Miss Ellie

You know, it’s not so much the cards life deals you, but rather what you do with them.  This was really driven home to me by Mrs. Ellie, a new resident of one of the nursing homes I used to oversee for Baton Rouge General Medical Centers.    

The 92-year-old, petite, well-poised and proud lady, who was fully dressed each morning by eight o'clock, with her hair fashionably coifed and makeup perfectly applied, even though she is legally blind, moved to our nursing home. Her husband of 70 years recently passed away, making the move necessary. After many hours of waiting patiently in the lobby of the nursing home, she smiled sweetly when told her room was ready. As she maneuvered her walker to the elevator, I provided a visual description of her tiny room, including the eyelet sheets that had been hung on her window. "I just love it," she stated with the enthusiasm of an eight-year-old having just been presented with a new puppy.

"Mrs. Ellie, you haven't seen the room .... just wait."

"That doesn't have anything to do with it," she replied. "Happiness is something you decide on ahead of time. Whether I like my room or not doesn't depend on how the furniture is arranged ... it's how I arrange my mind. I already decided to love it ... "It's a decision I make every morning when I wake up. I have a choice; I can spend the day in bed recounting the difficulty I have with the parts of my body that no longer work, or get out of bed and be thankful for the ones that do. Each day is a gift, and as long as my eyes open I'll focus on the new day and all the happy memories I've stored away.” 

So whenever I feel sorry about a difficult situation that life has handed me, I just remember Mrs. Ellie and “decide ahead of time”  that I’ve been dealt a winning hand!

A Jury of Your Peers

Like many of you, I watched the recent Annual Academy Awards on tv.  What a show!  The auditorium was filled with world famous actors, actresses, directors, and other professionals—people that we’d say “have it all.”  Yet, they were all gathered there hoping for the one thing that their money and fame can’t buy:  The recognition of their achievements by their peers. 

British philosopher Samuel Johnson once said, “Life affords no higher pleasure than that of surmounting difficulties, passing from one step of success to another, forming new wishes and seeing them gratified.”  And, in this way, we are all alittle like Denzel Washington, Hallie Berry, or Ron Howard:  We all want the pleasure of seeing our achievements recognized.  

In behavioral healthcare, like most of life’s pursuits, its easy to focus on the negatives, what went wrong, what didn’t meet our expectations.  Yet daily, there are literally hundreds of opportunities to recognize and applaud what was positive, what went right, and those around us who met and exceeded our expectations.  Look around.  Catch someone being good.  Give someone that pat on the back they deserve.  Say “thanks.”  Let someone experience that same thrill that everyone at the Academy Awards show was hoping for: The recognition of their achievements by their peers.  Because life is a self-fulfilling prophecy:  Expect success and you’ll get success.

Do I Really Need to Have This Conversation?

“I have an angry patient who wants to talk to ‘The Administrator,’” he says as he leans into my office, the smallest hint of a smirk on his face. 

“What’s he angry about?,” I’ll ask. 

“I don’t know, but he’s really, really angry, and he’s scaring the staff and he demands to talk to you,” is the reply.

Ugh.  Of all the fun stuff that hospital administrators get to do, talking to disgruntled patients, aka “customers”, is one of my least favorite.  My wife says its because I don’t like conflict…but I deal with conflicted situations all day long elsewhere in the hospital, so maybe that’s not it.  My dad says its because I want everyone to like me…but my mentor, CEO Bill Morrison, said if “everybody likes you, you’re not doing your job” and I believe that to be true.  Maybe I don’t like feeling like we’ve let the patient down, failed to meet our customers expectations. 

But at the same time, I’m always curious as to what the complain might be, and maybe just alittle incredulous that anyone would complain about our fine operation.
 

So, off I go to find the patient.  I used to say “off I go to find the patient and resolve this issue” but over time I’ve discovered that sometimes people don’t want the issue resolved, matter of fact, sometimes I make it worse when I try.  What’s that Terri Clark country western song?  “I Just Wanna Be Mad for Awhile.”  My wife tells me the same thing, “Sometimes I just want you to listen and not try to solve my problem for me.”  So, I’ve learned to:

1.     Be Quiet:  Introduce myself, say “I hear you have something you want to share with me.” And then be quiet. 

I then follow with four additional steps that I’ve found help effective deal   with conflicted situations:

2.     Listen:  Duh. “Listen”?  Thank you, Dr. Obvious!  But what I mean is “actively listen.”  Active listening includes:  Maintain eye contact.  Nod to show I’m listening.  Don’t interrupt.  When the patient pauses, as if to say “now YOU say something”, I’ll simply say “What else is going on?” or “Can you elaborate?” Most of all, I resist the temptation to interrupt, argue, or otherwise say “You’re WRONG!”

3.     Evaluate:  While I’m listening, I’m evaluating what’s being said, how its being said, what’s motivating the conversation.  First, try to see the issue from the patient’s point of view…someone told me once “If its true for the patient, its true…their perception IS they’re reality.”  Second, evaluate the content.  My good friend and psychiatrist Dr John Parkinson told me that “every conversation takes place simultaneously on two levels:  The manifest content or what’s actually being said, and the latent content or what the patient is trying to communicate.  For example, the manifest content of  “I haven’t seen my nurse in over 8 hours!!!” doesn’t mean “and I’m worried about her”, it more likely means something like “And I’m scared for my safety.”  So I put myself in their shoes and figure out what’s being said and, more importantly, what it means.

4.     Reflect:  In order to make sure I’m receiving what the patient is sending,  I use one of those standard psychologist techniques:  reflect the patient’s comment by repeating their comment back to them in the form of a question:  “So, you’re saying that it was so noisy last night that you couldn’t sleep?”  “So, you thought the tech was too rough moving you to your wheelchair this morning?”

5.     Ask what their expectations are.  “How would you like me to resolve this?” or “What would you like me to do?”  or “What can I do for you today to improve your stay with us?” 

Interestingly, I’ve found that if I allow the patient (or staff member, for that matter) vent, show that I’m listening and interested, and reflect their concerns to show my understanding, more often than not when I ask what I can do, they say something like “I don’t need you to do anything, I just wanted to make sure you knew about it.”

What comes next is one of the lessons I learned from my father, who told me he learned it in the military:

“Tell people what you’re going to do.  Do it.  Then go back and tell them it’s been done.”

…and I’ll try to remember all this the next time someone knocks on my door and says “I have a very angry patient on 3-North who demands to talk to you…”!

The Real Measure of Success

My mother passed away in March 2003 after a long battle with Alzheimer’s disease, so I tend to think of her more this time of year.  Although she was born in Richmond Virginia, she had lived all over the world, first as the daughter of an Army chaplain, then as the wife of a career military officer.  She hadn't been back to visit Richmond in over 30 years.  

My sister Winston and brother David made plans for Mom’s funeral, including a memorial service and burial in her family’s plot in Richmond.  When it came to publishing her obituary, we were stumped.  She was born in Richmond, but had lived all over, retired to North Carolina, and had been in a nursing home in Mississippi.  Eventually, we decided to publish the obituary in Richmond, Hattiesburg Mississippi, and Fayetteville NC. 

About 30 family and friends indicated they’d attend the service.  Imagine our surprise the day of the service when almost 90 folks showed up!  Although it had been over 50 years since she lived in Richmond, most were my mom’s former neighbors, classmates, and members of her church, including her high school boyfriend and the minister who now served the church her father—my grandfather—had last served.   A nursing assistant from her nursing home in Hattiesburg had traveled all the way to Richmond to say goodbye.  Many friends from Fayetteville also attended.

I was stuck by how this is the real measure of success;  not wealth, fame, or power, but to be have touched people’s lives in a way that you are fondly remembered even after an absence of decades.  And that’s an opportunity that is presented to those of us in healthcare each and every day:  The opportunity to touch peoples’ lives in a way that you are fondly remembered decades later.  Seize that opportunity.

10 Wishes

When I was an undergraduate at the University of Richmond, I took a senior psychology seminar from Dr. Barbara Sholley.  One day, Dr. Sholley presented us with the question:  “If I could give you a pill that would guarantee that you would always be happy, would you take it?”  Many of my fellow students thought that was a “no-brainer:  Happy every day, who wouldn’t want that?  I was the only one who argued against it, saying you can’t know happiness without knowing disappointment.  Thirty years later,  Dr. Sholley and I still debate the question when we talk, but a recent list she shared with me sums it up better than I ever have:

1. I sincerely wish you will have the experience of thinking up a new idea, planning it, organizing it, and following it to completion, and then having it be magnificently successful.  I also hope you’ll go through the same process and have something “bomb-out.”
2. I wish you could know how it feels to run with all your heart and lose badly.
3. I wish that you could achieve some great good for mankind, but have nobody know about it except you.
4. I wish you could find something so worthwhile that you deem it worthy of investing your life.
5. I hope you become frustrated and challenged enough to begin to push back the very barriers of your own personal limitations.
6. I hope you make a stupid, unethical mistake and get caught red-handed and are big enough to say those magic words, “I was wrong.”
7. I hope that you give so much of yourself that some days you wonder if it’s worth it all.
8. I wish for you a magnificent obsession that will give you reasons for living and purpose and direction and joy and life.
9. I wish for you the worst kind of criticizer for everything you do, because that makes you fight to achieve beyond what you normally would.
10. I wish for you the experience of leadership.

If you could have all these experiences, weather them, and then proceed with your work, you would be forged as strong as steel and would be head and shoulders above most people who could not survive such tests.  Life presents us with many challenges, some big, some small.  Many times those big challenges result in even bigger disappointments and we’re tempted to just give up but surviving disappointments makes us stronger and better individuals.