Thanks to the vision of one man, health-care workers now have an emotional outlet to help them deal with the stress and loss that they face on a daily basis.
Krishna Komanduri, MD, first met the young man about a decade ago while completing his cancer training in San Francisco. The man was in his early 30s, about the same age as Dr. Komanduri, and had been healthy - a runner, in fact - before developing a type of cancer called Hodgkin's disease.
"He's really one of those patients who has stayed with me the longest," says Dr. Komanduri, a stem-cell transplant physician now working at the University of Texas M.D. Anderson Cancer Center in Houston. Sitting in an auditorium among other M.D. Anderson clinicians, Dr. Komanduri describes how he had recommended a typical regimen of chemotherapy, to be followed by a series of radiation treatments.
The young man did start the chemotherapy. But from the beginning, he resisted the idea of radiation, worried about the potential for long-term damage, including to his heart. Dr. Komanduri tried to dissuade him - repeatedly. Without the radiation, the risk of recurrence was significantly greater, he told the patient. But he couldn't make any headway. "I went as far as I could," he says to his M.D. Anderson colleagues, "without alienating him or pushing him away."
Finally, he says, he had to learn to live with - both professionally and personally - the consequences of the patient's decision.
Dr. Komanduri's story unfolds during a powerful hour in which doctors, nurses, and other M.D. Anderson staffers break from their usual focus on blood-cell counts and chemotherapy side effects to discuss the emotional underpinning of decisions they make every day. The sessions, called Schwartz Center Rounds, are held on a regular basis at hospitals around the country - the result of a vision of Boston health-care attorney Kenneth Schwartz.
During his 10-month battle with cancer in the mid-1990s, Schwartz wrote an account for the Boston Globe Magazine - an article that's still circulated among clinicians - detailing his fight for survival and the significance of seemingly small acts of compassion along the way. Several days before his death, Schwartz amended his will to launch the center that today bears his name.
The idea behind the rounds, developed by the staff at Massachusetts General Hospital Cancer Center and the Kenneth B. Schwartz Center, was to create a safe place for hospital staffers to express the frustrations, fears, and sadness that can reverberate during the drive home. Virtually no subject is off-limits - coping with angry patients, treating sick colleagues, the role of spirituality, and delivering bad news, among others, are all valid. Underlying many conversations is one common thread, a psychological tightrope that clinicians frequently walk: how best to provide compassionate care and really connect with patients without becoming vulnerable to a personal burnout.
"Unfortunately, it had been looked at in the past as a vulnerability and a weakness to show emotion when caring for patients," explains Jon Du Bois, MD, a physician leader for Schwartz Center Rounds at Emerson Hospital in Concord, Massachusetts. "I think it's finally time to say that the human side of caregivers can be as important as their medical judgment and their medical knowledge. I think the real art as a caregiver is to blend both."