In Shock: My Journey From Death to Recovery and the Redemptive Power of Hope, by Rana Awdish. 2017. (New York: St. Martin’s Press, $25.99, 266 pages, hardcover.) (Also available from Bantam Books as In Shock: How Nearly Dying Made Me a Better Intensive Care Doctor.)
This beautifully written and compelling book details this physician’s pain, misdiagnosis, surgeries, loss, and recovery after she suffers a catastrophic rupture of a tumor during the seventh month of her first pregnancy and effectively bleeds to death in the very hospital where she works. As she experiences multisystem organ failure, stroke, and complete hemodynamic collapse she also experiences the dehumanizing experience of being viewed as “a case”—defined by her abdominal pain and fetal demise rather than as a person. As a patient she is often disbelieved, patronized, judged, and even rebuked for being difficult. When Awdish makes the decision to not hold the baby who dies, a nurse determines that this was not the right answer and tells her, “You should hold the baby. I don’t want to be graphic, but after a few days in the morgue, their skin starts to break down and you won’t be able to anymore, even if you change your mind.”
The dehumanization isn’t limited to the conduct of the medical staff, though. Her description of a discrepancy in the hospital bill is wrenching. “Receiving a bill for the attempted resuscitation of the baby, for example. My husband took on the task of reconciling the bill with the lack of a baby. The billing department explained that the bill was generated when we had failed to enroll her in our insurance plan. No one could explain, of course, at what exact juncture we should have called our insurance company, seeing as how she’d never technically been alive. It took four phone calls to settle the charges. A trivial oversight, by a department ostensibly not involved in patient care, had the potential to bring me to my knees.”
Awdish uses these experiences to question and redefine everything she has ever considered (or hasn’t) about patient experience, patient engagement, doctor satisfaction, and the meaning of health care. Rather than defend these comments and attitudes, she seeks to transform them into words and actions that build and repair, sustain and inspire. “It is entirely possible to feel someone’s pain, acknowledge their suffering, hold it in our hands and support them with our presence without depleting ourselves, without clouding our judgment. But only if we are honest about our own feelings.”
Her interactions with obstetricians, maternal/fetal specialists, and radiologists are not unique, of course. They parallel the stories that women tell us in childbirth class, in consultations, and which sometimes emerge even during labor. These kinds of dehumanizing words and actions are one of the reasons women seek midwives and doulas to accompany them, especially if they are birthing in a hospital. Yet not even all planned homebirths or midwife-attended births remain low risk and the hospital can suddenly become a woman’s Plan B. Sometimes obstetricians are involved and sometimes they become the primary caregiver. If the doctor or nurse we were to begin working with at that point had read Awdish’s eight pages of communication tips and attended her workshop, both we and the pregnant woman we accompanied could anticipate a vastly different human connection.
From her “tips” for the physician before the encounter we read: “The emotional state of the physician impacts everyone in the room. While it is important to take the temperature of the room, it is equally important to know what emotions you are bringing with you. Think of yourself as a thermostat. You have the ability to return the temperature of the room to neutral. Your emotions should never add to the heat, they should only equilibrate the room.” And this wise counsel; “Take a moment to check in with yourself—are you hungry, thirsty, tired, or otherwise distracted? It is likely that you are all of the above. What can you do to tend to yourself in a minute or less that will help you be more present for the encounter? A well-timed snack, a peek at a picture that reminds you of what you are looking forward to at home later, or a deep, cleansing breath can center and calm your nervous system. It can deactivate the flight-or-flight mode … and allow you to focus on the patient. Allow yourself the gift of being able to truly see.”
In her hospital’s training program all new employees are taught the difference between “avoidable” and unavoidable suffering. The goal is to “mitigate suffering by responding to the unavoidable kind with empathy and by improving our processes and procedures to avoid inflicting the avoidable kind whenever possible.”
What midwife, doula, childbirth educator, or patient hasn’t fervently wished to be attended by or consult with a physician who was more patient, sensitive, empathetic, and compassionate? If Dr. Awdish’s trainings become commonplace, we can hope medical providers will be better able to offer compassion, empathy, and even vulnerability. Ultimately, her book is about honing both kindness and technical skills. That both are vitally important is no surprise to the midwifery community!