I was in a meeting after some horror show had played out in the birthing unit. It featured a ruptured uterus, a dead baby and multiple units of blood, and the STAFF were traumatized. We were planning a debriefing session: the venue, the time, the invitee list. One of the managers thought we were taking things a little too far. She said, “We have to remember, the women aren’t here for us”.
Are the women here for us? Not exactly. But care is not a one way street, and we need to talk about that.
I listened to Dan Ariely’s TED talk “Our buggy moral code.” Dan spent months; stretching into years, in the hospital after third degree burns affected most of his body. During that time he had to have many painful wound dressing changes. You may have heard that having burn wounds attended to is one of the most painful things imaginable. Dan said that the nurses would rip off the dressings quickly. And, they would start cleaning the most painful parts and work their way towards the least painful. They would rush through the work as quickly as possible. He would beg them to do it slower, give him a rest, save the worst parts for last, but they said “No, its better this way. It would be much more traumatic, if we did it the way you suggest”.
Once Dan got well he started doing research into whether what people believed about pain was true. He did a number of experiments using small electric shocks, plunging ice baths, vice grips on fingers, things like that. He rigorously measured the responses to the degree of pain his subjects experienced. Dan found that the average overall pain that people experienced was much reduced if things were taken slowly. His work revealed that many of the things that health care workers did to burn patients as a matter of their intuition were wrong and should be changed.
There are two powerful messages in Dan’s story. The first is the message that the patient is often right. We should listen to our patients much more than we do.
But I’d like to deal with the second message, made very clear went Dan went back to the hospital and spoke to the staff who looked after him. He explained his results to his favourite nurse. She said that there was one very important thing that Dan didn’t measure. He hadn’t looked at how the treatment made the nurses feel:
She said, “Of course, you know, it was very painful for you. But think about me as a nurse, taking, removing the bandages of somebody I liked, and had to do it repeatedly over a long period of time. Creating so much torture was not something that was good for me, too.”
In obstetrics we are the creators of torture. We often are witness to suffering, many times we, like the nurses who looked after Dan, are the ones inflicting it. We are regular bystanders, harbingers, creators of pain: we are victims of vicarious traumatisation and perpetrators of violent acts. It is true that sometimes we save lives in the process. But these uglier views of typical clinical events must be faced and examined carefully.
It is not good for staff to come to work and harm patients in the course of their care: intentionally or unintentionally. But the nurses did hurt Dan, they felt they had to, as part of their job. The pain they inflicted affected them so deeply they could not listen to what Dan was saying. Some part of their selves disengaged.
The day of the horror show, a mother was hurt and a baby died. I’m not getting into the fault of it. The thing is we were the audience and the cast of a tragedy. We need to review that play and not only to find out what scenes might have been better acted.
I think that when the manager said “the women aren’t here for us” she was extorting us to remember our non-starring role: the women aren’t here for our entertainment. She felt we should keep this professional distance, keep our emotions in check, toughen up and get back to work. The implication was there that if we didn’t, there was something wrong with us. But there is something more wrong when we don’t take the time to consider not only what happened, but how we feel about what happened.
There are times, I get called in to look at a tracing, or to give some advice, to births I have no other business being at, and when I get there, I realize that my services are not required. The woman is being supported, the midwife and family are there, and whatever they called me to do was a false alarm. Still, it is very hard to leave. I mean, it’s easy to leave a place where you are not wanted….but in this case, there’s a feeling of going out into the cold rain from a warm hearth, and you would like to linger, you would like to be invited to stay. But I don’t. That women wasn’t there for me. It’s enough for me to know that the warm hearth exists.
Instead, I’ve got a permanent invite to the parties that no one wants to attend. There’s a rush of adrenaline with all the drama of a five alarm fire. There’s a ruptured uterus, a dead baby and multiple units of blood. Like they say, it’s a crazy job but someone’s got to do it. Turns out that women want that someone to be a person who cares deeply about them.