On being present, not perfect | Elaine Meyer | TEDxLongwood

Elaine Meyer is on a mission to change the world... one conversation at a time. In her intimate talk, Meyer draws on both professional and personal experience to illustrate the profound gaps in healthcare communication and how to close them.

Dr. Elaine C. Meyer is the co-founder and director of the Institute for Professionalism and Ethical Practice (www.ipepweb.org) at Boston Children's Hospital and Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School. The first of its kind, IPEP has trained thousands of health care practitioners across the Harvard teaching hospitals and the globe in the relational and communication competencies essential to conducting challenging conversations.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

I'd like to start with a story.

Addison was an eight-year-old little boy.

He was as blond as could be,

he had a quirky sense of humor,

he loved to build, he loved Legos.

The other thing he loved was Spider-Man,

he loved all things Spider-Man.

Addison also was a very thin little boy,

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

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

You see, Addison had cystic fibrosis,

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

It was all new to me.

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

he actually made it to the playroom,

he was able to build
some battleships with Legos.

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

and he also was able to make it through

what I considered
a mini-mountain of medication.

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

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

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

He had had a lot of activity that day,

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

So he climbed into his bed,

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

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

And I thought to myself,

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

Addison had had a great day.

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

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

I breathed a sigh of relief.

That was, until his mother
asked me the question.

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

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

I kept thinking to myself,

"There are a lot of people
in this hospital

who know a lot more than I do."

I felt so unprepared.

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

I did not feel particularly
comfortable or capable

when it came to these kinds
of conversations.

But I have to tell you,

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

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

I felt so privileged to hear them.

She told me what she was worried about:

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

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

But she also shared with me her hopes.

Of course she hoped for a cure
for cystic fibrosis,

and the thing she was most hopeful for

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

that they would always
include him to birthday parties

and never leave him out.

That was what she hoped for the most.

That day I learned
some very important lessons.

I learned, first of all,

how important it is to tell your stories,

to be listened to, and to be known.

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

to be doing this conversation
or listening,

but I was called upon that day.

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

Addison and his mother
set me on a path that day

that really has been my entire career,

and that is to help foster
these kinds of conversations

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

and to help healthcare people

to feel more confident and comfortable
in these conversations.

So that is what I've dedicated myself to.

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

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

And I want to invite
every single one of you

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

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

It was a happy time in my life,

I was pregnant for the third time

and my husband and I
were very, very hopeful

that this pregnancy was going to take.

You see, we had suffered
two miscarriages before this,

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

So, with this news,
I went to the clinician

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

It was very early and the clinician said,

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

We'll try again next week."

So, we tried again next week.

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

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

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

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

and the fear is starting
to creep up on me.

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

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

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

I explained this to the clinician, I said,

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

we didn't hear it that time.

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

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

And I said, "But I am!"

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

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

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

(Laughter)

I couldn't believe what I was hearing,

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

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

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

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

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

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

(Laughter)

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

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

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

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

I'm starting to think the worst.

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

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

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

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

and there was none of that.

And then she said those fateful words,

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

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

I said, "Really? What? Anything!"

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

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

(Laughter)

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

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

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

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

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

I found out that I had had
my third miscarriage.

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

The next morning I found myself
in an operating room.

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

I was very nervous
about this, very fearful.

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

all in their surgical
scrubs suits and their caps,

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

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

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

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

But that didn't happen.

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

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

And again, it was a "note to self"

about how important
these conversations are.

But I have to tell you,

I had an anesthesiologist
who was behind me,

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

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

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

I will watch over you."

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

Those words sustained me,
I have to tell you.

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

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

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

It was really scary.
I felt very fearful.

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

who said, "Give me your hand."

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

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

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

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

That was the other thing I remember,

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

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

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

Those experiences really stayed with me.

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

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

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

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

social workers, psychologists,
chaplains, medical interpreters.

We bring them together with patients
and with family members.

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

about these kinds
of conversations, what matters.

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

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

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

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

and the way we treated them.

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

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

I have learned through my own training,

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

I mentioned a lot of "doing,"

and so much of our experience
and our training

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

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

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

it's about the emotional standard of care.

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

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

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

We work with actors;
they are really coached

by our family members and our patients.

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

How to introduce herself.

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

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

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

Not really. You may be:

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

I work here in the pediatric
intensive care unit."

You start with wherever the person is at.

The way you introduce yourself,

sitting down -

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

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

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

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

Just sit down. Lean into it.

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

There's something happening here.

This could be any kind
of a difficult conversation:

it could be about a new diagnosis;

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

they could be hearing
about a medical error,

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

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

to help make the situation whole again.

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

The other thing
in the one-room schoolhouse,

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

especially in this art form
of conversation like this.

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

You all know these guys, right?

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

What are the ingredients of these kinds
of difficult conversations?

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

Remember the lion? He was after courage.

So, what I would say to you is,

"Never, ever underestimate
the power of your courage,

your leadership,
your willingness to go there

with a patient, with a loved one."

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

Carl Rogers, the great psychotherapist,

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

Do you know what that means?

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

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

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

What about Scarecrow? What was he after?

Remember what he wanted? Brains.

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

your clinical experience, your wisdom.

Very important.

If you were newly diagnosed
with prostate cancer or diabetes,

you certainly would want
a clinician in front of you

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

that wouldn't scare or frighten you,

that would help you feel like,

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

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

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

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

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

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

I may say something like,

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

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

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

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

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

the compassion, the mercy
that we can show people,

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

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

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

So many of these conversations
are about hope.

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

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

You get the idea.

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

about how this all came together
for what I would call

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

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

He had joined the
Emergency Medical Transport Team,

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

I'm not with people very long."

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

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

he was called on an emergency transport

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

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

and out of the corner of his eye

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

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

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

Effortlessly, he found himself
walking in that direction.

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

And then the next thing he did was,

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

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

He realized that this was sacred space,

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

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

It was extremely scary.

That family thanked him
and the team afterwards,

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

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

So many times people naturally devalue
the conversations that we have

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

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

and to going there with the patient.

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

is to share with you
a piece of my inspiration:

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

and all I have to do is think about him

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

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

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

And I encourage every single one of you

who's sitting in these seats today
or listening to this

to dig deep, find your taproot,
find your inspiration,

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

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

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

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

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

Thank you.

(Applause)