Breaking Down the Compassion Wall

Apr 24, 2020

Hospitalist Ryan Murphy reflects on the care his dad received as one of Utah鈥檚 first hospitalized COVID-19 patients. The experience shaped how he communicates with patients鈥攚hether or not they have COVID鈥攊n spite of isolation, masks, and physical distancing.

Ryan Murphy | 4 minutes

A few days after my dad flew to Salt Lake City from California, he developed a small cough and fatigue, and then started getting fevers. At that time in late February and early March, we were only testing people who had come from high-risk countries (like China or Japan). After a confusing trip to Urgent Care and an overnight stay at the 人妻中出视频 of Utah Emergency Department, he subsequently tested positive for COVID-19, and was admitted to the hospital on a Friday. Everything happened quickly after that. By Saturday, he was in the ICU for increasing oxygen needs. By Sunday, he was on even more oxygen. By Monday, he was intubated.

Being a doctor and the son

My dad, Neal, recently retired from a long career in academics and private practice in dentistry. He is a native Midwesterner and proud husband and father. Growing up in the 1950鈥檚 and serving in the Air Force Reserves, he learned early on how to be tough and stoic.

One of the first things I did when my dad was admitted was deliver his cellphone and charger so my mom and I could talk to him. Like other health systems in the country, 人妻中出视频 of Utah restricted visitors in March. It was hard to be apart from him.

When you work in health care, you are very conscious of all the potential errors that can and often do occur. I鈥檝e been on the other side, where we say, 鈥淭he outside records aren鈥檛 there,鈥� or, 鈥淭he history we got was incomplete.鈥� I鈥檝e always told myself that if any of my family were seriously ill, I would be there. I would sit in their hospital room and never leave. I wanted to be there with him, even if he was sleeping.

I also didn鈥檛 want to hassle the nurse every hour, asking about his latest labs or vitals, so I called twice a day. I called the off-going nurse at 6:00 in the morning to hear about the night, and then called again at 6:00 in the evening before shift change. Many of my dad鈥檚 providers also called me in the afternoon after rounds.

We didn鈥檛 know if my dad would survive after he was intubated, so I made a point to FaceTime with him and my mom to talk about what he would want. I鈥檝e had hundreds of conversations over the years with patients about their 鈥済oals of care.鈥� 鈥淚f your heart were to stop and you were to die, would you want us to try and bring you back to life with CPR?鈥� or 鈥淲hat kind of restrictions in your daily life would you be comfortable with?鈥� But when it came to talking with my dad, I was like a medical student having the conversation for the first time. It was hard, awkward, and so painful to get through. We said our goodbyes, wrote down final messages for friends and family, and talked about what he would want at his funeral.

Fortunately, my dad recovered after being on a ventilator for five days. The first days were touch and go, but after that he stabilized and started to get better. He recovered, discharged, and is now staying with me. The experience has helped me break down what some have called the compassion wall鈥攖he barrier created by the extra precautions COVID-19 requires.

Another compassion wall experience

Ryan's colleague Emily Signor admitted his dad from the emergency department to the inpatient unit.

鈥淭here鈥檚 a compassion wall,鈥� says Gene Scerbo, who is also part of a hospitalist team. 鈥淵ou don鈥檛 feel like your level of compassion can get through it to your patient. You feel guilty you can鈥檛 provide a hand on their hand; ease the burden of their disease.鈥�

That experience has taught Signor something valuable. 鈥淚t鈥檚 important for me to know each patient as a human being, with thoughts and emotions. It鈥檚 something I want to continue to emphasize in my career.鈥�

Steps to break down compassion wall

1. Help patients stay connected

I empathize with patients who don鈥檛 have their family with them. I make sure that patients can communicate with their family and that they have a phone or an iPad and a charger. I recently had a patient who was recovering from COVID-19 after being very ill at another hospital. He hadn鈥檛 been able to FaceTime with his wife and two kids until recently. We made sure he had an iPad available.

2. Answer their questions

Instead of saying, 鈥淒o you have other questions?鈥� I ask, 鈥淲hat other questions do you have?鈥� I ask this multiple times before I leave the room. I also make sure they have a pen and paper, or their cell phone, to write down additional questions after I leave.

3. Validate emotions to close the physical distance

When I see COVID patients, I鈥檓 in full protective gear including a face shield or a PAPR. When I see non-COVID patients, I鈥檓 wearing an ear loop mask. No matter what kind of room it is, I have to do a lot of communicating. In light of the pandemic, I rely on my eyes and my body language, but even that is limited. I don鈥檛 sit down like I usually do, I touch things minimally, and I don鈥檛 shake hands. I stand six feet away鈥攁nd it鈥檚 really awkward. I recently had a patient who became very emotional. Normally, I would sit down and be close, but I had to stand six feet away and just hand him a box of tissues.

Given these precautions, I try to validate patients鈥� emotions by telling them that I recognize how scared they must feel. I spend time focusing on their emotions first, instead of diving straight into the medical details. I believe it is easier for patients to listen to the medical analysis if you address their emotions first. Then, I ask, 鈥淲hat is your understanding of what is going on?鈥� Learning what a patient already understands about their care helps me tailor the conversation to their needs.

4. Share the decision-making

One of the hard things about COVID is the unknown. We developed protocols and processes in the several weeks between my dad being hospitalized and my return to clinical service. But there are still unknowns. I鈥檝e adopted a mindset similar to other clinical decisions that don鈥檛 have clear answers. I embrace shared decision-making. I tell them, 鈥淗ere are your options, here are the pros and cons of each.鈥� I say, 鈥淚 would recommend this, or I would prefer that.鈥� Ultimately, you have to be transparent and honest with what we know and what we don鈥檛 know.

Download the Four Ways to Break Through the Compassion Wall 1-page quick tips.

Thank you is an understatement

My dad repeatedly commented on the great care he received. Our teams constantly asked what he needed, accommodated his various requests and answered his many questions.

Paul Yannopolous in the Emergency Department and my hospitalist colleague Emily Signor should be commended for their compassion and courage serving on the front lines and caring for my dad early on before we had many of the protocols we have in place now for known or suspected COVID-19 patients.

If there is anyone I would want taking care of my dad while he is on a ventilator in the ICU with ARDS from COVID, it is Nate Hatton and Emily Spivak, who have been two leaders in our institution in the management of COVID-19. Both kept me up to speed on my dad鈥檚 progress and involved me in decision-making with numerous phone calls. I particularly want to recognize Nate for clarifying how much I wanted to be the doctor versus how much I wanted to be the son鈥擨鈥檓 going to steal that line.

Lastly, I want to recognize the dozens if not hundreds of people evenly remotely involved in my dad鈥檚 care鈥攅very provider, nurse, pharmacist, assistant, therapist, case manager, social worker, technician, unit coordinator, custodian, transporter, greeter, valet, volunteer, staff member, and institutional leader. No amount of thank you emails, fresh cookie deliveries, or stories on Accelerate can capture my family鈥檚 gratitude.