It is my hope that the following story will help to guide you on a journey of self-discovery and growth. I would like to awaken your ability to see from our patients’ perspective and help you notice how an “old” way of speaking, combined along with the power of our body language, can add to our patients’ already traumatic experience. Imagine how it could be different. Ask yourself, “What can I do to push the bar ever higher?” You wake up with a busy day planned: work, meetings, kids and family. You are going about your day and suddenly you start experiencing some discomfort in your chest. It catches you by surprise; you don’t give it much thought. It comes and goes for about 20 minutes. Then, suddenly, it won’t stop; in fact, it is getting worse. A million things start going through your mind, my husband, my kids, (where is my insurance card?), my job and my parents. Surely I can’t be having a heart attack! I am far too young. Then you think, should I go to the hospital? By now, the pain is getting worse. You call 911. The next thing you know, the fire department is rushing through your door. It is all happening so fast. You are frightened and your heart is racing. The EMTs start an IV; all the while they are asking you 50 million questions about your medical and family history. “Are you a smoker?” they ask. You say, “Yes,” and they tell you, “Not anymore.” You are being rushed now to the emergency department at your local hospital via ambulance. On arrival, your care and treatment is turned over to emergency department staff. They ask, “Are you a smoker?” Again, you say, “Yes,” and they tell you, “Not anymore.” Things are getting a bit fuzzy and you are afraid, knowing that something is not right. You suddenly fall asleep. As you awaken, you are told, “Your heart went into a funny rhythm and we had to shock you out of it. Don’t worry, we’ll take care of you.” Now another team, from the cardiac cath lab, enters and you are taken to the cath lab for a “procedure.” You notice that they are running down the hall, which increases your fear. They ask you, “Are you a smoker?” You say, “Yes,” and they tell you, “Not anymore.” You are put into a room that is extremely cold. Several people are moving furiously around you to get your clothes off and hook you up to all sorts of things. You are embarrassed about the fact that you are a smoker (you’ve tried to quit several times). You apologize for your weight as they remove your underwear to shave your groin for the procedure. You barely meet the doctor who is now going to put a tube into your groin which travels to your heart to see which one of your coronary arteries is blocked. (This all feels very uncomfortable to you because you look everything up on the Internet before making any decisions.) This feels like a nightmare. The doctor’s first question is, “Are you a smoker?” After you say yes, he continues asking you several questions, but you can hardly remember your name at this point. Someone tells you that your husband and kids are here in the waiting room. Now your mind shifts to them, and the thought that you could have just died, and better yet, you still might. So many things are swirling around in your head. You start to cry and the doctor insists that he gave you enough numbing medication and he isn’t hurting you, so why are you crying? They sedate you and when you are almost awake again, the doctor tells you that you have a blockage in your right coronary artery. You have the choice to put a stent in or go for bypass surgery. You have no idea what either of these things entails. You are frightened beyond imagination. The staff is telling you not to worry and that it won’t be so bad. More sedation comes as you tell the doctor that they are the experts and to do what is best. You have never let someone take total control of your life before now. You feel helpless. When the procedure is over, you hear the doctor say, “I will go out and talk to her family.” It makes you wonder what happened. You can’t remember everything, and you are worried about what the doctor did and whether you are okay. The nurse brings you a pill and tells you that you will be taking one every day for the next year or so. Don’t stop taking this no matter who tells you to, except for the cardiologist. Asking questions to the staff is futile at this point; you know they aren’t at liberty to tell you anything. When the procedure is over, you are transferred back to a cart where you await transport to a room to recover. Someone says to you, “That wasn’t too bad now, was it?” (Are you kidding me?) Your family meets you there and the staff asks them to wait for a minute while they get you settled. You can see the tears in your family’s eyes and it adds to your sadness and confusion. The cath lab hands your care over to the nurse that will take care of you for the next few hours. She says, “Hi, I am your nurse for the day, are you a smoker?” Your guilt is starting to mount as your family starts filing in to see you. They assure you that you will stop smoking and lose some weight. All you want is to scream, “Okay already! When did I lose control of my life?” You leave the hospital with a set of new rules and a bag full of despair. At some point, real depression sets in as the guilt of smoking and being overweight becomes a constant reminder of what happened and what could happen. You give it a try, but you don’t have the tools or the right state of mind to make positive changes. If this is hard to imagine, maybe it would be easier to imagine being the husband, daughter, son or parent of this patient. What these patients mostly desire is nonjudgmental care. They already know what they need to change. We all know what is healthy for us, right? Until that “little voice” in your head chimes in, like when you are eating a double cheeseburger combo, saying, “Just this once will be okay.” When our patients receive a diagnosis of heart disease, they not only get a diagnosis that disappoints them, but a dictated set of “new rules” from medical staff on how to live their lives: lose weight, quit drinking, quit smoking, take all these medications and get more exercise, etc. This is where our inner critic rears its ugly head. The patient feels guilty, depressed and hopeless. The critic convinces us that we cannot change, and that we are nuts for even entertaining the idea. It points out our past blunders and our current shortcomings. In most cases, this is not the best place to be for passionate change. We remain where we are and hope by some “medical miracle” that we get better. The above scenario could happen at any moment to you or someone you love. How would you want them to be treated, with all of their imperfections? What you do and say as a medical professional can give these people the best chance for “true resuscitation.” My wish is that you will see how small changes can benefit our patients for a lifetime. How can you empower your patient for change? Most of us desire to make a difference in our patients’ experience. If we did not, we would not be here. Yet we have only a short time to touch our patients’ lives in a way that compliments their care. Focusing on what is happening now and asking compassionate questions is key. Avoid asking the old rhetorical questions out of habit, such as, “That wasn’t so bad now, was it?” These create barriers in communication between you and the patient and tend to lead the patient away from their true experience. Leading questions like these can set up possible self-defeating thoughts, such as “Other patients must be tougher than me,” or “I must be weak because I was scared to death in there!” This kind of question also sets up a path for the caregiver’s response, which shields us from having to be in the present. We are task-oriented and a life is at stake. It also keeps us from having to listen to the patient. I have found, as a caregiver, that staying in the “now” and going through the experience with the patient allows me to have a deeper and more meaningful interaction with them. Following are some examples of alternative questions to try: • “How was that for you?” • “What would make this easier for you?” • “How can I support you in this?” • “Can I do more for you? “ Most importantly, be willing to hear the answers. I assure you that it does not take any more time. It also allows you to take the patient a step beyond in their process. We have no idea what has went on in this patient’s life before they made it to us. Minimizing their perceptions can be deflating. Their tolerance may be spent. When a patient cries, please do not stop them, do not tell them not to cry and that it will be okay. Crying is a great stress reliever (and you really have no idea if it will be okay). A compassionate smile and a moment to listen will work wonders. Try to imagine where they are and choose to be in the experience with the patient. We take for granted an amazing trust that patients have in us as medical professionals. What they are looking for is a person who will witness their experience and see them as more than just the next patient. Call us an empowerment team if you will, helping to give the patient the belief that they can make it through and that they have the ability to make changes. Be assured that these people know all of the bad habits they need to change and that several people will be involved in reminding them along the way. Ask yourself, “Do I really need to know if this person smokes to give them the best care, or is it a way to shame them into changing?” Notice that when we have a patient that is one of the cath lab team’s family, we take care of them with an especially tender heart. Open your heart to all patients and notice how it changes your life. Two years ago, I decided to become a Life Coach. The results were so astounding for me personally that I started introducing the techniques into my professional work. My interaction with coaching clients as well as my patients has become more genuine and rewarding. The outcomes have opened my eyes to the need for coaching in our field, which is how “The Cardiac Coach” was born. Here is what patient interaction looks like from a coaching standpoint: I ask, “What have you noticed about your experience?” Then I will ask them to go deeper. (The feelings are the same as all other feelings of grief). If they are angry, I will go into the anger with them. Let them be angry. If they want to cry, I let them cry. I want my patients to honor all of their emotions, not just the good ones. They are all a part of who we are. After I notice a shift in their emotions (which usually happens quickly when a person is allowed to experience what is reality for them), then we can deal with what is to come. So many people go right to the “be positive.” It is a great thing to be positive, but literally impossible with underlying suppressed emotions. When you experience what is happening in the moment, you then are free to move forward. The next step is eliciting information about the patient’s values, beliefs, fears and support system. From here, you can plan your health goals in a way that is true for that individual. What is coaching? Coaching gives patients your presence. I find that most of my patients have emotions that need to be addressed before they can even get to a place of change. Once they have really worked through what is going on inside of them, they can begin to see from different perspectives and find a way to achieve what they instinctively know is right for them. Coaching is a way of listening and asking questions that elicits the client’s true desires and values. The change then comes from their values, intensity and aliveness. I assist them in processing emotions, visualizing what is possible, making realistic goals, setting up support systems, conquering obstacles and self-limiting behaviors, as well as focus and accountability. Coaching improves clinical outcomes through less hospital admittance and more compliancy in self-management. Having a coach who is in your corner increases patient motivation and action. A happy and healthy life is within reach. For more information, go to www.thecardiaccoach.com or call Terri at (480) 236-6524.