As a nurse practitioner, I have the privilege of helping people achieve their health care goals. But in light of recent events surrounding social justice, I find that I am increasingly challenged in new ways. Ways that my training and likely other nursing or medical schools did not address. I have that uncomfortable feeling of being ill-prepared to address the ramifications of social justice on the health of my patients. Let me share one abbreviated story.
C.M. is a 57-year old Hispanic female seen for “not feeling well” for the past five days. She speaks primarily Spanish, needing our clinic translator. Symptoms started while in the middle of cooking dinner for the family. She had a sudden and profound wave of feeling tired, having to sit down and rest with relief after 20 minutes. No pain, nausea, dizziness, sweating, fever. No past medical history. Unemployed. She is apathetic with an unremarkable physical exam. 12-lead ECG revealed marked ST-T wave changes in inferior and lateral leads.
I immediately went into auto-mode, as many providers do when having been through a case many times. I explained what was going on with her heart, the seriousness of the situation and that she needed to go to the hospital for further evaluation. At this point, CM’s daughter, with whom she lives with, joined the conversation as she had been waiting in the lobby. I felt resistance and panic from the daughter right away about bringing CM to the hospital. After going back and forth with the daughter, there was frustration and silence. The daughter removed her Bluetooth earpiece and began to sob. She couldn’t handle one more stress being sandwiched between work, caring for her mother, her sister with special needs, and her own three school-age daughters, let alone the financial impact. On top of that, CM’s daughter was gravely concerned that if CM went to the hospital, an undocumented immigrant, then she would be setting her up for deportation by U.S. Immigration and Customs Enforcement (ICE). Sobbing continues, and the once stoic CM now is tearful.
My immediate reaction is to put my arms around both of them, and offer them tissues. We remained silent. Before I knew it, I was also overwhelmed with emotion and empathy for this family, shedding a tear with them. Now, what to do? I feel awkward and uncomfortable. Following my human instincts, I asked if we could pray together. We stood holding hands in silent prayer, no more than 2 minutes, taking in our “vitamin P.”
Emotions in a patient encounter are a real clinical challenge and, if not handled well, can have devastating effects. I have to call out that the emotional piece of patient care goes missing in training programs. As I think back about my own training, I was prepared to be systematic. That use of auto-mode in providing care has cultivated an emotional numbness in me that disregards emotions and feeling uncomfortable. Clinicians have to become more comfortable with being uncomfortable. For me, in that moment of uncertainty, as a human being, I advocate turning to prayer, or “vitamin P,” to find comfort and clarity. Recall, the word prayer, by definition, is an expression, an earnest hope, and does not require any religious affiliation.
For me, vitamin P has been a successful, real-time way to address challenges alongside traditional evidence-based practice. My patients appreciate the time and value of kind words shared. I realize not all people are at a place, emotionally or psychologically, to engage with patients in this way. At some point though, there comes a time to unpack feelings we carry from our patients’ struggles. Prayer can give voice to these emotions, help process, and bridge a gap in patient care, with one human connecting with another.
And for CM’s case, after our vitamin P, we found clarity and connection to determine the best decisions for her.
I urge all clinicians, including those in academia, to do better by patients in the next generation of providers. Prepare yourselves to be uncomfortable. Consider taking your vitamin P.
Daisy Sherry is a nurse practitioner.
Image credit: Shutterstock.com
