Thursday, June 13, 2013

Team Better.

When I took down your history on a note card, it all sounded so awful. A bumpy ICU course. Out of the intensive care unit but then a setback that took you straight back. Aggressive critical care with a molasses slow recovery. The discussion was punctuated with a deep sigh by my colleague.

"So I am thinking the goal is just lots of rehab and a long term acute care facility of some sort."


"Yeah, man. It's bad. Super unfortunate."


And that was pretty much our exchange verbatim. A story laced with morose head shaking and helpless shrugs. The good fight had been fought. This would be your lot in life unless something really dramatic happened. A miracle even.

Let's be clear. You'd had a set of really amazing physicians doting over every aspect of your care. Smart ones with far more facts in their heads than I have. They'd consulted other smart people and all of their collective brainpower had not gotten you better. At least, not in the way that I define better.

Of course, they'd pulled you hard with all of their might from the grips of death. So technically that counts as better. But it was sad to see your face as you came to the realization that getting away from the death grip doesn't mean you've escaped the claws of disability.

So, yeah. "Long term acute care" was the plan for you which, for me, really meant not much more than making sure that nothing bad happened before a social worker could locate you a facility. And that, coupled with your age, didn't sit well with my soul.

After meeting you that first day, I couldn't stop thinking of you. I agonized over what our team--your new team--could offer you that hadn't already been tried. How could we add to this and was there any way for us to fight the inertia of your current assessment and plan?

The chart described your pre-hospitalization self. Mostly healthy with one or two medical problems that didn't explain the irreversibility of your current state. And you were young. Younger than me with a life filled with people and love and even a little dog. I'd bet you still had things waiting for you in the dry cleaners and a few dishes in your sink. This wasn't supposed to happen.

And so the things I offered you weren't rocket science. The most I can say that I did for you was not accept that you were destined for chronic disability.

"Listen. I've been reviewing you chart and I want you to know what has been going on." This is how I started that conversation that day. All you could do was nod your head because with so many devices connected to your body, your voice was rendered useless. I explained your hospital course including the parts where your body tried to slip away but didn't. And when I did your eyes squeezed shut and tiny tears rolled out of the sides of them and onto your dry cheeks.

"I just don't see a reason why you can't fight your way back. There isn't some. . .I don't know. . . like physiologic reason why. And by physiologic I mean like in the way your body is wired that would make you not get better."

"I want to get better!" you mouthed. And I understood.

Better meant you'd have a fight on your hands. It would mean determination and pushing hard through physical therapy sessions. It would mean keeping your spirits up by any means necessary and doing everything you could to not succumb to the suffocating blanket of depression. I told you just that and you furrowed your brow and let me read your lips once more, uttering those words like some kind of covenant vow. "I WILL."

And I looked at you and held your hand to let you know that I would fight, too. That I would come in every day and look at you like you could get better and talk to you like you will. That this would be modeled to my residents and students and we wouldn't give up on you or the possibility of you not going to a nursing home. Together, we would all be "Team Better."

And so. Something amazing happened. You started fighting harder than ever. And every single day, someone came up to me with an incredulous expression in awe of whatever stride you'd just taken. One after the other. Closer and closer to the person you once were. Or better yet, the one you would become once you left.

The other day, I looked at you pushing your walker with the therapist and said, "Look at you! You are amazing!"

And you smiled at me and said--this time audibly, "I feel GOOD! Like I'm gonna get all the way better!"

"We are Team Better, remember?"

You laughed when I said that. "We are. We are!"

We are.

I want to thank you for showing me another aspect of what I can do as a physician. Now I know that sometimes it has nothing to do with fancy work ups or high tech procedures. Sometimes the best thing I can do is believe that you can get better. Or healthier. Or off of drugs and alcohol. Or whatever it is that that threatens to nudge me into the learned helplessness that impedes everyday miracles. I can't fix everything. But I can make up my mind to at least try believe in the tiniest chance of your recovery. Because if I do, just maybe at some point, you will, too.

Happy Thursday.


  1. so beautiful... the best gift you can give a patient, i believe!! thankful for you on your patients behalf!!

  2. Now THIS is a testimony . Amen.

  3. I have a feeling team better is going to go all the way on this!!

  4. I read this at exactly the right moment to read it, when I needed it. Thank you for being the doctor, in the truest sense of the word, that you are.

  5. From the deck of the Poop,

    Great piece of writing.. you continue to amaze the ole Poopdeck,
    I went to a school board meeting one night and spoke, with I very rarely do. Almost never. I used the "Learned helplessly theory to drive home a point of putting, otherwise motivated, students in a situation where they could see no way out, they would just GIVE UP. When I read the words I smiled and thought about your using the "Drum Major instinct" in one of your speeches at Tuskegee.

    Keep doing it Dr. KD



"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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