What If It's About Attitude?

What if it’s about Attitude?

When I go to work I leave my personal belongings and my personal life in my car. When I get on the phone with my patient it’s all about them. Why are they calling? What’s really the problem? 

I’m listening to the tone of their voice, back ground noises, and what’s beyond their words. My attitude is I want to help you. I know that if my intentions are good, my words and actions will follow. Over 90% of my patients are stressed. I try to hear what they are saying, knowing that if they are angry or upset their words are often not the whole story. Why are they frustrated and hurting? Often they are losing their ability to cope. They need help and they’re scared. They are losing control. 

I want to get to the root of their problem. I need them to trust me and talk to me. Often they don’t know what they need, I try to help them figure out what they are trying to say. When did you first notice this problem? How did it start? Often a problem doesn’t have a clear starting point, then I look for a gradual progression to the problem: stress that won’t let up, repetitive work or activity. Emotional and mental stress can often lead to physical breakdown. My best friend swears she developed breast cancer due to working in child welfare and having to take children away from their parents. The emotional pain traumatized her “motherhood”. I would swear I developed appendicitis due to being scheduled to work Christmas Eve and Christmas Day at both my jobs while raising a young family. I was stressed to my “core”. As health care providers we try to help our patients identify what’s really wrong. It’s our responsibility to encourage them to want to get better. It’s my goal to give them hope, to see a little light at the end of the tunnel.
“Look what you’ve already accomplished, here’s the next steps.” “Can you see the light at the end of the tunnel? You can get through this.”

Sometimes it’s all about Attitude. I want them to be well. Sometimes they just need to believe someone cares. They need the tools, strength and motivation to get better and they need to take responsibility to do their part in getting well. It’s my responsibility to teach and offer resources. It’s their choice whether they accept my help and  what actions they will take. 

Group Health Cooperative has Primary Care Behavioral Health in their clinics. When I first heard about this I thought, “How am I going to work with Mental Health?” I can appreciate that Behavioral Health workers in the clinic with primary care, could be handy in cases of depression or anxiety or with patients whose health was complicated by other mental health diagnoses. At first, I wasn’t sure how to utilize them. However, over the first year of having them available I’ve come to realize that every diagnosis carries a behavioral component. Now, it seems like an incredibly bright and insightful idea, it’s progressive and important, a step in the right direction. Anytime a patient is not improving, needs more time to talk, or needs help coping, we send them in. Our behaviors and choices affect the food we eat, our stress, our compliance, the risks we take. Our attitude and behavior is a reflection of our sense of personal responsibility.  Often whether we are sick or well, can be a matter of value and self -respect. Sometimes patients need help to find a reason to care. What’s your motivation?

I took care of a young mother in the hospital who had lung cancer. She was smoking 2 packs of cigarettes a day. She loved her children, her husband,  and cigarettes – in that order. She was a very strong and independent woman. She came in for surgery, stayed a few days and went home. We of course told her to quit smoking but she refused. She loved smoking, it was part of who she was. About 6 months later she was back, the cancer was back, and she had pneumonia. She was still a really tough woman; I admired her strength, independence, and determination. She said “This cancer will not kill me, I will beat it, I will not leave my children without a mother”. She was very ill and we were giving her chemo and antibiotics. She was getting so much fluid that she developed generalized edema and her arms, hands, and fingers looked like huge sausages. Her lab values were deteriorating, she was told she had a 50/50 chance of living and the doctor wanted to stop the chemo. She said, “No, I can take it”.  She continued to decline. I called the doctor around 2am on the night shift and said I was worried about her, she was retaining so much fluid and I couldn’t watch her all the time since I had a full load of patients on my medical unit. He transferred her to the ICU. When she left my unit, I was sure she wasn’t going to make it, I was sure I would never see her again. I couldn’t imagine how anyone who was so fluid overloaded, and had so much against her could survive. She continued to decline and was given less than a 20% chance of survival, she was intubated and continued to decline. The doctors pressured her husband to make her a No Code. 

He eventually, reluctantly, agreed. Somehow, in the middle of the night she woke up enough to extubate herself and she lived. She walked out of the hospital a few days later. She did stop smoking. She came back to visit a few months later and brought us baby Jade plants. I was pleased but embarrassed to see her, I had given up on her before she was ready to give up on herself.

She taught me to never give up on my patients until they are ready to quit trying. It’s my job to keep working, searching, and trying until my patients say they are ready to quit. I was working in Palliative Care at the hospital and one of my patients was a Catholic Priest. He had been non-responsive for a couple of weeks, there was a nun who frequently visited and cared for him. I was wondering how much longer he could hold on. She said, “I bet he makes it to Palm Sunday, it was his favorite Mass”. He died on Palm Sunday at 11am, She said, “Just in time to celebrate Mass with Jesus.”