Joan Wickersham

Putting the human touch in health care

By Joan Wickersham
June 11, 2010

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THERE IS a lot of disturbing news these days about hospitals, usually about a scandal or a screw-up or a budget crisis. This isn’t one of those stories. This is about what it takes to make a patient feel well cared for, even when every detail doesn’t go perfectly.

My friend P needed a new hip. She put it off for awhile — it was hard to find the time, and she was scared. But she limped and was starting to lose her balance. So she scheduled a date for surgery.

At the pre-op visit, the nurse, anesthesiologist, and surgeon all explained clearly, thoroughly, and kindly what would happen during surgery. Then she got a call from the case manager, who asked how her house was set up. Was there a bathroom on the first floor? Did she have a chair that would let her sit with her hip at the proper angle? The compassionate efficiency of the process made P feel safe. “I didn’t have to figure out what I would need, or even what questions to ask. They had it figured out.’’Before the surgery, while she lay on a bed outside the operating room, everyone came out to speak to her reassuringly: the nurse, anesthesiology resident, and finally the surgeon. The surgeon’s manner was confident, energetic, respectful. He explained the procedure again, and wrote on her right hip with a magic marker. She let him know she was nervous — would both her legs end up being the same length? “We’ll be very careful,’’ he said. “We’ll measure twice and cut once.’’

She smiled. She knew he probably said that to all the hip replacement patients.

The surgery was performed under spinal anesthesia, so P was awake. The anesthesiologist sat next to her and stroked her head. P said she was afraid of hearing the saw. “Would you like some ear plugs?’’ the anesthesiologist asked. P said yes. She was comforted by the thoughtfulness of the offer. The ear plugs never showed up, but it didn’t matter; the noise of the saw didn’t bother her.

The surgery took place in a teaching hospital. P could hear the surgeon explaining to the residents what he was doing. She was struck by the respectfulness of his tone.

When he was finished, the surgeon asked P, “How do you pronounce your husband’s name?’’ Startled, she told him, and watched him pull out a cellphone. The surgeon spoke briefly to P’s husband, and then handed her the phone. Still lying in the operating room, she was able to tell him she was fine.

The next day P got an excruciating headache that would last for four days, a rare aftereffect of spinal anesthesia. She also had an allergic reaction to morphine that caused a painful rash. An aide caring for P in the middle of the night had the idea of putting ice on her neck, which helped the headache some. The nurses smoothed talc on the rash. The surgeon came every day, checked her progress, asked gentle smart questions, and answered P’s questions thoughtfully. His manner was confident but not arrogant. She noticed the same demeanor in the residents — professional but humble — and recognized that in addition to teaching surgical skills, her doctor was passing along his own way of interacting with patients.

The human piece of health care is something that can’t be quantified or politicized, so it doesn’t get talked about or written about much. Yet to the patient, it’s often the thing that makes the biggest difference. We need access to procedures and technologies, yes, but we also deserve to feel seen, listened to, and cared for — not perfectly, but with empathy and imagination.

The gist of this story is that P had successful hip replacement surgery. Not everything was perfect — the ear plugs, the headache, the rash. But what P remembers is being treated with respect, intelligence, and kindness. She remembers the feeling of trust created by the staff’s level of engagement and compassion. And she remembers the gentle hands of the aide who thought to bring her ice in the middle of the night.

Joan Wickersham is author of “The Suicide Index.’’ Her column appears regularly in the Globe.

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