I had an elderly patient with a medical history that could fill a phone book. He was back again in the ER with worsening belly pain, and I had an immediate gut feeling that there was “badness.” He came alone, and when the CT scan report came back with multiple surgical emergencies, I told him the results.
His expression was flat, and he nodded in understanding. He asked me to call his daughter. I made the phone call, and the fact that his INR was elevated bought us a little time. The reality was that the patient would probably not survive surgery, but he still wanted to proceed.
A tsunami of questions came spilling out of my mouth.
“What can I do for you? Do you need more pain meds? Do you want me to call more family? Can I adjust your pillow? Are you a religious person and do you need me to contact one of the chaplains?”
“What can I do to make me … er … you feel better?”
PAs are healers … fixers, but sometimes, we need to stop, breath and listen. The same drive that pushes us to help others can drive a patient to the other side of a deep chasm. There are times when our patients know the reality of their situations, and their job is to face that reality. Our job is to walk with them, the best we can—silently.
Do you know why we fill the patient’s room with mindless chatter? Fear. To stop and listen, especially in sad situations, means that we are opening ourselves up to sorrow. To truly listen encourages empathy, and empathy can hurt. Instead, we focus on adjusting a pillow, ordering more medications or outsourcing the empathy to the nursing staff.
Empathy is a skill that all PAs need. I believe that empathy lives in us all, but the key is to allow it to surface. One thing that I do when I am in a patient’s room is to sit. I position myself close enough to make human touch a possibility, if appropriate. And then, I tell myself to be quiet. Especially when someone is dealing with a life-changing or life-ending diagnosis, listening is sometimes the best/only thing you can do.
The patient doesn’t need false promises or a “positive” spin on the situation. They need someone to walk through the dark with them. This is the art of saying nothing.
We know that the road we’ve chosen is not easy. From the beginning when we started down this career path, we knew that we chose heartache. There are good days when we celebrate with our patients, and then, there are days when we cry with them. Sometimes, the best medicine we can offer our patients is our silence.
Rachael Jarman, PA-C, works in the ER of a busy Minneapolis hospital and as a pre-PA admissions coach, and occasionally, as a guest lecturer for PA programs in Minnesota. She is a graduate of Philadelphia University’s PA program.