The hospital case was a difficult one: a dying mother with seven school-aged children, an angry husband, and the patient’s sister who constantly clashed with the husband over medical decisions once the patient could no longer make her own.
It was a perfect case for Schwartz Center Rounds , a program now taking place at 195 health care facilities across the country, where caregivers talk about cases like this one, challenging for emotional – not medical – reasons.
These were the inaugural Rounds for United Hospital in St. Paul, Minnesota and hospital chaplain Verlyn D. Hemmen, who facilitated the session, told me that they were a huge success, with about 120 doctors, nurses, social workers, administrators and others in attendance. (I have changed some of the details to protect confidentiality.)
One of the issues that came up was the appropriateness of caregivers crying in front of patients and families. A member of the panel presenting the case recounted that at a family conference, the patient’s sister had gone around the room pointing at different caregivers and telling them whether they could continue to care for the patient, depending on whether she had seen them cry about her sister. She pointed to one doctor who she had not seen crying and told him she no longer wanted him involved in her care because he had not been appropriately emotional.
Verlyn said that story led to a lot of discussion about whether caregivers who show emotions are crossing a professional boundary that should not be breached. By and large most attendees agreed it is absolutely appropriate to display emotions in front of patients, without seeming hopeless or “falling apart.”
Verlyn said one veteran nurse began crying as she recounted the case, and she was shocked at her reaction. “Like many of us, this nurse sees herself as a professional, able to move on, but our bodies and emotions don’t always see it the same way,” said Verlyn. “I don’t think she realized how much emotion she was storing. This is what makes Rounds so crucial. They are an opportunity to identify, acknowledge, express and normalize these difficult emotions and find out that we are not alone. Caregivers need to process these hard cases because they don’t go away. ”
Verllyn said lots of other issues came up during the hour-long Rounds session, including the lack of psychosocial support in the Intensive Care Unit for the patients’ children as they witnessed the process of their mother dying.
What do you think about crying in front of patients? Is it appropriate?