When empathy is found in unexpected places [PODCAST]

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We delve into the powerful narrative of patient vulnerability and resilience. Our guest, writer Rachel Litchman, shares her deeply personal experience of being hospitalized, highlighting the disconnect between patient needs and systemic responses. We explore the profound moments of empathy that came not from the highest authorities in health care, but from those on the frontlines and in overlooked roles. This conversation uncovers the challenges of authority, compassion, and the shared powerlessness that can spark true human connection in the face of medical crises.

Rachel Litchman is a writer.

She discusses the KevinMD article, “Top-down hierarchies in health care harm patients and health care workers alike.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Rachel Litchman. She’s a writer and a homeless services consultant. Today’s KevinMD article is “Top-down hierarchies in health care harm patients and health care workers alike.” Rachel, welcome to the show.

Rachel Litchman: Thank you, Kevin.

Kevin Pho: So let’s start by talking about the story that you shared on KevinMD for those who didn’t get a chance to read it.

Rachel Litchman: So I had a recent hospitalization, and I wrote about some of my experiences during that hospital stay, where I interacted with a lot of people in the medical system: nurses, CNAs, and doctors. I found myself not necessarily surprised, but feeling seen as a lot more human by folks in the health care system who were lower on that health care hierarchy. And so I wrote about some of those experiences and also some of the really not-so-great experiences I had throughout the hospitalization. I felt that people who were higher on that chain of authority really overlooked me, and that led to some pretty significant consequences for me, especially upon discharge, when I was discharged essentially into homelessness because I couldn’t get up the stairs of my apartment.

Kevin Pho: So tell us about that hospitalization. Just tell us your story for those who didn’t get a chance to read your article yet.

Rachel Litchman: Sure. So I have several chronic health conditions, and around late July, I just noticed things were getting a lot worse. I ended up just standing up and getting really severe hypertension, and that would happen pretty much every time I stood up. Then that led me to basically collapse on my floor. I had all these electrolyte disturbances. I got really, really weak, and so I ended up admitted to the hospital after that, and I was so weak that I was not able to walk.

So after that hospital stay, I was then discharged to a physical rehab facility. The physical rehab facility was an acute care rehab facility, so those facilities tend to be like two weeks maximum. While I was there, I was still really struggling to make progress and to be able to walk. But because of that two-week stay, and because my insurance was being very difficult and not wanting to cover the stay, after nine days the rehab facility said, “You know, we got to discharge you,” even though they knew that my apartment had twenty stairs and I wasn’t able to get up those stairs.

So I said, “OK, we can try to figure out a plan.” But then the day before discharge, I got hospital-acquired COVID, so I was too weak to even get up the stairs with my arms. That had been the initial plan: I would scoot up the stairs in my apartment with my arms. But I was too weak with COVID to even do that. So I ended up just going to a hotel after discharge because I couldn’t even get up the stairs in my apartment, and then after that to a friend’s place, until I was recovered enough from COVID to get up the stairs in my apartment. So that’s what happened over that month and a half.

Kevin Pho: And so tell us about some of the interactions that you had with the spectrum of health care workers during your hospital stay.

Rachel Litchman: Yeah, so I think one of the initial experiences I had was in the ER, and there was this nurse. I had been hospitalized in 2020, and I was shocked by just how much the health care system had gone downhill since 2020, because I’d been in that same emergency room. I remember in 2020, I was able to be seen pretty quickly, and this time I was just put in a hall bed in the emergency room. I was in the ER for over twenty-four hours because they had no beds upstairs, and it was impossible to even see a doctor.

And so there was just this nurse this entire time. I wasn’t even really assigned to somebody, but she was really, I think, the one looking out for me, because I had to be catheterized and doctors had to put in orders for that, and no one was really paying attention to the fact that this was very, very urgent. So there was this nurse who was really looking out for me, making sure that happened, because the doctors just were not getting to me in time, and things were getting pretty severe with my pain, with needing to be catheterized. And so I think that was one of the first interactions where I felt very helpless, but I felt seen, that there was this nurse looking out for me when other folks on my care team were not. So that was, I think, one of the first interactions that really stuck out to me.

And then I think the second one was when I was in the hospital. I was having a really hard time after they gave me this medication called Compazine, and it had some psychiatric side effects, and they did not warn me about that. And so I started to feel very, very anxious after they gave me this med, and I told a nurse, “Hey, I’m feeling very, very agitated right now, and it happened after I took this medication. Is there anything I can give for anxiety or anything?” And the doc’s like, “No, no, no, we’ll just wait till it wears off.” But this was happening for seven hours. I was still feeling extremely agitated, and this nurse was basically just begging the doctors, “Hey, can you just give her this med?” And I was like, “No, no, let’s just wait till it wears off.” Finally, after seven hours, they’re like, “Yeah, you can give her a for anxiety.” They gave me the med, and things immediately got better.

And so I think that was again one of those situations where people who were closer to me and also lower on that chain of authority were able to help me better, were able to see what I was going through better, and hear me more than doctors and people who were higher on that chain of authority, who were more detached from my care. So those were a couple of experiences I had.

And then in the rehab hospital, there were just several conversations I had with CNAs and people who were just cleaning the room, a lot of people who didn’t even want to be in health care but were just there because they needed a job. A lot of the conversations we had were a lot more humanizing, I think, just being able to ask about who we were. They learned about me; I learned about them. Whereas I think a lot of those conversations never really happened with people who were my doctors or case managers. No one really asked, “Hey, what do you do for work? Why are you here? What happened?” It was sort of just to the point, like, “We need to get you out of here because your insurance won’t cover anymore.” So those were a couple of the experiences that I had in both.

Kevin Pho: And after you had some time to reflect on these experiences, why do you think there was such a big divide between your experience with people in lower authority versus those in higher authority?

Rachel Litchman: I think a lot of it just has to do with power dynamics and a feeling of powerlessness. For me and a lot of the nurses and CNAs, I think there was this shared feeling of, you know, there’s only so much we can do, and there’s only so much that we can say that will be heard. And so I think there was this kind of mutual understanding of being really in the thick of it and being able to see firsthand what it feels like, what it looks like, to really be suffering and going through these experiences. A lot of times the doctors aren’t even in the room when a lot of these medical crises are happening; they’re just giving the orders. And so I think that’s also part of it.

There are also just socioeconomic differences. I think that’s one of the big ones too. For me as a patient, my hospitalization was related to my health, but it was also related to the fact that I couldn’t get up the stairs of my inaccessible apartment. And so there was this socioeconomic divide, where there was this social factor involved, and that was something that I think people who were lower on that chain of authority were better able to understand and maybe experienced themselves: I guess, the understanding that there are sometimes social factors outside of your control that can lead to hospitalization and can lead to health crises. Those things are just as important to acknowledge, and they’re not necessarily in the patient’s control.

Sometimes I feel like if you are not experiencing those things, like housing instability, and maybe you’re a doctor, there’s a level of blame that happens, like, “Oh, why are you in that situation? You can just go home. You’ll be fine.” And so I think sometimes there’s this disconnect when there’s not this understanding of socioeconomic differences and how those can contribute. A lot of times there’s this feeling of shame that can happen from folks in the health care system who aren’t living through that experience.

Kevin Pho: Now, while you were hospitalized or in a rehab facility, was there any resource that you could turn to, like a patient advocate, where you could express some of your concerns?

Rachel Litchman: Honestly, not really. I think the thing that happened a lot was, like I said, I have this housing situation where I can’t get into my apartment, and they’d be like, “Oh, just get accessible housing. Here’s this resource list of ten organizations that do accessible.” I’m like, “Yes, I work in La Services. I’ve contacted all these organizations.” What you don’t understand is there are three- to ten-year wait lists for all of these places.

And I remember when the case manager gave me those resource lists, I had to tell her, “Yes, I’ve contacted all these organizations. I’m on all their wait lists.” She was just kind of in disbelief. She seemed to think that I had not been trying hard enough. I think there is this level of disconnect where, if you’re not someone going through that experience of trying to find adequate housing, to find accessible housing where you don’t have enough income to pay the $3,000 rent in this city, it’s really hard to understand that a lot of times resources just don’t exist for people who are disabled and poor.

And I think that’s really hard for people who haven’t experienced that to understand. They’re like, “Oh, well, I know this organization that exists that does XYZ. How come you can’t get help?” And I think they don’t understand that these organizations exist because the system is fundamentally not working, and people have to go to these organizations in order to get triaged, just the same way they would in a health care system. And oftentimes there aren’t even enough resources. Most of the time there aren’t enough resources, even when you go to these other nonprofit organizations for help.

And so that was, I think, a big barrier that I faced. Yes, I did have people in the hospital saying, “I’ll give you a resource list,” but that was kind of the most they would do, give me a resource list. And I’d have to tell them, “Yes, I work in the social services system. I’m aware of these resources. I’ve contacted them, but their wait lists are extraordinarily long. It’s not going to help me right now, and I need help right now.”

Kevin Pho: So now, I know that you can’t talk to the doctors who care for you during your hospitalization, but there are a lot of physicians who are listening to this podcast. So if you could talk to them and share a message, what would you say to them?

Rachel Litchman: You have more in common with your patients than you might think sometimes. It’s really easy for someone to be in a situation like I was. All it takes really is one health crisis, and you’ve lost your income, you’ve lost your job, you lose your housing. These things aren’t the fault of the patient. It’s just, again, our systems aren’t working. And so it’s really, really easy to be in that situation. I think that’s one of the keys to empathy: being able to see that you’re not so different from the people you’re treating and that, at the end of the day, it could be you just as easily as it was me.

Kevin Pho: Well, Rachel, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Rachel Litchman: All right, thank you.

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