Optimized for caring

Feussner, Derek - VUMC PGY-II 9-2013 - with Mark McCaw

Mark McCaw, Associate Director for the Siloam Institute, explains the primary care preceptorship program to Dr. Derek Feussner.

Editor’s note: This blog is written by Vanderbilt internal medicine resident Dr. Derek Feussner who recently completed four weeks of training at Siloam.  He writes about his experience…

So often, in large urban medical centers, patients come and go with little focus given to their spiritual, emotional and cultural well-being. As residents at Vanderbilt, we strive to do a phenomenal job taking care of acute medical problems, diagnosing and treating complicated illnesses and performing research to advance medical knowledge. What we often overlook, however, is a patient’s spiritual health.

During my time at Siloam, I was able to see firsthand the direct relationship between spiritual, mental and physical health as it relates to a patient’s entire care. I remember taking care of one such patient who presented for a routine follow-up visit. Based on my chart review of her chronic medical conditions, her normal recent lab work and the appropriateness of her medication regimen, it figured to be a straightforward patient-physician interaction. However, when I entered the room and began speaking with her via an interpreter, it became clear there was much turmoil in her life. She had recently lost her husband and was attempting to care for her young daughter with limited resources and limited social support. Her entire family still resided in her middle-eastern homeland and her contact with them was limited.  Using the skills I had learned through my daily interaction with Siloam’s wonderful medical team I was able to obtain a social work and pastoral consult in one single visit. She met and prayed with our pastor and was set up with resources to obtain medications and care for her daughter. There was nothing specifically wrong with her body’s physiology, but her health was certainly suffering and she was spiritually ill.

Throughout “generic” medical training, residents are taught about religion and how it relates to medicine; about poverty and how it affects patients access to adequate health care – but what we never learn is how to truly care for someone in their entirety. The majority of patients have strong spiritual belief systems and these intertwine entirely with how they perceive illness, medical intervention and prevention of health problems, but as residents we rarely inquire as to patients spiritual needs. Being able to work in an environment where taking a spiritual history is “normal” has opened my eyes to the need for a more holistic approach to patient care. I look forward to carrying this knowledge into my future practice.

An Invitation

Yesterday I spent the afternoon at a pool party.

It may seem unremarkable; Nashville summer is eat-your-ice-cream-quick hot and this is the weekend of fireworks and barbeques, too-pink skin and Chaco tan lines. Yes, this party may have fit the American mold in that there was food, laughter, and the sun shone bright, but that is where the similarities end. This was the first pool party I had ever attended in which I did not speak the primary language, or know what most of the food I was consuming was called.

This was the first pool party I’d ever been to that was thrown especially for me.Jesus welcoming us

Let me just say this: the people of El Shaddai know how to throw a surprise party. Although Caleb, James and I were shocked to discover that the small gathering we’d been expecting from a casual invitation the week prior was in reality a full-blown party, we felt comfortable. In the midst of the jokes and homemade coconut ice cream of this Spanish-speaking congregation I found myself at home, a welcome addition to this beautiful community, simply because through love I was invited to be.

As I peruse the Holy Word I’m struck by the fact that God has forever known the importance of an invitation. I’ve often puzzled over the seemingly simple queries of the Lord, from the “Where are you?” of Garden of Eden fame (Genesis 3:9) to the seemingly flippant “Would you like to get well?” to the lame man at the pool of Bethesda. (John 5:6). Doesn’t God already know the answers? This week I realized that God uses questions as an invitation towards engagement with Him. Through questions God invites me to be found and be healed, to grasp tightly to His bloodied hand. Through Jesus, God reaches out an invitation to engage with me.

This week I met “Biruh”, a beautiful young refugee woman. Biruh is three months young to America, the beloved younger sister of her older brother “Myo”, a new employee of Tyson® working 60 hours a week. Biruh is severely anemic and very weak. Biruh is also deaf and mute. Along with James Dolezal, I accompanied Michael Daniel, Siloam’s Physician’s Assistant, to visit Biruh at home. When we arrived, we were shocked at what we found—Biruh, sitting despondent in a corner of the small living room, head hanging low. She was in the company of a neighbor, a man who (when prompted) attempted to communicate with her by speaking loudly. “That means she has to use the bathroom,” he said confidently as Biruh almost imperceptibly moved her left hand. When asked about her family (Biruh was unresponsive) the neighbor promptly disappeared to locate them, leaving us alone with Biruh for almost ten minutes.

She didn’t lift her head the entire time.

Eventually her family returned and confirmed what I feared: Biruh spent the majority of each day in the tiny apartment, alone. Her mother commented that, although she asks Biruh to clean for her, she is “lazy and slow”.

As I looked at Biruh I felt that I had never seen a more vulnerable person. Here was a person begging with her whole being to be invited to engage; and as we prayed for her before departing I hoped she realized that Jesus was extending that bloodied palm towards her. As we prayed for healing for Biruh, body and mind, I prayed the truth of Scripture, “My ways are far beyond anything you could imagine…He who did not spare even His own Son, how will He not also freely and graciously give all things?” (Isaiah 55:8, Romans 8:32).

I cannot understand Biruh’s pain, her loneliness, or God’s purpose in her debilitating disability. But I remain confident that God invites her to be His, to rest and be healed, and so I hope. I hope in the invitation that will allow her to feel at home with a family of strangers. I hope in the promise of “how will He not also…?”. I place my hope in that bloody cross, and I pray for Biruh, because through His love I am invited to do so.

Claire Johnson - CHI 2013 participant Claire is a participant in Siloam’s Community Health Immersion.

Compassion is a Universal Language

Entering the room I expected to see “Mrs. Garcia” sitting awkwardly due to some pain in her right leg. compassionate-touch - courtesy of boldgain blogHowever, she had also listed “depression” among her complaints,  I did not know what to expect. I did notice the vacant expression on her face and assumed that the leg pain was not the only thing on her mind.

While Dr.Wills conducted the physical examination I wasn’t interested in the content of the questions he was asking but rather the manner in which he asked them. Contending with the language barrier and aided by the use of a phone interpreter we learned that her pain renders her almost useless at home and doesn’t allow her to get more than four hours of sleep a night. Obviously, these are factors which contributed to her feelings of depression. Right here the questioning could have ended, pain medication, anti-depressants, and sleep medication could have been prescribed, as well as a referral to see a physical therapist and she could have been on her way. However, Dr. Wills chose to delve deeper and involve the other resources available at Siloam.

I accompanied Mrs. Garcia to Rebecca Swift’s office (she is the staff behavioral health consultant) where we learned that when Mrs. Garcia had left Cuba, both of her sons and their family’s application to relocate with her had been denied by the Cuban government. Just listening to her talk about both of her sons and grandchildren – I could see that she was missing a huge part of her life and her heart. While explaining this, she began to cry and I found myself reaching out to pat her back as an assertion of what Rebecca was saying – that she was a good mother and she raised fine young men. When Rebecca had finished, Mrs. Garcia was offered and agreed to prayer from the Siloam Pastor, Doug Mann.

I have had the pleasure of speaking with Doug on occasion and his sense of humor is unmatched, but to see him in this context: praying with a woman who felt alone and worthless, was a true blessing. Through his beautiful words, Doug was able to illustrate to Mrs. Garcia the love that God has for her and the great lengths that He is willing to go to in order to pursue her. As tears continued to stream down her face all she could say was, “gracias,” over and over again. When she was on her way to leave she turned to me, hugged me, and kissed me on the cheek. It was right then I realized that I had witnessed something special in this woman’s life.

I have always understood the term “whole-person care” as not only seeking the physical well-being of a patient but also ministering to their mental, emotional, and spiritual health. In theory this sounds like an excellent way to go – especially when considering that all aspects of health have an impact on one another. However, actually caring for the “whole person” can be a very daunting task for any individual. While I do believe that it can be done, there is definitely a better outcome if a team approach is taken. Siloam has mastered this;  not because they try to “fix the problem” but because they truly care and love the people they serve. While there is a wealth of knowledge to be gained from a clinical perspective at Siloam, what I am finding most beneficial from my time here is the way they show love and bring hope to their patients.

Manzella, Elias - 2013Elias is a participant in Siloam’s Community Health Immersion.

Discernment – a sorting process

Guest blogger, Debbie Smith, MA, Director for the Center for Women in Medicine, is a life coach and leader with Medical Christian Fellowship at Vanderbilt.  She serves on the Siloam Institute’s oversight committee. Today, she writes about discernment and announces a Nashville-area discernment retreat.

Debbie writes…

Sorting Hat - Harry Potter

House affiliation is discerned using the “Sorting Hat” in Harry Potter’s adventures.

As I meet with medical trainees and professionals, one of the most common questions that comes up is how to know which option to choose when they are confronted with a fork in the road.  Whether it is something as large as vocational calling and direction or as ordinary as how to handle a relational interaction with a classmate or colleague, there is a longing to know how to make good choices.

Recently, I have met with many trainees who are contemplating choices such as choosing a residency program; whether they should take a year away from medical school to participate in personal or professional growth opportunities; how to navigate difficult family relationships, or whether to make a significant financial expenditure.  One of the things I have learned from my own spiritual journey is that God cares about every facet of our lives and that He longs for us to turn to Him for guidance and companionship as we sort out the options before us.

The discernment process is just that – a sorting process.  In her book, Pursuing God’s Will Together, Ruth Haley Barton says:  “Discernment literally means to separate, to discriminate, to determine, to decide or to distinguish between two things.  Spiritual discernment is the ability to distinguish or discriminate between good (that which is of God and draws us closer to God) and evil (that which is not of God and draws us away from God).”  She also quotes Ignatius of Loyola, founder of the Jesuits, in defining the goal of discernment as “finding God in all things in order that we might love and serve God in all.”

One of my goals for the work of spiritual formation that I am engaged in within the medical community is to provide contexts for individuals to slow down and engage with the questions that are swirling in their mind and heart.  Our culture, and particularly the culture of medicine, doesn’t always encourage this sort of thoughtful reflection and prayerful consideration, but Jesus invites us: Come to me. Get away with me and you’ll recover your life. I’ll show you how to take a real rest. Walk with me and work with me—watch how I do it. Learn the unforced rhythms of grace. I won’t lay anything heavy or ill-fitting on you. Keep company with me and you’ll learn to live freely and lightly.” (Matthew 11:28-30, The Message)

Medical Christian Fellowship will host a Day of Discernment retreat on Saturday, February 9th from 9 am – 4 pm at St. Barthlomew’s Church (Nashville, Tennessee, USA).  To register, click here to download the registration form.

“There are moments in life…”

“There are moments in life, when the heart is so full of emotion that if by chance it be shaken, or into its depths like a pebble drops some careless word, it overflows, and its secret, spilt on the ground like water, can never be gathered together” -Henry Wadsworth Longfellow

I have never really been in touch with my emotions. I have managed them as someone with a chronic disease who waits until a visit the Emergency Room to treat a compounding illness from not seeing a primary doctor for the smaller problems over the years. I generally manage to “effectively” ignore vulnerability. I rarely entertain its validity. However, those who are close to me would say that I am a “crier.” If it does reach ER status, I am bound to be crying, and an emotional hurricane ensues.

Lately, I am finding myself unable to suppress my tears as before. I sense them welling up within me like an unwatched bathtub that slowly fills to the brim, about to overflow.  I feel them building with talk of the refugees, saying “good morning” to the little ones running around the apartments, and watching the people in the clinic get through each day.   Regardless of the newness surrounding these emotions, I am still keeping them suppressed. I do notice a constant lump in my throat.  Yet, that suppression is now being challenged.  I swear every person I come into contact with says just what I need to hear in that moment.  I valiantly fight the tears internally. How can all of these wise, courageous people be surrounding me at once? From being simply checked in on, to others sharing their “story,” I am encountering love.

The only simple explanation I have is that my emotions are moving as a result of meeting this love in the others around me. It is not that they are specifically planning what comes up in their conversation with me, it is a testimony to how each of them lives their life. The words they share rise to meet my struggle. Their wisdom is hitting me in the deepest place because I am in such a raw state. The sense of peace they have given me is a matchless gift.  The tears that result remind me of just how real these internal responses are.

Although they seem slightly uncontrollable right now, I have learned that if I unpack my emotions I may begin to discover new passions, and find deeper meaning in the presence of the people who have been placed in my life to aid in my journey.

Emotion: Noun: A natural instinctive state of mind deriving from one’s circumstances, mood, or relationships with others.

Home Visits

On Wednesday, I was able to participate in my first house call, with Dr. Henderson. When we got to the church where we were supposed to meet the interpreter and then go from there to the patient’s house, there was a misunderstanding and the lady whose home we meant to go  walked in. After some confusion and talking back and forth through the interpreter, we were able to communicate our desire to talk to her in her own home. She cheerfully invited us and so we piled into the cars to head for her apartment.

As I watched this happen, I wondered why it was so important to Dr. Henderson that we go to her home. She was there, we were there, it made more sense to just treat her there as she was expecting us to. We went through an awful lot of hassle to drive a few miles down the road to do the exact same thing.

Once we got in the apartment, took our shoes off,  sat down on the chairs the family pulled out for us, and started talking to her, I realized why the doctor cared so much that the visit be in the patient’s home.  Sitting in her living room, we were able to hear about her family, we saw pictures of them on her walls and heard stories of the major moments in her life they depicted. We were able to get a better feel for her diet. We saw exactly what and how much she was eating. It gave us a much bigger  sense of who the patient was as a whole, not just as a list of symptoms. It was personal, conversational, and relaxed. The patient felt heard, and the doctor was able to better judge where she was.

I saw that the point of the house call was to invest more in the patient. A doctor could address the patients concerns more easily and more quickly in the clinic. A house call isn’t about efficiency. It was about getting to know her, to step into her life, and to take the extra step in caring for her as a person. There is an added element of love in being willing to drive the extra miles, take your shoes off, and listen for awhile that often gets left out of a standard office visit.