Saturday, November 10, 2012

Thoughts on Hospitals and Healing

by Miki Kashtan

For many hours every day for more than two of the last three weeks, I was in a hospital setting, supporting my beloved sister’s recovery from a major surgery. I have a lot of very personal experiences - of sorrow, helplessness, and moments of grace - that are now part of who I will forever be. This piece is about what I learned from all of this about why so many of us hate being in hospitals and what it would take to create hospitals that are truly designed to support healing.

Despite everything that I am about to say, I am confident that all of us who were with my sister during this time would rate the care we received as excellent. We were in a hospital ranked in the top 5% in the US. Nonetheless, my overall conclusion is that hospitals, as currently conceived and designed, are not conducive to healing. I have no research to cite for any of what I am saying, only my own deep intuitive humanity that speaks to me, my soul’s mourning about what I saw. This mourning is made especially poignant given that I have absolutely no doubt about the dedication, care, and commitment to the well-being of patients on the part of everyone we encountered while at the hospitals. I am not talking here about the rare individual whose spirit has been so damaged that they end up taking their suffering out on other people (commonly known as sadistic). I am talking about a system and a setup in which people whose hearts shine are unable to create a healing environment.


To clear up any confusion there may be, in talking about healing I am making a distinction between healing and curing. A quote from the book Choices in Healing, by Michael Lerner from Commonweal, an organization dedicated to individual and global health, might help make this distinction clearer: “A cure is a medical procedure that reliably helps you recover from an illness. Healing is an inner process through which the human organism seeks its own recovery--physically, mentally, emotionally, and spiritually.” There is no question whatsoever that hospitals are places where people’s lives are routinely saved, where multiple diseases and conditions are treated with stunning success, and where everyone is committed to supporting such processes in happening.

This remarkable success, however, is not relying on our innate, organismic capacity to heal. While everyone is aware of this almost miraculous biological and spiritual process, it is assumed and taken for granted, not nourished, not actively mobilized, and it is often interfered with in order to allow for the efficiency, reliability, and technical accuracy of the procedures that take place at the hospital. To whatever extent healing happens, it’s because life is so glorious and powerful, that healing happens despite the hospital environment, not because of it.


Choice and Agency

From a private hospital ad
As I see it, part of the process of healing, especially from serious trauma like surgery, is about regaining our sense of power and efficacy, recovering from the profound helplessness of being at the full mercy of others, and unconscious. Were I to design a healing environment, I would set it up in such a way that in whatever manner the person healing could have choice, they would simply have it. I am talking here about the most elemental aspects of choice, such as who enters the room when.

While we were in the hospital, we never knew what would happen when, except for those medications that had a schedule associated with them. If a specialist was called in for a consult, or a nurse to come in and change dressings, we were never told when they would come. It was exceedingly difficult to plan anything, to have some sense of predictability, of having a life and creating the necessary conditions for healing by ourselves.

Another example is the use of language. When a medication is offered and for whatever reason the person makes the choice not to take it, their chart says that they “refused medication.” In my ear, this is a loaded word that connotes someone who is uncooperative, who is making a choice that is based in some stubbornness, who is not supporting the people who are offering care. I would so want, instead, for the chart to simply say “chose not to take medication” - more descriptive, and in that way more honoring of the person’s agency and choice. This may seem incredibly small in comparison with other things, I totally see that. Nonetheless, given that language is my specialty, I believe that words, and word choice, are reflective of a frame of mind. I remember one incident in which we called the doctor because we wanted to change how something was done to be more aligned with how we wanted it. When the nurse came with the changed order, she said something like, “the doctor decided it will now be this way” - in no way acknowledging that the change arose from our explicit request, which we had previously communicated to her and which she felt unable to agree to without the doctor’s agreement. Patients are not the only ones who operate without agency in a hospital.


Rhythm and Peace

Although it is well known that sleep and rest are absolutely essential for healing, it is next to impossible to sleep through the night in a hospital. Hospital staff enter the room often several times during the night. Sometimes they turn on the light to administer medicine and take vital signs, and in the process engage in animated conversation. At one point when I was there, one of the nurses left the light on and the door open as she went to look for something and came back thirty minutes later. It’s evident to me that this method is not the only one possible, because some of the nurses did manage to enter quietly, hang an IV bag without hardly making any noise and without turning on the light, and delay the taking of vital signs in all but the most acute conditions.

Especially following surgery, which is a profound affront to the body, resulting in parts of our bodies being exposed, touched, and manipulated in ways they are absolutely not designed for, it seems essential to me that we would need a peaceful environment for healing. Soft voices, warm light, smooth transitions. This is not the way of the hospital.

Case in point is the IV machine. Whenever anything stops flowing, for whatever reason, it starts beeping. There’s a button on it called “silence”, which creates about two minutes of silence before the beeping starts again. We discovered this button and got permission to use it. Most people are not shown how to operate this button. When the IV machine stops flowing, which happened at least once on any given shift, the current setup means calling the nurses station, and waiting for someone to come take care of it. Under the best of circumstances, this is a few minutes. Even when they do come, I was astonished to see that they don’t push this button themselves. Instead, they tend to take the actions necessary for fixing the problem while the machine beeps. I imagine that after years of hearing these sounds they tune them out. Meanwhile the patients lie in their beds hearing the beeping. Every time we walked around the department some room or another was beeping. It’s part and parcel of the hospital sound, almost, this perennial beeping. 


Nutrition

What I am about to say here is not based on our experience of this particular hospital episode. We provided all of our own food for my sister. We chose to do this because of essentially having zero trust that hospital food would provide the necessary vital nutrients in support of her healing. Hospital food is almost a code word for something unappealing. I know I have read on many occasions about how hospital food is full of chemicals, additives, and sugar. If anyone ate hospital food indefinitely, I am confident they would not be able to maintain a state of health.

Food, when done with care and thought, is its own medicine. The internet is exploding with research about the healing qualities of so many foods. In addition, our relationship with food can itself be conducive to healing or not. Being in a hospital doesn’t have to mean dishes that lack any esthetic beauty, for example. I can easily imagine meals made from organic, wholesome ingredients, carefully chosen in support of specific illnesses, lovingly placed on plates and trays that create a pleasurable experience for those whose bodies are ailing and are striving to regain their health. 


Connection

Compared to my memories of hospitals from decades ago, the conditions we encountered in terms of being able to create a loving environment for my sister were superb. We were fully welcomed to have a presence in her room around the clock. I am so grateful to whoever pioneered these changes, because I still remember the horror of being ushered out of someone’s room because visiting hours were over.

And, still, most people in the hospital, most of the time, are alone. My heart broke time and time again when I saw people who were relying only on staff for support. I try to imagine someone being alone in their room, in a moment of need, waiting, sometimes up to thirty minutes, without the company of someone that loves them to take the edge off the discomfort. It reminds me of all the many times I have seen people in cancer treatment waiting rooms, or receiving difficult treatment, without support.

If hospitals were designed to support healing and human needs, anyone who was alone would be offered someone to care for them, to be their companion, to be the first person to receive their requests, to attend to their bodies and spirits, for as long as they wanted it. Because love and connection support healing. But in our current system, they happen by accident, not by design, either because, as in our situation, family and friends exist, or because some particular nurse or even housekeeping person happens to be exceptionally loving and supportive. I wish, instead, for love to be built into everything that happens in a hospital.  


Nature

 

We are an integral part of nature, despite incessant efforts on the part of Western civilization to change, hide, or suppress this fact. It’s no accident, to my mind, that it’s so common for people to send flowers to hospital rooms.

The windows in the room where my sister stayed, as in every room in that hospital, don’t open. Day in and day out, each person that works at the hospital or is attempting to heal in one of its rooms, is breathing artificially circulated air, without connection to any natural environment. I know that the reason for this is to prevent infections, a rampant risk in hospitals. Perhaps there can be no solution to this quandary. Or perhaps it’s more fear than reality. I cannot know.

What I do know is that I want every person who enters a hospital to have the opportunity to be in nature, even after major surgery, as soon as possible. The sounds and the sites of fresh air, plants, birds, and the occasional brave animal that manages to stay in our urban settings are all reminders to our own animal organisms that we are part of the web of life. How can they not be healing?

The word “sterile” has two meanings, and their overlap is far from accidental. In an effort to create a sterile environment as in protection from infectious pathogens, we have created a sterile environment as in absence of life. I’d like to believe that we can allow life into the hospital, bring in the passion of living, and still find ways to protect those who are extra vulnerable to infection. If we put our immense creativity, as a species, to solve this and other life promoting problems, I am confident we could. 


Hospitals for People

Ultimately, I have very little to add to the grand vision of Patch Adams, who’s been fundraising for years in his efforts to build a hospital based on compassion, generosity, and fun. If you are curious, he has a vision of an entirely free hospital that I wholeheartedly support. 



In conclusion, I want to invite you to imagine that all hospitals could be designed around healing and human needs, and that anyone who’s in need of medical care would not think twice before agreeing to go into a hospital because it would be so welcoming and loving. This is not only a big concept, it would also translate into the minutest details, similar to those I included here.

An IV machine would be programmed effectively such that when a person went to sleep for the night, the upcoming doses of medicine would already be entered into the machine, and would automatically start pumping when the right time came. This is elementary technology that would be easy to implement if this were the priority. Patients would be full partners with the doctors and nurses in deciding on their own care. Every morning someone would review the schedule with the patient to know who is coming when, so each person could plan. The rooms would be peaceful, decorated, lively… I could go on and on, and I imagine the message is clear. I long for a time, a place, a world, in which healing is promoted, nurtured, supported by everything and everyone in every hospital. I hope that my writing about this, in some small measure, would inspire all of us to put this vision, this longing, on the table for conversation. Nothing can happen before it’s dreamed about on a large scale.
 

12 comments:

  1. You go, woman. I am so holding this vision with you.

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  2. Here's a short tedtalk pointing towards the effects of closed air systems on microbial ecology in hospitals and other buildings. (A little support for opening windows from our scientist friends) http://www.ted.com/talks/jessica_green_are_we_filtering_the_wrong_microbes.html

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  3. I’m really touched by this post. I recently had the privilege of teaching a meditation course for doctors and other health care workers. What pain from their side too. Truly we need to dream about this (and act), for the benefit of all of us.

    I’m particularly struck by what you wrote about food. I’ve been deeply frustrated for many years by the way the health care system seems to downplay or even ignore the well-documented relationship between food, health and healing. This creates so much suffering for so many people. I fear it’s yet another consequence of our current economic system. What can we do about this?

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  4. So much I enjoyed about this read from the distinction between cure and healing to seeing and listening to Patch Adams. Inspiring and hopeful..providing a tangible vision which feeds me,thanks!

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  5. So long as self-interested financial considerations are valued more highly than a patient's healing, our creative genius will remain unrealized. Conventional medicine and attitudes about the nature of what is considered to be illness need to be examined and questioned. This is happening and changes are taking place gradually. There have been set backs over the years fostered by ignorance, arrogance and greed. As an example of how things may have been going in the 50's, check out this scene from the movie, People Will talk. About three minutes into it, Dr. Noah Praetorius (Cary Grant), a physician who teaches in a medical school and founded a clinic dedicated to treating patients humanely and holistically enters his clinic.
    I was so delighted when I first saw this movie with this portrayal of this marvelous physician.

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    1. Oh yes, the link to the movie scene:
      http://www.youtube.com/watch?v=0jM_9usV3Yg&feature=relmfu

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  6. while being two months in hospital before havinhpg birth, i was so upset frustrated and in pain of all of these same points you wrote about. i dream with you for a major change at hospitals. but what are the chances, with so many forces determine the reality (budgets, fear of law suits, same stuff work many years etc.)?

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  7. Amen, sista'. I'm sending this link out to my midwife friends.
    I would love for modern medicine-- with its expertise on diagnostics, drugs and surgery--to find its rightful and humble place among the community of healers and healing traditions in this country and all around the world.

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  8. ...including the most elemental, foundational healing modalities you mention here...loving presence, kindness, healthy food, fresh air, sleep....

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  9. I appreciate how you could lay out your vision of what could be without denigrating the people working in the current system -- clearly identifying that there are systemic issues here, not issues with specific people or a specific hospital. I also love the clarity of identifying a few key elements that could drastically change the hospital experience -- nature, nutrition, choice, peace. I mentioned this to a friend, whose first response was: "Hospitals cost so much already! Who would pay for this?!" I feel sad that this is the first question, rather than looking at what the purpose of hospitals is, how it could be done, or what would really contribute to healthy people. I guess there is such a fundamental lack of trust in the possibility of change. Patch Adams' vision was inspiring and does give a sense that not only is it possible, it has worked! It would take money, but really what it would take is will and enough people to trust in the possible. I do know hospitals now are incorporating things like healing touch, healing gardens, even music and sound healing -- all of which are shown to contribute to health. It seems like some of this could be done without a big outlay of money, as you say. I'm encouraged by programs that connect organic farmers with schools and can imagine an extension of this. I could imagine all these changes being applicable to people in schools, rest homes, etc. Dare I also say, prisons? I do know some prisons have gardening programs and the like. Healthy food could decrease behavioral problems, seems to me. Wouldn't it be great to offer compassion to people in the health care industry, to live it, and to be part of teaching it in medical schools? I believe they are doing more to teach empathy and compassion than they used to. . . but I don't know this first hand. Thanks for the vision. And, I wish you and your sister well in this healing journey.

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  10. I am sad as I read Miki's piece as I also desire the highest good of the patient. I am a dedicated healthcare provider, struggling each and every moment, to provide care that meets the spiritual, psychological and health needs of each of my patients. Honestly, given the years of education, time studying, and financial expense preparing for this ministry, my experience has been working with empathic, caring men and women in all aspects of this ministry. Of course, there are those exceptions, as there are in any walk of life, and I, and countless others, are just as sad as you are about those who seem to choose financial gain over care. Please know that 'greed' is not my goal, nor the goal of countless providers and hospital staff. Saving lives is a need, and most often, health issues with patients often arise with no 'prearranged schedule.' The patient with the highest need is taken first, so this may mean another is left waiting until the highest need issue is taken care of. Also, the kitchen prepares food for thousands of patients, with very diverse dietary needs. Perhaps in meeting with the nutrition and kitchen planners, more light will be shed on the needs that realistically can be met? Also, I am saddened as I read responses filled with judgement., most especially in an NVC environment where being open to hearing the needs of everyone is a precious goal. I am left wondering if any of you have taken the time to have a conversation with a health care provider to learn about their precious hopes, needs and pressures of working in a large system? Perhaps their input would have greatly informed the perspective of this piece? Perhaps it is easier to critique a system or another using only our personal understanding of an experience, as one who has not entered into earnest dialogue with another?

    My dream would be that each of us: the healthcare providers, the nutrition staff, the drug and medical supply companies, the government, patients, the social service team, insurance companies, and all those involved in hospital care would gather, dialogue and earnestly hold each other with respect and dignity. My dream is that we throw away our 'judgements' and honestly listen to each other with empathy and openness to learn and discover the needs of each and mutually work together to meet the needs of all that supports the highest good of all involved. My hope is that we strive to remember that we often have the same 'needs',to support the highest good for all, we simply need to work together to creatively find strategies to meet these needs. Also, each of us may discern: What contribution can I make to meet these needs?

    Please, let each of us remember, mutually working together, taking responsibility for our persoanl contribution, while using the NVC precepts as a foundation to dialogue and strategy exploration will result in a more empathic hospital system, community and world.

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    1. Dear Debbie,

      I am so grateful to you for writing this. It may not have sufficiently clear from my blog, so I want to perhaps clarify my intention: it was exactly to highlight that despite the health care system being totally filled with people like you, who care deeply about patients, who want everything to work, it still doesn't work.

      I am a bit confused, in fact, because I was saying explicitly that I am not talking about individuals; that we have a system that cannot be made to work despite people like you and all the others.

      What I am after is a large vision that changes the terms, where it's not about what can realistically be done - because that "realistically" is within the terms set by insurance companies and legislation. It is this setup that I am after, not the individual cooks or nutritionists. We had a lovely conversation with a nutritionist who was bemoaning the fact that the kind of ingredients that we would want all people to have are simply not available in the current system.

      Again, I am appreciating very much hearing of your particular struggle, and the added lens of complexity this brings. You highlight, for me, the poignancy of the situation.

      Miki

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