Yesterday I had two separate diagnostic imaging appointments. One was for an ultrasound at the cancer agency and the other was for a follow-up mammogram at a diagnostic imaging centre. I finished treatment for breast cancer six months ago. Both appointments involved my poor beleaguered breasts, but otherwise the two experiences could not have been more different.
I sat in my therapist’s office today and deconstructed each appointment. I’m figuring out why I am so desperate for kindness in health care settings. A chunk of that is my own stuff – I seek comfort when I’m feeling vulnerable. But no matter my own personal reasons – I hope we can all agree that being mean to people in hospitals and clinics is not an acceptable option in Canada in 2017.
I present these two experiences to demonstrate how easy it is to be kind, how it does not take more time and how kindness is up to individuals and lack of kindness cannot be blamed on the ‘system.’ Never forget the system is made up of people. Even in a health care culture that does not promote kindness for its own staff, there is opportunity for exceptional folks to go against culture to demonstrate caring for those they’ve committed to serving.
1. I waited among the bank of chairs in the hall, the first appointment of the day. A gentleman pushing a laundry cart called down the hall to me: ‘Hello there!’ This perked me up and made me smile – scared, anxious me, sitting alone in the cancer hospital for my first post-cancer treatment scan. Hello there mattered.
2. A man came out of the ultrasound room. A man to do my breast ultrasound! But he had a warm smile and called me by name. Come and get changed, he said and I’ll meet you in the room. Put the gown on with the back open, he added before he disappeared. I was greeted warmly and clearly told what to do. I appreciated the option of the gown. (This will make sense as you read my other experience).
3. I changed and went into the room. The lights were darkened and there was soft classical music playing. The environment was comforting.
4. The whole ultrasound took about half an hour. This nice man talked to me the whole time. He asked about my cancer treatment in a conversational kind of way. He told me what he was doing as he was doing it and also shared with me what he was doing next. Providing information about what was happening and what to expect next was a great comfort.
5. He said – this might hurt. Tell me if you feel pain. He also said, ‘I’m almost done’ as he was wrapping up. He told me when he left the room and why. He wasn’t afraid to acknowledge my pain.
6. I was still wound tight as a top, clearly worried that all my cancer wasn’t gone. He said to me, ‘don’t be worried.’ I knew full well he wasn’t allowed to tell me anything about my scan. The results of the ultrasound would be faxed to my oncologist in a week (alas, it is the holidays, so I won’t find out the results until the new year). But his ‘don’t be worried’ – even if it wasn’t true, validated my concern and was actually sweet. He lessened my anxiety with his words.
I walked out feeling okay. It wasn’t what this man did – it was how he did it. And none of it took more time. And, surprisingly to me, it did not matter one bit that he was a male technologist because of his compassionate approach.
And then, one hour later, in sharp contrast, I experienced the cold, the officious, the not-so-kind experience.
1. I had a mammogram earlier this month, but had been called back for another appointment. I asked the booking clerk when she phoned, ‘why do I have to come back?’ She said she didn’t know. So I spent sleepless nights thinking they found more cancer. Not telling me why I had to come in again seems cruel.
2. My husband, having dropped our son off at school, met me at this appointment. We sat in one crowded waiting room until I was called into another waiting room. On the door it said: Women only. No men were allowed. My husband sat on a bench outside the elevator for the next hour. Not permitting my partner to accompany me is not patient or family friendly.
3. I sat in the second waiting room for a long time. I was hoping I wouldn’t get the same technologist as before, as she was unfriendly. (Irony alert: having a woman technologist does not guarantee a good experience). It turns out I got another woman, who was equally as unfriendly. I knew then unfriendly was the culture of this diagnostic imaging centre, and only the most exceptional clinicians would rise above it.
Then there was this sign:
I knew to expect it because I had been there before, so I was wise to them. I brought a cardigan to wear in the mammogram room. At my last appointment, I had to strip from the waist up in front of the technologist and stood there, unnecessarily exposed, cold and topless. This time I brought my own cover-up.
There’s so much to say about this sign. First, the idea of being efficient by not encouraging gowns is baloney. I sat in the waiting room for 40 minutes. Forty minutes is plenty of time to change into a gown, isn’t it? And for environmental impact? Yes, I guess doing laundry is bad for the environment. All my years of hating hospital gowns and I never would have guessed their solution to sterile gowns would be to take away the gown. Yes, I could have taken a gown but this was clearly not encouraged. There were other signs too, saying NO CELL PHONES. There was a stereo on the floor, tuned into a Christmas music radio station that cut in and out as people walked past and played loud commercials. The room was packed. All of us women were lined up in rows in chairs, our fear palpable. Signage and physical space sets the tone for the whole patient experience.
4. Once I was called in, I had to strip from the waist up. I put my cardigan back on and pulled it tightly around me. The woman did not introduce herself. She did not tell me what she was going to do. I said casually – it is too bad we don’t have gowns. ‘Gowns just get in the way,’ she responded. Oh. Dignity starts with giving options to minimize patient nudity. (Do I really have to say this?).
5. I don’t want to discourage women from getting mammograms, but this mammogram hurt a lot. She did tell me they wanted a closer picture of one part of my breast – which happened to be in an awkward position – close to under my arm. I was jammed into the mammogram machine. I whimpered as she tightened the machine around my breast – this one, my cancer side, still swollen with edema from radiation. She did not acknowledge my pain and clamped down on it some more. Not acknowledging pain does not help with suffering – in fact, it increases it.
6. She must have taken ten more images. Each time it hurt more. I tried to breathe but I was told to hold my breath. I was starting to feel dizzy and clammy. I had no idea when she would be done. Being left in the dark about what’s going on is anxiety-provoking in an already anxiety-provoking situation.
7. Suddenly, it was mercifully over. I stood in the corner, my back turned and got dressed. I was told to sit in the waiting room again, but I didn’t know why. Another woman came about 20 minutes later and told me I could go. I wasn’t informed what was to happen next or when my test results would be shared with me. I got out of there as fast as I possibly could. Knowing what will happen next does help.
I met my husband in the hall and he enveloped me in a hug. What took so long? Did they find something? he asked, clearly alarmed. I shook my head and said, just please take me home.
Listen, I don’t need emails or comments telling me I should have spoken up. I know how to speak up. I also know how to submit a complaint but I gotta tell you – a lot of good that’s done me in the past. Sometimes all we can do is put our head down and endure horrible situations. I don’t always feel like being an advocate. I am not always strong. That’s ok too.
But I hope I have demonstrated with these stories how one person can make a difference. That the little things matter. That what is not a big deal for health professionals (like topless patients) might be a big deal for us.
Those who work in health care can make a hard situation better by demonstrating compassion. For my whole mammogram experience, all I can say is: I know you can do better.
As Anne Lamott says, there are only two prayers: Help me help me help me. And thank you thank you thank you. For the ultrasound technologist, I say thank you. Thank you for making things a little bit easier for a scared, traumatized woman with breast cancer. What you did mattered. In fact, all those so-called little things you did – that took no extra time at all – mattered to me a lot. For you, I am tremendously grateful. xo.