Good Intentions

I spend a lot of time every day asking people to do things.

I have discovered that written orders get overlooked, phones go unanswered and everybody is busy.  But if you plead your case in person, sometimes a "no" turns into a "yes."  I think.  Or maybe they just want to shut me up.

"Can you please do this crossmatch before you go to lunch?  The patient is on the OR table?"
"Can you please not worry about placing the foley catheter?  I will do it in the OR."
"Can you please go to the blood bank and check for one unit of A neg?"
"Can we please do two cases before lunch?"

While I see my begging and "personalized care" as being very patient-focused and caring, I suppose some may see it as annoying and micro-managing.  I constantly ask myself: "What if this were me? or my family member?  What would I want my doctor to do?

Duane Elmer, an author of several cross-cultural training books, gave a great little story regarding intentions versus outcomes in his book Cross Cultural Servanthood.

"A typhoon had temporarily stranded a monkey on an island.  In a secure, protected place on the shore, while waiting for the raging waters to recede, he spotted a fish swimming against the current.  It seemed obvious to the monkey that the fish was struggling and in need of assistance.  Being of kind heart, the monkey resolved to help the fish.

A tree precariously dangled over the very spot where the fish seemed to be struggling.  At considerable risk to himself, the monkey moved far out on a limb, reached down and snatched the fish from the threatening waters.  Immediately scurrying back to the safety of his shelter, he carefully laid the fish on dry ground.  For a few moments the fish showed excitement, but soon settled into a peaceful rest.  joy and satisfaction swelled inside the monkey.  He has successfully helped another creature."

How do we get our outcomes to line up with our intentions?  

Today, my "struggling fish" was a patient who presented with active vaginal bleeding at 33 weeks.  When I arrived to evaluate her, an IV had been started, but fetal heart tones could not be heard and the nurse thought she felt placenta in the vagina.  On ultrasound, I saw a complete previa and a fetus whose heart rate was 60 bpm (normal is 110 - 150 bpm).  She was taken to the OR for an emergent C-section.  A CBC or labs had not been drawn.  My primary focus was delivery of the infant. 

Anesthesia had another focus.  He wanted another IV line.  My begging began.  "Please, the baby's heart rate is very low, can we just start? This line is running fine." 

He couldn't get another line.  Minutes ticked by...3, 5, 7 minutes.  "Please, I need to be cutting now...."

"Can you just shut up?"  His words shocked me.  Is this really my life now?  To beg to be able to do my job?  To plead on behalf of the attempt to save a life so that I can be yelled at?  And why yell at me?  Because I am impairing his concentration?  Because it wasn't clear why I was in a hurry to do the surgery?

Or am I like the monkey?  Are my attempts to help my patients just compromising the team effort, maybe not even effecting my outcome? 

The greatest obstacle to contend with as a medical missionary is this quandry of "good intentions."  The complexity of differences in cultures that are thrown together in a mission hospital combined with high stress situations create the perfect storm of misunderstanding, dissention and frustration.  As Elmer writes in Cross Culture Servanthood, good intentions are not enough - people can't see inside to read our motives, they can only judge our actions.  Whether we are persistently asking for something the other person is not wanting to give, or we are snapping back out of frustration, it is those moments that make or break the team dynamic.  Unfortunately, once those impressions are made, it is very difficult back-track and re-establish a trusting and healthy working environment.

What would I do differently about today?  Ahhh....the rub of hindsight....