“This patient is uncooperative, has barely spoken since hospital admission two weeks ago, and is at a high risk of escape and suicide.”
The conference room was filled with staff members seated around a table. Many others stood with their backs to the wall. It was a hot, poorly ventilated, overcrowded room.
As visiting professor, I was seated at the head of the table, introduced, and given a glass of water. The patient was seated next to me. She observed me from the moment I entered the room. Readily she consented to being interviewed, had no objection to being questioned in front of the staff, and to my surprise, she was exceedingly cooperative.
The patient knew the interview could aid her treatment. She told a sad story of her life of multiple traumas and abusive relationships from childhood to her present middle age. An hour appeared to pass in just a few minutes.
At the end of the interview, I said, “You are one of the most interesting people I have been privileged to meet. You have the strength to change and improve your life.”
“I agree,” the patient said, smiling confidently.
“Thank you for telling your story. I was informed you may choose not to cooperate. I have never interviewed a more obliging or pleasant person. Please tell me why you decided to fully participate.”
The patient said five unforgettable words: “You gave me your water.”
She stood up, hugged me, was escorted back to her room, began to cooperate with the staff, and when discharged from the hospital, she was significantly improved.
During the post-interview staff meeting I was asked, “Where did you learn that trick? You had that patient eating out of your hand.”
I replied, “Can you picture what it must be like for a patient whose life is being unraveled by a stranger in front of a crowd of judgmental staff members?”
“I had no idea why the patient was cooperative. When she said, ‘You gave me your water,’ I was shocked. You referred to it as a ‘trick.’ Please understand, it was no more than a simple act of kindness, but it must have meant much more to the patient. It meant that I cared about her.”
Patients immediately determine whether the provider cares about them. The patient’s perception of the caregiver as caring has profound healing effects. I have observed the power of this perception consistently over the years I’ve practiced psychiatry.
When we are treated with kindness, dignity, and respect we are more likely to feel valued and cared for if it is authentic, genuine, and real. It will never have favorable effects if it is a ‘trick,’ a technique, or merely meaningless words.
A staff nurse stood up and said, “Dr. Brown, I have been a nurse for as long as you have been a physician. I know the patient, or I thought I did until you interviewed her today. Honestly, I’ve never seen anything like it. How can doctors, nurses, counselors, all healthcare professionals learn to relate to patients as you did today? Can it be taught? Thank you.”
“Thank you for your kind remarks. Thank you for all your years of sacrifices that too often come with being a nurse and thank you for your important question. Yes, people can be taught to treat others with kindness, dignity, and respect. It must never be a technique. It must become one’s habitual, usual, ordinary way of treating others with kindness, dignity, and respect.”
Kindness, dignity, and respect embody the basic character traits of people who are altruistic, who value the wellbeing of others, and make themselves available to others, especially to those who are in need.
Many medical, nursing, and helping profession students begin with strong altruistic motives. However, by the end of their extensive and costly training, fewer maintain this altruism, though exceptions exist.
The nurse’s question reminded me of an Army Captain with unrelenting suffering from combat-induced posttraumatic stress disorder (PTSD). I have his consent to tell you his story, an amazing example of the relationship between the meaning of an experience and its lasting grip on a person’s life. I first wrote about this in Sacred Ground, the Psychological Costs of 21st Century War, 2014.
“Don’t be concerned about being late, Captain,” I said. “I have nothing more important than meeting with you. Please tell me your situation.”
Distraught, wringing his hands, appearing physically unwell, the Captain said, “I haven’t slept for 3 months. Every time I close my eyes; I see a picture!”
“What’s the picture?”
Reluctantly, the Captain said, “We had a good day. I lost none of my Soldiers…that’s a good thing because things had heated up in Iraq. We were restricted by our Rules of Engagement, but nothing bad happened to my company.
“I turned in my vehicle at the Motor Pool and took a shortcut to my headquarters. I was walking past the Medical Aid Station when two Soldiers, dragging a 3rd Soldier between them, approached me saying, ‘Save our brother…save our brother.’”
“I knelt to see if I could help. The wounded Soldier had brain matter protruding from his skull. That’s the picture.”
“What happened to the two Soldiers who asked you to save their brother?”
“It’s strange, but they would not leave me. They spent the rest of the night with me.”
“What did you and the two Soldiers talk about?”
“They talked about their buddy. He was only 19 years old, did not even have a driver’s license, had a girlfriend, and he was from Iowa.”
“Do you think you were there to save the wounded Soldier?”
“Yes, that’s what I’ve been thinking,” the Captain replied, tears slowly streaking down his cheeks.
“Captain, no one could have saved the severely wounded soldier—not you or even the best neurosurgeons.”
The Captain stared at me in shock. He said nothing.
“Could you have been there for some other reason?”
“Like what?” the Captain asked.
“You tell me.”
“Could I have been there for the two Soldiers?”
“They will never forget you.”
The Captain felt his guilt and shame disappear. He realized his role was not saving a wounded Soldier but comforting the Soldier’s friends during their grief. Understanding the truth freed him from his burden.
The Captain slept that night for the first time in 3 months.
Once the Captain understood his trauma, he needed little psychiatric help. His story highlights how grasping the true meaning behind a trauma can bring emotional relief. The Captain’s correct interpretation was both psychologically and spiritually affirming.