much
variation in hospital culture, administration and leadership.”
Every patient needs a strong advocate to make sure to be
touched and handled with kindness and competence, said Mickey Osterreicher, a
Buffalo lawyer whose medical journey began in 2011 with a diagnosis of prostate
cancer but later included the removal of a malignant melanoma and its
metastasis to his brain. A life-threatening drug reaction required even more
interventions.
Along the way, he lost 40 pounds of muscle, making it more
difficult for nurses to draw his blood — “the one thing I’d always taken for
granted as being easy,” he said. “But some people are really good at it and I
didn’t feel a thing, and other times it really hurt and left me bruised.”
He wasn’t afraid to challenge his physicians, noting that
some people are intimidated to do so if they feel their treatment is too rough.
“Certainly as a patient you have every right to speak up. Certainly, some
doctors weren’t happy when I did and bridled at criticism.”
While still facing quarterly M.R.I. and PET scans, he is
healthy today. His best advice for getting the kindest care possible?
“Have a family member who can be diplomatic.”
Caitlin Kelly
(@CaitlinKellyNYC), is a freelance writer in Tarrytown, N.Y., and a frequent
contributor to The Times.
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