Season 2 Episode 2

Good Medicine:
Rethinking Patient Care

Good Medicine: Rethinking Patient Care

Season 2 Episode 2

About The Episode

Dr. Rana Awdish shares her profound journey from being a critical care physician to a patient fighting for her life, and how this experience revolutionized her perspective on patient care. After losing an unborn child and nearly losing her own life due to a burst tumor, Rana witnessed firsthand the gaps in the healthcare system, particularly in how medical professionals handle emotional care and communicate with patients. Her experience led her to advocate for a healthcare approach that emphasizes empathy, effective communication, and the small yet impactful acts of care that can significantly alter a patient's experience. Her story is a powerful reminder of the potential for personal adversity to drive positive change and the importance of compassion and empathy in medicine, and in our everyday lives.

Connect with Dr. Rana Awdish

"We have to have individual tools, system tools, but also a framework that says: you can't solve everything, but you can reduce the suffering of the person in front of you."

- Rana Awdish, Physician and Writer

Season 2 Episode 2

Episode highlights

00:28 A Word from Connie Fontaine and Harry Cohen
01:11 Introducing Dr. Rana Awdish
03:26 Unpacking the Journey: From Physician to Patient and Beyond
06:32 Transforming Medical Communication: A Personal Mission
08:31 Developing a Compassionate Communication Training Program
11:03 The Power of Empathy and Compassion in Healthcare
18:12 Listening is a Form of Devotion
20:01 A Roadmap to Difficult Conversations
22:46 The Heliotropic Way to Reflect Competence
25:06 Applying Compassionate Communication in Personal Life
27:05 Using Curiosity as a Tool
29:58 Checking in on the Availability of Others
31:35 Practicing Efficiency vs. Authenticity
33:45 Navigating Emotional Support During Crisis
35:10 Self Compassion: Releasing the Need to be Perfect
37:41 The Healing Power of Acknowledging and Sharing Pain
41:44 Concluding Thoughts on Compassion and Presence

Key Links & Resources

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About Dr. Rana Awdish

Dr. Rana Awdish is the author of In Shock, a critically acclaimed, bestselling memoir based on her own critical illness. She is a sought-after public speaker, delivering inspirational keynote addresses to groups ranging from professional medical societies, to members of Congress, to organizations combatting homelessness.

A pulmonary and critical care physician, she serves as the current Director of the Pulmonary Hypertension Program at Henry Ford Hospital. She also serves as Medical Director of Care Experience for the System, where she has integrated compassionate communication strategies and Narrative Medicine practice into the curriculum. 

Dr. Awdish received the Schwartz Center’s National Compassionate Caregiver of the Year Award in 2017. She was named Physician of the Year by Press Ganey in 2017 for her work on improving communication and received the Critical Care Teaching Award in 2016. She has been inducted into the Alpha Omega Alpha medical honor society and the Gold Humanism Honor Society

Her narrative non-fiction essays have been published in The Examined Life Journal, Intima, CHEST and The New England Journal of Medicine. She has written editorials for The Harvard Business Review, Annals of Internal Medicine, The Washington Post and The Detroit Free Press. Her essay The Shape of the Shore was awarded a Sidney by the New York Times and was nominated for a Pushcart Prize.  

Prior to coming to Henry Ford, Dr. Awdish completed her training at Mount Sinai Beth Israel in Manhattan. She attended Wayne State University Medical School and completed her undergraduate degree at the University of Michigan in Ann Arbor. She is board-certified in Internal Medicine, Pulmonary and Critical Care Medicine.

Full transcript: Dr. Rana Awdish

[00:00:00] Rana Awdish: As a patient, I heard my colleagues say things like, we’re losing her. She’s circling the drain, or she’s trying to die on us. All of these statements that felt like they were attributing blame to me, in a sense. There was difficulty with the emotional aspects of the care as well. The sort of, you’re so lucky to have survived, so I’m not going to attend to any of the grief that I think is pretty common. 

[00:00:28] Harry Cohen: The voice you just heard was Dr. Rana Awdish and she’s about to tell her story of how she went from physician to patient and what that journey taught her and how she’s transformed her own care practice and teaches other physicians.

[00:00:47] Connie Fontaine: Yes. She was a patient who lost an unborn child. She died on the table, and has come back to do so much great powerful work that she’s going to talk us through today. And yet one of the things that I took away was these messages are not just for physicians and those in the medical community, but for all of us. It’s, not just the big things, but the small things that make a difference.

So let’s jump right into this.

[00:01:11] Introducing Dr. Rana Awdish

[00:01:11] Harry Cohen: So it is my absolute honor and excited privilege to introduce Rana Awdish, I have been, Connie and I have been waiting for this podcast and this podcast for quite some time. I reread your book. I listened to several of the videos and interviews and commencement addresses in preparation for this. And I have to say, I wept several times just the other day. I finished one of your, Talks and was literally weeping and a friend 

[00:01:45] Connie Fontaine:

[00:01:45] Harry Cohen: came in and said, are you okay? And I said yes, I’m okay. I’m preparing for this podcast. Our guest is going to be amazing. And I am so excited about not just your story and what you have done and how you will articulate to our audience, but how much good we can do together.

So without further ado, please welcome the author of In Shock, the Director of Pulmonary Hypertension Program at the Henry Ford Hospital and the Medical Director of Care Experience at Henry Ford Hospital System. And a lot more.

 Rana Awdish.

[00:02:24] Rana Awdish: Thank you very much, Harry. I’ve been looking forward to it as well.

[00:02:28] Connie Fontaine: It’s great for us because yeah, we get to see you through the book which I would say, In Shock: a book to not read on an airplane because I too cried more than a few times during reading it. But the fact that everything I had so many aha moments, Rana, that were not as a physician but as a mother, as a patient, and quite frankly, as a business woman, and so many of the concepts are for everybody.

And so we really look forward to unpacking that with you today.

[00:02:56] Harry Cohen: before we allow you to talk, I want to say one more thing, which is

 our mission is that your wisdom, I believe, we believe has so much more opportunity to help so many more people than just the medical audiences that you get to speak at frequently. I want to expand your message to more people.

So that is my motive that your wisdom, we can get into the heads and hearts of more people. 

[00:03:26] Unpacking the Journey: From Physician to Patient and Beyond

[00:03:26] Rana Awdish: I appreciate that. I appreciate the work that you’re doing to spread these heliotropic principles and good in the world. And I think there’s a lot of alignment. Medicine’s sort of an easy target because there are lots of places that we can improve. But as you said, there’s resonance across a lot of different industries. 

That is the reason that, that we fell in love with you, i. e. your competence and achievement and story and what you are already doing.So would you mind just giving context for the audience? Yeah, I appreciate the opportunity to do that. I just by way of background wanted to be a physician from the time I was a child. Our, family pediatrician saved my infant brother’s life and that was a really striking moment to see how knowledge could change the trajectory of someone’s life and literally be life saving if you could listen in the right way.

And I, went down the path of achieving that goal, undergrad, medical school, residency, and I chose critical care as my fellowship training because it really felt the most medicine y medicine. It was just where all of the things were happening. And at the very end of my training, literally on the last day of my training, I got very sick myself.

I was seven months pregnant and I had, what I didn’t know was a tumor in my liver and it burst. It was like a collection of blood vessels. So when it burst, I effectively lost all of my blood volume into my abdomen. And that night really in the hospital died, I went into multi system organ failure.

I ended up on a ventilator. I was in horrible refractory shock. I got 26 units of blood cells. Really, my whole blood volume replaced multiple times over. And and then for the next few months, got to experience medicine very much from the other side of the bed. And to see this profession that I had really esteemed so highly and held in incredible regard, I saw how we got the technical aspects of the care just right, but there was like this gap we had a really hard time attending to difficult emotions, sitting with suffering, knowing what to say, and how to deliver serious news well. I saw a lot of the failures and I recognized myself in those failures. And that was really a motivation for me to be different when I went back.

[00:06:24] Harry Cohen: And you took that horror and it was a long journey. You took that horror and you transmuted it. 

[00:06:32] Transforming Medical Communication: A Personal Mission

[00:06:32] Harry Cohen: Tell people a little bit about, okay, so then you created this. How do we help residents in the medical ecosystem not do what I was exposed to? 

[00:06:43] Connie Fontaine: Maybe give a couple examples because they’re pretty prolific examples that you talked about at the end of the book or at one of the videos. Just

[00:06:51] Rana Awdish: Yeah. The first most apparent thing was just the language that we used around patients. So as a patient, I heard my colleagues say things like, we’re losing her. She’s circling the drain or she’s she’s trying to die on us. All of these statements that felt like they were attributing blame to me, in a sense.

There was difficulty with the emotional aspects of the care as well, which was a little bit more subtle. The sort of, you’re so lucky to have survived, so I’m not going to attend to any of the grief that I think is pretty common. And so for me, the first ask of myself when I was well enough to do so was to learn communication strategies that could be in my own toolkit so that I could meet that challenge better.

Over those whole 14 years of training, we devoted zero to communication, zero, not a class, not a seminar, not an hour at lunch and learn, nothing. And it was the most important aspect of my job. So seeking that out first for myself was very important. There were colleagues at the hospital who had been through training and recommended it.

And together we just formed a coalition of people that thought we could do something differently.

[00:08:14] Harry Cohen: and you created this magnificent training, which is offered to not just medical students, but actually residents because they have to have some experience with patients so that they can learn how to do it better.

[00:08:31] Developing a Compassionate Communication Training Program

[00:08:31] Harry Cohen: Rana could you articulate how you took your vast, amazing journey and experience and learning and as the director of care experience for this huge hospital system, how did you formulate a training that could do so much good?

[00:08:48] Rana Awdish: So very much a team effort. I wouldn’t want to give the impression that in any way I did this by myself. There was,a really dedicated group of physicians that sought out training outside of our organization through Vital Talk and then adapted programming that they were doing specifically for our needs.

What I really credit Henry Ford Health with is as a patient, I had this experience that was hard and that was fraught and I saw lots of failures. And rather than try to suppress that in any way, they just built me a bigger stage and said, you have ideas about how we can be better. How can we support you? What do you need?

And so the resources that the organization was able to put behind the communication training, it couldn’t have happened without that. And it couldn’t have happened if we weren’t a learning organization. If we didn’t genuinely believe that when our patients come to us with something that is an opportunity to be better, we owe it to them to find a way to do it, even if it’s one of our employees.

[00:10:00] Harry Cohen: beautiful because I saw the amount of resources deployed. You had an actor, you had two facilitators. The curriculum was very detailed and long and you were able to cut to many of the issues and credit t o Henry Ford. And let’s see if we can spread this to more hospital systems.

It seems so  valuable

[00:10:24] Connie Fontaine: That they were willing to shine a light on it. And enable you to help facilitate this conversation. It isn’t something to be embarrassed about. That’s, one of the things you made very clear in your writing was this is how we were trained. And there was a reason also to protect yourself, but there’s a different way.

And we’re glad that you’ve brought this different way to light.

[00:10:43] Harry Cohen: And I was so honored to sit through one three hour class of which there are many, and was so impressed with the articulation of how to do and not do appropriate communications. 

and it’s such basic stuff. But what I came away with is, Oh my God, this is wonderful for physicians.

[00:11:03] The Power of Empathy and Compassion in Healthcare

[00:11:03] Harry Cohen: It’s every single person in a healthcare system should go through this training,But also felt like everybody should go through this training So I wanna distill some of the essence of this wisdom. When you talk so beautifully about the tiniest little things from people who, wheel the patient down the hall and what they can say to make them feel cared for, those are the moments that I believe the listeners of this podcast can get, which is the tiniest exchanges of compassion. And empathy listening and being present for someone else’s pain. I came away from re listening to some of your talks more present with a dear friend who was crying. I was just able to be there and said nothing and didn’t try and solve and fix and provide here’s what you should do and jump in too quick with. So here’s what we’re going to, going to move forward. And it was because of your work, slash wisdom. So share some of those

[00:12:11] Rana Awdish: I’m grateful to you sharing that. And you speak to a really important point, which is the first thing we almost had to deprogram ourselves of was this feeling that our presence lacked value if we couldn’t fix it for someone, because that’s so ingrained in medicine, but also our culture that we’re just meant to fix things.

And what else is worthwhile? And I’ll give you an example. We went on to have a son who was born prematurely, and I was visiting, once I was discharged myself, I would go to the NICU every day, and one day I pulled into the parking structure, and the parking lot attendant, who knew nothing more about me than that I drove in every day, said, “I see you come here every day and you don’t leave until after my shift is done. I sure hope whoever you’re visiting gets through this okay.” And I was like blown away because he, in his role, just watching people come into the structure. He was observant and present enough that he was able to witness my suffering and express a presence that even my care team couldn’t.

And they had all of the information available, right? And he knew nothing. So it really, we worked really hard to integrate those kinds of stories at Henry Ford into our orientation to really illuminate the fact that it’s a whole culture of caring.

It’s not one person’s responsibility more than any others. The transporters were some of the heroes in my story. They protected me when I would leave the ICU and felt very vulnerable. And so that’s something that’s available to everyone, but I think the first most necessary step is you have to believe it matters.

[00:14:12] Connie Fontaine: And I think you, you do that very well in explaining that, physicians, there’s a reason for this. This is not about demonizing the medical field. There’s a reason, it’s a very important way of training, and there’s a way to experience that emotion. You also highlight that it’s hard because once you experience that emotion, you’ve got to find those rays of joy every day too.

Do you want to talk a little bit about that?

[00:14:33] Rana Awdish: Yeah. Because this learning was all a sequence, it didn’t just arise out of nowhere. The first place I came to was like, we just have to show more empathy. We have to learn how to demonstrate empathy for people who are suffering. And as I practiced that, I found that it could actually be really depleting. if I didn’t have a way to process it, that I would I had this belief that I needed to neutralize other people suffering with my own body. And that’s just not a sustainable plan. And from there, I started to read about compassion versus empathy and the idea that transmuting that sense of affiliation into action, Finding something that you could do in the moment that would serve the person who was suffering, however small, was a way of releasing it.

And that was a really helpful transition to me. It doesn’t mean that we don’t still need spaces to process hard things, and we do, we have peer processing sessions. This was especially important during the early waves of COVID. We have to have individual tools, system tools, but also a framework that says: you can’t solve everything, but you can reduce the suffering of the person in front of you.

[00:16:01] Harry Cohen: so that beautiful mic drop moment, 

[00:16:06] Rana Awdish: Yeah, you can’t fix the suffering of the world, but you do have an ability to reduce the suffering of the person in front of you.

[00:16:16] Harry Cohen: And it’s that insight, which is what the parking attendant did. I want every single person to be that parking attendant 2 things. 1 to understand how important it is. And to be vigilant for the person who’s coming to the NICU.

He didn’t know where you were going, but that I want that to be our legacy. I gotta be that parking attendant. I don’t even need, I don’t need to be a physician. If I’m a physician, I got so much, I can be anybody who’s eyes open and I can relieve the suffering of the person in front of me on the airplane and the train, the anywhere, anytime. With the tiniest of gesture, a hand, a phrase. I want you to know I’m there for you. I just love the simplicity. And you also said that, people have to know that it’s really true empirically that this stuff works. This is what we talked about. Steven Tresiak’s work on compassion. I was just reading him this morning. All the data shows that it’s powerfully healing. Okay. But knowing isn’t doing, and I do think that what you have shown in every time that I have both listened to you and in every conversation I’ve had you, you don’t come off as the expert. You come off as a learner 

[00:17:41] Rana Awdish: still learning how to do this, It’s humbling work. No matter how many times you approach it with your little bag of tools and you feel ready, you always encounter something that’s right at your learning edge that you hadn’t considered and you have to go back and see what else is available. So it’s humbling work.

[00:18:04] Harry Cohen: Now we know it’s true. What have you seen work so that we can spread it more? It’s the do more of that consciousness.

 

[00:18:12] Listening is a Form of Devotion

[00:18:12] Rana Awdish: You know, in addition to valuing our presence when someone’s suffering, I think, understanding that listening, our attention, is a form of devotion and people feel that when they have your undivided attention and you let them work through something that’s difficult for them. They’re not actually expecting you to have a solution. I’ve found, naming what I hear and reflective listening, repeating it back to people, “it sounds like you’re really worried.” Whatever the worry is, “it sounds as if this is all feeling very scary.” Just naming it can help align you with the person who can feel very isolated.

And that alignment, that affiliation, I think it’s the first step in helping the person to see that you’re going to partner with them. You know that they will be the one to do the work, but you’ll support them. Because we have trainees from all over the world, we try to offer many different skills that will be accessible because not everyone’s going to feel comfortable based on their cultural background of saying to an elderly person, “you seem really anxious,” that might not be within their framework, but they may be very comfortable with statements of respect of saying, “I’m so impressed that you’re here at your husband’s bedside every day.”

There are many different entry points , but they have to feel resonant and true to the person who’s expressing them. And so we work hard to help them identify what works for them.

[00:20:01] A Roadmap to Difficult Conversations 

[00:20:01] Harry Cohen: so I was able to attend the training and it was three and a half hours and I, there was so much in it and it was so well organized. There’s a great acronym, which I could not repeat, but if you could articulate the essence of the high points of the training. I think the listeners will go. That sounds great. I want to get some of that nutritious and delicious.

[00:20:24] Rana Awdish: What we try to offer the participants is a roadmap to difficult conversations and we break it down into micro skills. So we start at the very beginning with a skill called “ask, tell, ask,” which just trains participants that before you come in with news, find out what the person knows already.

So it can be something as simple as, could I ask you what your other doctors have told you so far? And then the tell part is making sure that you give a very brief headline statement without jargon so that someone can absorb what is undoubtedly serious news. And later in the conversation to ask and assess for understanding, How might you tell your family when you go home about what we discussed today?

So I can judge my own communication and its effectiveness. That comes at the beginning. Then there’s a lot of work around just how do you attend to emotion? And there we use the NURSE acronym, so you can name it. You can offer statements of understanding, of respect, of support. You can explore with genuine curiosity.

If someone’s quiet, reticent that skill repeats throughout conversations, right? It’s not deploy it and you’re done. It’s beginning, middle and it’s always present. And then there’s the actual roadmap itself of progressing through a conversation where we map out someone’s values. What do they care about?

Where do we have alignment with those values? How can we propose a plan of care that aligns with what the person wants in a way that’s respectful of who they are as a person and what their hopes are for their life outside of the hospital? So those micro skills are throughout. The overall road map is something they get to practice with the actors so that they can really anchor on skills that are effective.

[00:22:29] Harry Cohen: And that training could, should be available to every single physician across the land,

[00:22:35] Rana Awdish: Yeah.

[00:22:36] Harry Cohen: period. In the meantime, the micro skills that we’re talking about paying attention to the person in front of you and being present is available immediately. 

[00:22:46] The Heliotropic Way to Reflect Competence

[00:22:46] Connie Fontaine: So society, societally often, and you point this out that arrogance is a form of, showing competence. That was where we believed in the medical field, how you show competence to your patients. And now you’re trying to drive it to a different way.

How do you demonstrate competence in a heliotropic way without being arrogant?

[00:23:05] Rana Awdish: What’s interesting is our patients judge our competence by our communication skills. That is the surrogate that they use for competence. They are, in general, although it does happen, not asking where we went to medical school and what residency we graduated from, what score we got on our boards and what percentile rank we were, they are judging our competence by our communication and importantly by our team’s functioning.

So if one person says one thing and someone says something else, then we’re not communicating within our own team. Having that set as our intention of communicating with one voice , in a clear way without jargon that is understandable at a pace that is acceptable for the person who is going through a hard thing that builds trust in a way that relates to competence.

I think at even a higher level,

[00:24:08] Connie Fontaine: I think at a much higher level. And I think it’s a similar thing, whether it’s in business and leaders can, the ones who communicate the best. The new version of a great CEO is just, it followed that same path that you’re talking about.

[00:24:21] Harry Cohen: Or in any role. I’m thinking about

[00:24:24] Connie Fontaine: A parent. 

[00:24:26] Harry Cohen: is it any different as somebody who comes to someone for some assistance and some help and listening is a form of devotion, and let me be clear and not use jargon in explaining something so that together we can solve this problem and we can get you on your way.

How about that for the, wow, that isn’t a roadmap for how we should be conducting our lives more better. Just like that, no matter what role you play in your life, whether you’re the parking lot attendant or you’re a salesperson or a CEO or a physician or a parent.

 

[00:25:04] Harry Cohen: try and do this.

[00:25:06] Applying Compassionate Communication in Personal Life

[00:25:06] Rana Awdish: that’s one of the secrets I think of this work is that it’s actually helped us in every aspect of our lives, all of the people who facilitate. So my husband is an attorney and he’s. He works a lot and sometimes he’ll come in the house and he’ll still be on a call and he won’t even know he’s in the house, right?

He’s walked in, but he’s still living in his work brain and it used to drive me crazy. Like at least be here when you’re here. And then once I started doing these classes and he did the same thing of walking in, ranting on the phone, usually swearing. I just said, it sounded like it was really difficult for you to get off that call.

And he was like, it was, I’ve been trying to get off it since 96 and that affiliation rather than an argument was an easier way to have that conversation.

[00:26:01] Harry Cohen: this is the microcosm right there that we, all of us can be eyes peeled, ears open for opportunities to do more of that. 

[00:26:13] Connie Fontaine: you asked a question, that was the thing you, if you felt something different on the inside, you feigned curiosity. So let me,

[00:26:21] Rana Awdish: That was the key. I’ve noticed you, you hit the nail on the head because it’s closing the gap between how you feel in the moment and who you want to be. How I felt in the moment was irritated and annoyed. And who I wanted to be was understanding

[00:26:38] Connie Fontaine: Yep

[00:26:40] Harry Cohen: And this is the essence, this being the person that you want to be remembering who you are, vote in the direction of the person you want to be. I don’t want to be an irritated, angry spouse. So why are you on the phone when you come in, wait a minute, how would I. Oh, I know what I can, it sounds it seems to me, I’m present, I’m listening. Oh

[00:27:02] Rana Awdish: and curious.

[00:27:03] Harry Cohen: instantly better,

 

[00:27:05] Using Curiosity as a Tool

[00:27:05] Connie Fontaine: Curious. Not judgmental.

[00:27:07] Rana Awdish: Curious became the most important thing, honestly during the pandemic, because having curiosity about people who had totally different beliefs than me, who, thought COVID was a conspiracy, after we’d suffered a lot in the ICU, watching so many people lose their lives. Just asking, ” what has this experience been like for you?”

And hearing from my patients that they weren’t allowed to see their grandchildren because they wouldn’t get vaccinated or they felt disposable because the world just wanted to go on with its economic work without them in the way. Hearing, genuinely from a place of curiosity about how they got to where they got to emotionally, really helped to form a new place to start from because if they felt isolated, I also had felt isolated for a different reason. But we shared that in common, and that was a starting point. If they felt disposable, I had also felt pretty disposable as a healthcare worker. We had that in common. And finding those areas of commonality, I think all of us could do well to do more of that.

[00:28:26] Connie Fontaine: I think that’s a great point. 

[00:28:27] Rana Awdish: And we certainly found that during the pandemic, having curiosity for the experiences of others was one of the most important things. 

[00:28:37] Connie Fontaine: one of the things that I continually enjoy is what does it mean to be heliotropic and constantly listening for what are the qualities that make somebody heliotropic and you embody them. Curiosity is one of those qualities that we love to be around, people who are genuinely curious. To be a good listener is to be heliotropic. Who couldn’t be better in our listening? To be more present is heliotropic. To be non judgmental Is to be healing. So the way you are demonstrating this both in the way you are as a teacher, as a physician, as a mother, as a wife is just so wonderful.

[00:29:24] Harry Cohen: One of the reasons that we wanted you on this podcast is that you are an exemplar. You are a person who is already heliotropic in the way that you live your life. And you can help so many people. Cause you already do that. They can look at that and go, I could do some more of that like you’re not a unicorn, you’re not sooo accomplished and so amazing. Although you are accomplished and amazing the lessons that we can take from that are, Oh

 

[00:29:58] Checking in on the Availability of Others

[00:29:58] Rana Awdish: it’s basic. one of the learnings for me that’s been transformative, even though it’s so simple, is just asking permission before talking about something hard, before bringing something up. I think physicians have a habit of just assuming that they have permission to say whatever they come into the room to say.

[00:30:25] Connie Fontaine: And actually checking in with someone to say, would it be all right to talk about what might come next? And letting them think for a moment of whether they have the capacity to have this conversation because they think medicine, unfortunately, The world tends to overvalue efficiency and not the actual connectedness that can come from a conversation Yeah that point is important with our spouses. It’s important with our children. Harry and I talk about this with adult children. We don’t have the right to just assume they want our opinion and they’ll let us know. So we’re pretty careful about that.

[00:31:06] Harry Cohen: Thank you, Connie, I agree, and your insight about connection is healing and effective. It is not necessarily efficient. It does take some time to build connection, but it’s really healing and good for both communication, understanding, aligning of values, creating a shared desired outcome together. It is simple, but it does take a little bit of time, just a little bit of

[00:31:35] Practicing Efficiency vs. Authenticity

[00:31:35] Rana Awdish: I get pushback in medicine about that exact thing. So I’ve come to separate efficiency into authentic efficiency, where you actually accomplish the thing that you set out to do and just efficiency for the sake of the clock. I can have an efficient visit with a patient in five minutes. There is no way they’re going to take the medication I prescribed, know what the side effects are, know when to call me, know what the red flags are. It was efficient. Didn’t accomplish a thing. It actually, you know, Steven and his book, Compassionomics talks about the fact that there is good data that shows it doesn’t actually take more time to be compassionate in an encounter, and I thank him for this because I tell every physician, someone feels acknowledged, feels seen and feels heard, they’re not going to have the need to reverse back to the beginning of the story and tell you all over again, which we all experience all the time because no one doesn’t think you listen.

It’s a way of diffusing some of the big emotions and it actually leads to shorter encounters. 

[00:32:46] Connie Fontaine: It’s interesting. I didn’t know that. It makes sense though, because people don’t feel like they’re trying to tell you 

[00:32:53] Rana Awdish: hmm. 

[00:32:53] Connie Fontaine: they want to make sure they’re heard. 

[00:32:55] Rana Awdish: Like a customer service call, like how many times have you repeated no, I already told you.

[00:33:00] Connie Fontaine: 

[00:33:00] Harry Cohen: This is what we mean by the metaphor of salt on roots. We’re talking about when you salt someone’s roots, you make them feel crappy. Many ways you can do that. One of them is not to listen. One of them is to be so focused on efficiency that you don’t express compassion and make them feel that you care for them. So this simplistic metaphor is what I can remember and come back to. How did I make my wife feel? How did I make the person in front of me feel? And that is either I was sun on their leaves or salt on their roots. And you get this completely.

[00:33:45] Navigating Emotional Support During Crisis

[00:33:45] Connie Fontaine: I’ve found this to be so helpful because often, our suffering is very real.

[00:33:51] Rana Awdish: Even when we’re bystanders to a trauma, we’re feeling something, but checking ourselves as to whether it’s appropriate in that moment for us to express our suffering. If the person in front of us is more impacted, I think is really critical.

[00:34:10] Connie Fontaine: Yeah. Cause the aha moment for me is, physicians say to you, how your tragedy was making them feel . Or they were so afraid you almost died on them. And it was, it’s that we do it in a much less significant way every day in which we express how we feel about somebody else’s difficulties.

[00:34:28] Rana Awdish: And I’ll tell you, that’s a mistake that I still make to this day. I catch myself telling a patient that I care a lot about you really scared me. And I don’t mean it in terms of you should feel bad for scaring me. I have to reprogram myself to say, everyone here was really behind you last night.

We know it was a rough night, but some of these patterns of speech are just so ingrained that having an awareness about them, so on a meta level you’re watching yourself as you speak and can recalibrate, is important.

[00:35:07] Connie Fontaine: But if you don’t recalibrate in time, How do you recoup?

[00:35:10] Self Compassion: Releasing the Need to be Perfect

[00:35:10] Rana Awdish: It’s funny. I’ve come to allow myself to be human with my patients. So I have in real time said , “You know, that came out wrong. I am sorry, would you allow me to start again?” I’m thinking of a patient I had who I just walked into her room assuming her life wasn’t worth living. I made an assumption based on the fact that she had terrible metastatic disease that was, not allowing her to eat, not allowing her to sleep, keeping her in constant pain.

And I went in saying, “my goodness, what you’ve been through and now not to be able to eat. How awful.” And she was like, that’s not how I feel. This treatment didn’t fail. It got me six more years. And she just corrected me. And I said, “I’m so sorry. I made assumptions based on your chart. Can we start over?” And I,

[00:36:19] Harry Cohen: So to me, mic drop, that to me is the beauty of what we’re talking about, to be heliotropic, to be the sun. You represent when you make a mistake, when you step in it, when you do that, you beautifully articulated, apologize well, just way you did. Can we start over? That came out wrong. Let’s start over.

I love that because we are all going to do that. We’re going to make that mistake. And wouldn’t it be cool if we could see it, just like that?

[00:36:48] Rana Awdish: I find self compassion within that. So releasing the need to be perfect in every moment to acknowledge I’m growing and human and not perfect by any means . That’s really nourishing for me. I release a lot of things that would otherwise hold me back. 

[00:37:12] Connie Fontaine: Do you find that harder to do at home with your husband and son?

 

[00:37:16] Rana Awdish: It’s always harder in your personal life because I think you release some measure of vigilance. These aren’t viewed as high stakes conversations in the way that some of my conversations are at work.

But my husband, by training does negotiation. So he’s often the more sane person in a conversation. And that’s okay.

[00:37:38] Connie Fontaine: Yeah. That is good. You know each other.

[00:37:40] Harry Cohen: Love it. 

[00:37:41] The Healing Power of Acknowledging and Sharing Pain

[00:37:41] Harry Cohen: Can you give people the background and the context, but the story, the quote that’s seared in my brain is may we metabolize our pain so that it softens our hearts and the story that you told about your son 

[00:37:58] Rana Awdish: Yeah. Yeah.

[00:38:00] Harry Cohen: That was the moment that really made that happen for all of us. So give our listeners that gift.

[00:38:08] Rana Awdish: I was really worried that I’d brought home so much sickness from the hospital that it had just irrevocably changed who he was.

And I carried that with me for a while, and I had gotten sick again, I’d had a surgery, I was home recovering, my husband always tried to keep my son away while I was resting, and he made his way into my room, and he waited until I opened my eyes and he said, ” is your pain small like the size of a quarter where they cut you, or is it so big it takes up the whole room and there isn’t any space for me?” And I remember just thinking oh my god that’s such a better pain scale than our zero to ten 

[00:38:49] Connie Fontaine: Zero to

[00:38:50] Rana Awdish: Right?

Like it has volume, it has mass, it expands, it contracts, it crowds out other things that are wanted. Wow! And it was then that I saw, that my worries about his capacity, even my own capacity, to go through hard things were really unfounded. They were just fears and that we all have the ability to metabolize the hard things into something different, into meaning, into an understanding of how to be with someone who’s in pain and that ability to just assess the situation, understand how to function within it, regardless of the constraints, and accept it.

It was so much more welcoming than the kind of petty accounting I was doing of my own ability to parent him. And it gave me a lot of peace that maybe he’s okay.

[00:39:49] Harry Cohen: He’s more than okay.

[00:39:51] Connie Fontaine: that the point of that story for me, and I hope for our listeners is that no matter what pain they have gone through, are going through, or will go through, let us give them proof that they can be stronger, better, and their hearts more softened from it, because of it , you know with self compassion, self love or compassion or love for others. I know that has been the case for me and the pain that I’ve gone through and listening to you and your story reinforces it. So I hope that that people can take solace from that that part of being heliotropic is not toxic positivity. It’s genuine understanding of suffering and wanting the best from it, even though it can take A while Thank you for sharing that.

That’s right And I think what I, and I started out just our quick hello before we started recording today, just telling you how much your book sucked me in all the way till the end. And I think people should know that your story is so big. We’ve broken it down to some really important principles, and it’s so important to us that we reflect back that the light that you’ve brought out of this crazy journey that I can’t even imagine eight years of healing, like you had to, and the joy after the grief and all of that. The book tells so much more, and it is, physicians will get something out of it, NP’s will get something out of it, but parents, people anything.

And so I just, I want to acknowledge that because it was a, it’s quite the journey that we didn’t get into today. There’s no way to encapsulate it in a conversation like this, but thank you for bringing all that light out of that great crazy journey you were on.

[00:41:41] Rana Awdish: Thank you.

[00:41:43] Concluding Thoughts on Compassion and Presence

[00:41:43] Harry Cohen: so Is there anything you’d like our audience to hear, remember, get from this?,

[00:41:55] Rana Awdish: Yeah. I think, your message of being the sun, not the salt encapsulates it beautifully and recognizing the power in that. That’s been a journey for me as a physician to understand that just our presence and our willingness to sit through hard things is the most important thing.

[00:42:17] Connie Fontaine: Game changing 

sure 

[00:42:19] Harry Cohen: And it’s not small. It seems like it’s small. It’s everything. with someone is a lot.

[00:42:28] Connie Fontaine: The emotion that emotional toll that it takes on a daily basis. And for all the healthcare professionals that are taking this on to become this evolved human, bringing humanity into the room because it does take a change, I know, especially for those that have been in it for a long time, for everyone that’s doing that. I commend them because it does make a difference to any of us that get put in that situation.

[00:42:52] Harry Cohen: And compassion fatigue. It turns out this is Steven Teresiak’s work and your work. It turns out that by giving to others, by being present, it is 

[00:43:04] Connie Fontaine: the fuel

[00:43:06] Harry Cohen: the fuel to our soul. Thank you guys. 

[00:43:09] Rana Awdish: Thank you.

[00:43:10] Harry Cohen: I

 thank you for the time.

[00:43:11] Rana Awdish: I’ve enjoyed our discussion.

[00:43:13] Connie Fontaine: We have too.

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