Hardwired to be kind
Written by Dr Brian Goldman.
Dr Goldman is an emergency physician in Toronto, Canada. He is also a writer who blogs at doctorbriangoldman.com and is the author of a book dedicated to kindness: "The Power of Kindness: Why Empathy is Essential in Everyday Life." Here he writes about his experience as both doctor and son - and how kindness can transform even the most difficult of experiences.
When a patient or a family member calls a doctor incompetent, he or she can brush it off. That's because it's rare to find a lay person who understands the difference between clinical skill and a good bedside manner.
When they call you unkind, there's a really good chance they know what they're talking about.
Years ago, I saw an elderly woman in the emergency department who was in the advanced stage of a degenerative disease. The family had brought her to the hospital because they could no longer care for her at home.
There was no compelling medical reason for her to be admitted. She was obviously cared for extremely well. She had no acute medical issues that required immediate admission to hospital. She was thin but well-nourished. She wasn’t dehydrated. She didn’t have pneumonia, and she didn’t have a fever.
Still the family members were at the end of their ropes. At the time, I did not see that. The disease had robbed my patient of speech. I felt as if I couldn't get to know her. I found myself annoyed by the insistence of her family members that she be admitted to hospital. I saw them as demanding and pushy.
I did what they asked, but I did so in a begrudging way.
A few weeks later, the woman passed away. A few months after that, the woman's husband wrote me a letter in which he told me flat-out that I had been unkind to he and to his family. He asked me to meet with his family because he wanted to see if a human being lurked under that abrupt demeanour.
The husband didn't call me incompetent. He called me unkind.
That was me on the giving end of unkindness. Many years later I understood what it felt like to be on the receiving end.
That happened nearly five years ago, when I rushed to the hospital following the death of my 92-year old father Sam. His death was not unexpected. He had advanced coronary artery disease and congestive heart failure.
For loved ones, those first moments of realization that a parent has died are all encompassing. They’re sacred. You want them to last forever because it’s simply too terrible to contemplate the moment after when you have to live the rest of your life without them.
The moment was interrupted by the arrival of the internist and night duty nurse. The internist looked uncomfortable. He spoke in sentence fragments.
"His heart rate slowed," the internist said. "His blood pressure went down. We tried to reach you."
Had I been him, I might have said the exact words he was saying to me. But I was not him. I was my father's son. And in that moment of intense emotion, I felt no warmth from him. No words of consolation. No acknowledgement of the shock we felt. Not even a pat on the shoulder.
I thought of that woman at the end stage of a degenerative disease and her family – the people I had been unkind to so many years before.
For the first time in my career and in my life, I had a well-formed sense of how that family felt.
I had empathy for them because I knew what they were going through. All too often, that's what's missing in health care these days.
There are many reasons for this. Stress is at or near the top of the list. Another factor is the apparent need for speed. These days, health care workers seem to be in a perpetual hurry. With colleagues, we finish each other’s sentences, and tell one another to get to the bottom line.
In the ED, we witness the suffering of patients who are grievously harmed in motor vehicle collisions and shootings. We see preschoolers and teens with meningitis and sepsis. We lose count of the number of patients to whom we have to deliver bad news and of the families to whom we must deliver the worst possible news.
Then, there is dealing with the inevitable medical mistakes on the job.
Each of these make us tune into to our own distress to the point that empathy for patients seems like climbing Mount Everest without proper gear or even a coat to keep you warm.
These were the factors that turned me into a middle aged man who was too self-absorbed to empathise with others.
I decided to go on a journey in search of my lost sense of kindness.
I went around the world and met some of the kindest and most empathetic people on the planet. Close to home, I met a man who sold donuts. He had the most profitable franchises in the system. Same donuts, just more profit. His secret is that he was the most inclusive employer in the system. Doing that lowered his employee turnover.
But why did the man become an inclusive employer? He empathized with his employees because was born deaf and knew what it was like to be discounted and even bullied.
I met other kind souls. A young woman in Brazil befriended a man in his late seventies who had been living on the streets of Sao Paulo for nearly 40 years. She helped publish his poetry and reunited him with his family.
Where did her extraordinary empathy come from? As a child, she had been the marriage counselor and confidant to her parents. She learned never to regret the past or to count on the future. She learned to find solace in moments of exquisite bliss.
The day she first met the homeless man, she looked past his long matted hair and garment made of heavy garbage bags sewn together. She saw a human being living in an exquisite moment of clarity in nature. She saw herself.
Slowly, I began to realize some things about me. Like many health professionals, I probably became a physician to try and do good deeds to compensate for a pervasive feeling of inadequacy and shame.
And that was my fix. Instead of running away and hiding from my mistakes and my shortcomings, I had nothing to lose by trying to acknowledge them.
I met with the family that accused me (rightly) of being unkind. It was not an easy session. The husband came along with all of his adult children and their spouses. As each spoke, their testimony gave me a vivid picture of a vibrant and accomplished woman, a loving partner and a devoted mother and grandmother. A picture that was hard to see when I first met her in part because she could not speak and in part because I was unable or unwilling to see it.
Their words touched me so much that I found myself crying, as did they.
That was the first time I apologized to a family and discovered kindness and generosity in them – something I have found with patients and families over and over again.
But the lesson that family gave me, more than any other, told me that deep down inside, I too am hardwired to be kind.
If the system makes us less kind than we could be, what is the remedy?
We need to fight back against the need for speed. We must slow down every chance we get. We need to practice mindfulness, and we need to slow our breathing down. We need to venture outside the hospital and look at nature.
And if we are prone to shame, we must learn to tell someone we trust about a mistake. If we give the thing we’re ashamed of some air, it will shrink down to a manageable size.
These days, I’m always telling my colleagues and budding physicians that if we want to be nurturing, the first person we must nurture is us. If we want to take care of others, we must first take care of ourselves.
And, if I want to remember how to be kind to others, the first person I need to be kind to is me.