Mind Your Manners!

Everyone has a bedside manner. It's the way you act when you're in the presence of the sick. The only question is what kind of bedside manner you have: good or bad.

I think, basically, it comes down to politeness. Manners are dropped when we as healthcare professionals become focused on the tasks we have to do for our patients rather than on the patients themselves in their humanity. When we treat them as lumps of wounded flesh, or machines that are still ticking, or jobs to be done, or problems to be handled, we stop thinking in terms of politeness and respect. Manners are customs between persons, a give-and-take dance between human beings. One can defer to a machine, but one cannot be polite to it.

Sometimes we stumble over ourselves trying to meet every little need and want before the patient even knows they want it, but in the process fail to actually connect with the human being inside of the demanding, slow, sick form before us. Sadly, sometimes we don't take the time to ask permission to touch, to explain what we will do, to step out to provide privacy, to beg leave to rearrange. We march right in to manhandle, scrub, and goad, thoughtless of the dignity we trample and the boundaries we cross so forthrightly. We enter a persons most personal realm - our eyes, fingers, instruments - bore into their bodies: We demand a trust, but are we willing to build confidence? In our hurry to put their stuff in order we lay a stumbling block before the feet of the blind. Perhaps very literally.

I take as a prime example, a blind patient I've worked with. You don't really HAVE to talk to an "normal" independent patient much. You bring in the lunch tray, you set it down with a hearty, "Here's lunch! Do you need anything else?" and you walk out. When you take in 'Pete's' tray, you have to take time to "show" Pete his meal. I draw up the table and set the tray squarely in front of him. Removing the lid, I guide him through the contents.

"You have salad, yogurt, a banana, mashed potatoes, gravy, pork chops, green beans, coffee, and milk. Your plate is right in front of you. Mashed potatoes are on the left of your plate; pork chops are on the right with green beans at the top. Here's your coffee. See it?" I ask as he touches the cup with his fingers and places it where he wants it. ('Pete' refers to his touch as "seeing") "Here's your yogurt and spoon." I've learned that it is easiest for Pete if I hand him his yogurt so he can set it where he wants it and find it without putting his fingers in it. "Your milk is behind your coffee and your banana is above your plate. Fork is on the left and knife and spoon are on the right."

Now, I could plop the tray in front of Pete and run, leaving him to messily "see" what is there for himself. I could rattle off the above explanation and split. But good manners demand that I stay until I'm certain that Pete has successfully "seen" his tray and knows where he is and what is happening. Good manners demand that I do this in a respectful manner, as one would give a guided museum tour to a party of professors, rather than as one would explain simple kitchen chores to a child.

The saddest instance in caring for Pete came the day Pete was turned around. He was getting a room-mate and the nurse had rearranged the room. He was in his wheelchair and had somehow been turned without realizing it as well. He asked me to bring him something from the table to the right of him, not realizing it was actually behind him, and to help him get into bed, not realizing he was trying to get into his room-mate's (unoccupied) bed feet first. He's a smart man, fully intellectually competent, but his world had been rearranged. It annoyed me that it hadn't dawned on the nurse that Pete couldn't actually function if he couldn't "see" his room and his stuff. He could have potentially panicked trying to find the door at the opposite side of the room. I brushed off the nurse's fluttering, and Pete and I discussed the location of his environment, beginning with the his orientation in the room (front, back, window, door, bed) and ending with the exact location and contents of all his drawers, tables, and belongings.

Yes, I chafe when I think that while I wait, nine other patient's trays are cooling on the cart. Yes, I itch with the urge to hasten and be on with other tasks unnumbered and unknown. But before me sits a person who needs to see. The choice is not whether I will care for his body, but whether I will treat him as a fellow. It is a question of whether or not my humanity and his humanity will find each other. As a patient his humanity is exposed. His hand lies passively open and waiting. It is mine to put my hand in his.

When we're through he tells me, "You know, you're not too bad. No matter what they may say, you're not bad."

I think he means to say that I met him as a person. He's returning the compliment.

Bedside Manners

What on earth do I need another blog for? Nothing, really. I'm starting this blog as a place to record thoughts from clinical practice, as distinct from the rest of my online life as my life at the hospital is distinct from my casual existence. I hope to be able to share experiences and insights into patient care in a generalized way that does not breach privacy or confidentiality. Maybe, this exercise will help me learn some more manners along the way. That's it for tonight.

The first rule of preparing for good patient care is to rest yourself beforehand. So off to sleep with me!