Ten Thousand Joys Ten Thousand Sorrows Storytelling and

Ten Thousand Joys, Ten Thousand Sorrows: Storytelling and Storylistening for Health Care Professionals Johanna Shapiro, Ph. D Department of Family Medicine UC Irvine School of Medicine February 2, 2017

To open our hearts, we must embrace the ten thousand joys and the ten thousand sorrows - The Buddha

Emotions in Health Professionals

Vicarious Trauma Negative emotions can lead to a residue of vicarious trauma Changes in our psychological, physical, and spiritual wellbeing that can occur because of our caring for others in circumstances of great suffering

Emotions are Scary Big fear Fear * Will become detached from emotions BIGGER fear * Will become overwhelmed by emotions • Impaired judgment • Burn-out • Personal vulnerability Scarier Fear

Emotions are Complicated Emotions that arise in difficult, stressful, tense clinical situations can be complicated, unpredictable, confusing, and distressing We do not do a good job of preparing ourselves and each other to deal with these emotions We often conclude that experiencing emotion is the problem; emotional detachment/suppression is the solution

Professional Alexithymia: difficulty in experiencing, expressing, and describing emotional responses Individuals with professional alexithymia… More comfortable communicating technical details of treatment than the meaning of the diagnosis and prognosis Unaware of or uncomfortable with their feelings and the feelings of patients and families Described as efficient but uncaring

Maria - Rafael Campo This G 2, P 1 gives us a confusing history. It sounds like she’s been pregnant approximately thirty weeks, although she can’t recall her last LMP. No pain, but bleeding for about two days. Of course she hasn’t had prenatal care, and God only knows where the father is. She works two jobs that keep her on her feet all day. She’s been in the United States six months, and doesn’t speak a word of English. Bet you she’s illegal. Cervical exam is unremarkable, the os is closed. I think we need an ultrasound to tell us more. Besides a look at the placenta, we need some confirmation of her dates. Her uterus can tell us more than she can.

Dealing with our Emotions: Embracing the Joys and Sorrows • Meditation/mindfulness training *Emotional self-regulation

Everyone Has a Story to Tell Homo Narratus � Everything is held together with stories. That is all that is holding us together, stories and compassion. - Barry López, Winter Count � [Stories] …are all we have to fight off illness and death. You don’t have anything if you don’t have stories. - Leslie Marmon Silko, Ceremonies

Medical Stories In medicine, we tell other people’s stories We tell these stories in a certain way (focused on details of disease) We ignore our own stories and the stories of colleagues

Storytelling in Medicine �In storytelling, the patient’s story is still central �We pay attention to our own thoughts and feelings: �We find our unique �Sharing our stories with others builds

Storytelling in Medicine – Embracing the Joys and Sorrows Telling our stories to each other helps us step back from our feelings – a then see them with Pause More clarity, less judgment We realize others have similar feelings We share them together and discover we can face them with less fear and panic accept, normalize and embrace them

Medical Listening In medicine, we listen to stories in a certain way We listen for pertinent findings, relevant We search for evidence that will lead to a differential diagnosis and discard the rest

Storylistening in Medicine Allows us to hear the story of ourselves or another without interruption, advice-giving, fixing, problem-solving Encourages generous listening, witnessing, presence, mindfulness Promotes self- and other

Schwartz Rounds Schwartz Center * Interdisciplinary panel of healthcare providers assembles to talk about their own emotional responses to a particularly traumatic or distressing case They tell their stories Audience of peers listens, comments, shares their own stories Premise: Caregivers better able to make personal connections with patients and colleagues when they have greater insight into their own responses and feelings

Schwartz Rounds Outcomes Increased insight into social/emotional aspects of patient care; increased feelings of compassion toward patients; increased readiness to respond to patients’/families’ needs Improved teamwork, interdisciplinary communication, appreciation for roles/contributions of colleagues Decreased feelings of stress/isolation; more openness to giving/receiving support

Finding Meaning in Medicine & Nursing - RISHI The Remen Institute for the Study of Health & Healing’s mission is to help participants: find deeper satisfaction/meaning in work lives strengthen their original sense of calling; renew commitment to medicine form community with colleagues from different professional backgrounds discover they are not alone in their emotional struggles and responses

Finding Meaning in Medicine and Nursing In a safe setting, colleagues contribute a story from their own healthcare practice grief, grace, healing, courage, mystery, intimacy, service Storytelling and storylistening can deepen participants’ connection to their day-to-day work and to their patients

Tell Your Stories/ Listen to Others’ Stories • Start telling your stories to your team members and colleagues • Listen generously to the stories you receive back

NICU - Dana Shuster Dying babies need warmth motion song Dead babies need nothing Why am I still rocking singing?