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I'd like to start with a story.

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Addison was an eight-year-old little boy.

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He was as blond as could be,

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he had a quirky sense of humor,

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he loved to build, he loved Legos.

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The other thing he loved was Spider-Man,

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he loved all things Spider-Man.

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Addison also was a very thin little boy,

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he was pale, and he had a cough
that literally wrecked his body.

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I had never seen or heard
anything like it in my life.

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You see, Addison had cystic fibrosis,

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and I was his brand-new,
newly minted nursing student.

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It was all new to me.

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Addison had had a good day -
I was so grateful for that -

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he actually made it to the playroom,

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he was able to build
some battleships with Legos.

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He also had all of his treatments
for his lungs, for his respiratory system,

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and he also was able to make it through


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what I considered
a mini-mountain of medication.

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And he was able to take that
with this special applesauce,

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with a lot of extra cinnamon,
that his mother had made for him.

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And together, his mother and I
helped him get through the day.

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He had had a lot of activity that day,

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and he was getting tired,
so he needed to rest.

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So he climbed into his bed,

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we tucked him in with, of course,
the Spider-Man comforter,

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and he went off to sleep,
drifted off to sleep.

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And I thought to myself,

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I was so happy for him,
he had had a good day,

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Addison had had a great day.

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Of course, as the new
nursing student, I thought,

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"He had a good day: I had a good day!"

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I breathed a sigh of relief.

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That was, until his mother
asked me the question.

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She simply said to me
and asked me, "Can we talk?"

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Well, I have to tell you,
my first thought was, "About what?"

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I kept thinking to myself,

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"There are a lot of people
in this hospital

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who know a lot more than I do."

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I felt so unprepared.

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I was trained as a "doer," you see.

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I did not feel particularly
comfortable or capable

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when it came to these kinds
of conversations.

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But I have to tell you,

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I had the good sense that day to sit down,
and I basically listened.

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And Addison's mother went on to tell me
some wonderful stories about her son;

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I felt so privileged to hear them.

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She told me what she was worried about:

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She was worried that the medications
weren't as effective anymore,

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that it took him longer and longer
in the hospital to get better.

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But she also shared with me her hopes.

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Of course she hoped for a cure
for cystic fibrosis,

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and the thing she was most hopeful for

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was that Addison's third-grade friends
would always stick by him,

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that they would always
include him to birthday parties

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and never leave him out.

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That was what she hoped for the most.

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That day I learned
some very important lessons.

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I learned, first of all,

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how important it is to tell your stories,

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to be listened to, and to be known.

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I didn't really think that I was
maybe the best person

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to be doing this conversation
or listening,

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but I was called upon that day.

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I learned that that day I was called upon
to be present, not perfect.

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Addison and his mother
set me on a path that day

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that really has been my entire career,

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and that is to help foster
these kinds of conversations

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across what people feel is a divide,
where we have to be perfect,

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and to help healthcare people

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to feel more confident and comfortable
in these conversations.

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So that is what I've dedicated myself to.

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What I'd like to do now
is to fast-forward a little bit

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and share with you a time in my life
when I was a patient.

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And I want to invite
every single one of you

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here in the audience to think of a time
when you were a patient

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or someone in your life was a patient,
and to go there with me.

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It was a happy time in my life,

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I was pregnant for the third time

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and my husband and I
were very, very hopeful

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that this pregnancy was going to take.

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You see, we had suffered
two miscarriages before this,

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but we still were hopeful that this one -
"Yes! We're going to have a baby!"

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So, with this news,
I went to the clinician

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and I'm hoping that I'm going to hear
the baby's heartbeat.

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It was very early and the clinician said,

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"Look, it's OK, don't worry about it,
it's really early.

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We'll try again next week."

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So, we tried again next week.

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Now, this time,
I didn't quite understand it,

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but there was something wrong
with the battery and the Doppler machine,

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so they couldn't really hear
the baby's heartbeat.

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Again, I leave the office
thinking, "uh-oh!"

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and the fear is starting
to creep up on me.

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I go for the third the next week,
for the third visit now,

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and again, now I'm really getting myself
kind of worked up and I'm worrying,

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"Uh-oh, is this going to happen again
to me, to my husband?"

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I explained this to the clinician, I said,

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"I'm worried. I really feel like I need
to hear the baby's heartbeat,"

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we didn't hear it that time.

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I said, "I really think
I need an ultrasound, I'm worried."

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And she said, "Well, I'm not worried."

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And I said, "But I am!"

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And I said, "Please, I think I need this."

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And she said, "Well, OK, we'll order up
an ultrasound for you,

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but I'm just going to put down
'because of maternal anxiety.'"

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(Laughter)

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I couldn't believe what I was hearing,

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I thought, "Really?
You really can't understand

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why I would be nervous,
why I would be anxious?"

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But I said, "whatever,"
I just wanted the ultrasound.

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So I find myself within a couple of hours
in the ultrasound suite in that position,

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you know, in the hospital gown,
flat on my back,

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and I am watching this radiology
technician's face like a hawk.

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(Laughter)

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Right? You guys,
you've been there, some of you.

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And it's absolutely expressionless,
I can't tell: good news, bad news?

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But I have to tell you,
the longer I'm not getting any good news,

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just by virtue that I'm
not getting good news,

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I'm starting to think the worst.

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So I say to her, I broke the silence,
I said, "Can you tell me anything?

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Can you see my baby's heartbeat?
Is my baby OK?"

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I'm kind of expecting,
"Yeah, there's the heartbeat,

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there's a little arm,
there's a little leg,"

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and there was none of that.

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And then she said those fateful words,

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she said, "Well, the doctor
will call you with the results."

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She said, "But there is
one thing I can tell you."

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I said, "Really? What? Anything!"

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And she said to me, "I want you to know

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that you did a really great job
filling up your bladder for the test."

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(Laughter)

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And I thought to myself, "Really?
Is this good news or bad news?"

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And of course, honestly,
I knew it was bad news.

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Because I thought, "If the best thing
that is happening about today

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is that I could fill up my bladder,
this is not good news."

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And in fact, over the telephone,
from a doctor who I didn't know,

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I found out that I had had
my third miscarriage.

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Of course, I was heartbroken.
I felt like a failure.

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The next morning I found myself
in an operating room.

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"Now we're going to have the procedure."

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I was very nervous
about this, very fearful.

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On the operating table, I see
a semicircle of surgeons and nurses,

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all in their surgical
scrubs suits and their caps,

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and I saw the clinician -
the "maternal anxiety" clinician -

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and I so had hoped
that she would come over to me

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and talk to me, maybe comfort me,
tell me what to expect,

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tell me maybe she was sorry
for what I was going through.

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But that didn't happen.

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And I just felt at such a loss
that I didn't have that opportunity

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and I thought, "How sad for her
that she wasn't able to do that, either."

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And again, it was a "note to self"

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about how important
these conversations are.

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But I have to tell you,

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I had an anesthesiologist 
who was behind me,

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I never did see the man's face,
but he put his hand on my shoulder,

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he squeezed my shoulder
and he talked to me in this left ear,

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and he said to me, 
"I will be with you the whole time.

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I will watch over you."

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And he said, "We'll get you through this."

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Those words sustained me,
I have to tell you.

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The next thing I knew,
I'm strapped down like this.

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And I would say, "Hey, wait a second!

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Wait until the patient is sedated
before you do that!"

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It was really scary.
I felt very fearful.

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There was a nurse
on the left-hand side of me

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who said, "Give me your hand."

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You bet your life I took that hand
and I squeezed it.

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It was a little strange
because she had a glove on,

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you know, it felt a little plastic.
(Laughter)

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But you know, it was a human hand
and it was warm.

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That was the other thing I remember,

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it was warm, and she squeezed it
as hard as I was squeezing her.

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And the next thing I knew,
as soon as the medications did their work,

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I drifted off and here I am,
talking to you.

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Those experiences really stayed with me.

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What I'd like to do now, 
with that as backdrop,

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is to talk to you about a philosophy
that I have come to with my colleagues.

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I like to think of it
as the "one-room schoolhouse."

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And in this one-room schoolhouse,
we bring together physicians, nurses,

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social workers, psychologists,
chaplains, medical interpreters.

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We bring them together with patients
and with family members.

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We leave our badges at the door,
and we learn together

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about these kinds
of conversations, what matters.

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I've learned from the families
that, years later,

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it isn't the medications or the surgeries,
the treatments that they remember.

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What they really remember is
the words that we said to them,

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our kindness that we extended,
how we made them feel,

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and the way we treated them.

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That's what stays with people,
the crucible of the whole experience.

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So this is what we learn
in the one-room schoolhouse.

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I have learned through my own training,

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as not only a nurse,
but as a clinical psychologist.

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I mentioned a lot of "doing,"

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and so much of our experience
and our training

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is focused on the technical
aspects of care, the clinical excellence -

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which absolutely we all need,
we all want, we expect that -

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but the one-room schoolhouse is about
the other half of the medical equation,

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it's about the emotional standard of care.

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I want to show you what happens
inside this one-room schoolhouse.

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On your right, my left,
is one of our physicians,

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one of our learners, and she is
actually with two of our actors.

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We work with actors;
they are really coached

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by our family members and our patients.

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She is getting the opportunity,
in a way, to try this on for size.

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How to introduce herself.

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A lot of times in the hospital,
people would say, "Hi, I'm G.I.,"

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"I'm renal.,"
"I'm cardiac."

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You have to start
with where they're at, you know.

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Not really. You may be:

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"I'm Dr. Elaine Meyer,
I'm a clinical psychologist,

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I work here in the pediatric
intensive care unit."

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You start with wherever the person is at.

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The way you introduce yourself,

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sitting down -

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When you sit down,
even if you only have five minutes,

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it seems so much better;
it's of higher quality.

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This doesn't have to be
about a healthcare conversation.

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This is a conversation in life
that's important, right?

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Just sit down. Lean into it.

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As you can see,
she's touching this person.

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There's something happening here.

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This could be any kind
of a difficult conversation:

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it could be about a new diagnosis;

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it could be that maybe
they're hearing about a miscarriage;

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they could be hearing
about a medical error,

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where this clinician might be apologizing
to them or talking to them

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about we're going to do
to make this right,

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to help make the situation whole again.

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So this is the kind of thing that happens
inside of the one-room schoolhouse.

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The other thing
in the one-room schoolhouse,

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is that practice makes better,
practice doesn't make perfect,

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especially in this art form
of conversation like this.

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Again, being called upon
to be present, not perfect.

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You all know these guys, right?

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This is one of the best mnemonics
because everybody knows The Wizard of Oz.

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What are the ingredients of these kinds
of difficult conversations?

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What I'd like to do is share with you
a way that I like to think about that.

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Remember the lion? He was after courage.

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So, what I would say to you is,

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"Never, ever underestimate
the power of your courage,

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your leadership,
your willingness to go there

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with a patient, with a loved one."

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This is not just about healthcare
conversations, this is in life.

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Carl Rogers, the great psychotherapist,

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teaches us that one anxious person
in the room is enough.

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Do you know what that means?

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That you have to be that calm,
non-anxious person, or try to be.

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Again, just as I did
with Addison's mother,

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I sat down and I listened,
I did the best I could.

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What about Scarecrow? What was he after?

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Remember what he wanted? Brains.

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This would be the information
that you have to share, the knowledge,

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your clinical experience, your wisdom.

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Very important.

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If you were newly diagnosed
with prostate cancer or diabetes,

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you certainly would want
a clinician in front of you

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who could explain what was happening,
in terms that you could understand it,

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that wouldn't scare or frighten you,

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that would help you feel like,

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"I can get through this,
we can get through this."

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Just a little example:
I work with a lot of kids

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and sometimes we may say things like,
"We're going to put you on a stretcher."

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Well, the kid may say, "Ouch! Stretch?
I don't want to be stretched!"

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This is the Scarecrow part
that we learn about: our word choice.

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Instead of saying to that child
"I'm going to put you on a stretcher,"

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I may say something like,

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"We're going to put you
on a little bed that has wheels,

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and then we'll be able to take you
where you need to go."

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So, that's the brains, the word choice.

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And what about Tin Man?
Remember what he went to Oz for?

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Heart. The heart is the little kindnesses
that we can extend every day,

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the compassion, the mercy
that we can show people,

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especially people who are hurting,
or suffering, or ill.

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Maya Angelou, the great American poet,
teaches us that in order to survive,

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a human being needs to live
in a home furnished with hope.

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So many of these conversations
are about hope.

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They're about learning to ask questions
like, "What's on your mind?

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What's worrying you? How can I be helpful?
What are you hoping for?"

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You get the idea.

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What I'd like to do is share with you
just a really brief story

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about how this all came together
for what I would call

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"a very reluctant learner"
to the one-room schoolhouse.

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This was a clinician who didn't want
to have these conversations at all.

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He had joined the
Emergency Medical Transport Team,

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so he just thought, "I'm going to bypass
having these conversations altogether.

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I'm not with people very long."

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Well, it was a good plan,
but it didn't quite work that way.

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After he had spent some time with us
in the one-room schoolhouse,

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he was called on an emergency transport

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to an emergency room
with a 14-day-old baby girl.

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The rest of the team
rushed over to the baby girl,

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and out of the corner of his eye

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he saw the father
at the foot of the baby's bed,

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and he was saying, "Come on,
little lady. Come on, little lady."

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The mother was in the corner
of the room, crying, alone.

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Effortlessly, he found himself
walking in that direction.

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He said, "I just couldn't believe
that I felt like I could do this."

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And then the next thing he did was,

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he knelt down next to the mother
and took her hand.

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He didn't sit. He didn't stoop. He knelt.

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He realized that this was sacred space,

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and he went on to explain to that family
what was happening to their baby girl,

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who, unfortunately, had severe dehydration
and was having a cardiac arrest.

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It was extremely scary.

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That family thanked him
and the team afterwards,

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and he said, "Well, I didn't do anything.
The team did everything."

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And they said, "Oh no,
you helped us through this."

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So many times people naturally devalue
the conversations that we have

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and think it's all about
the procedures and the actions,

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and he learned that day that it was really
about being present, not perfect,

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and to going there with the patient.

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So, coming full circle here,
what I'd like to do

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is to share with you
a piece of my inspiration:

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that's a lot younger me
and that's my little boy,

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and all I have to do is think about him

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and all the people who helped
bring him into the world,

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and I've got my inspiration
to know why these conversations matter

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and to keep having them
in my world, in my work.

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And I encourage every single one of you

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00:18:52,405 --> 00:18:55,435
who's sitting in these seats today
or listening to this

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00:18:55,865 --> 00:18:59,930
to dig deep, find your taproot,
find your inspiration,

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so that you, too, can have
these kinds of conversations

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with people you're taking care of
and that you love.

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And I'd like to give and close
with this last message for you:

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"Once upon a time,
you wanted to change the world."

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And I want to tell you that you still can,
one conversation at a time.

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Thank you.

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(Applause)