Wyzga On Words

Do Not Swim, Hike Or Go To The Hospital Alone.

Let's begin here.  "The Short Life and Lonely Death of Sabrina Seelig" as reported by Anemona Hartocollis for the NYTimes reads as a cautionary tale: don't take Ephedra; make sure your jury relates to the story of your dead client; be aware of struggling hospitals, and so on.

What happened?  A 22 year old college student took Ephedra to stay up all night to complete a paper.  Feeling ill in the morning she called 911, an ambulance was dispatched, she was taken to a struggling Brooklyn hospital where she was given sedatives, strapped to a bed, slipped into a coma that evening unattended by the hospital staff and died 6 days after admission.

Her lawyer lost her case for any number of reasons.  I was not there nor part of the trial team.  I do not know.  What is reported is that there was (as there will always be) conflicting testimony, an uneven balance in the gaggle of experts, blame on the plaintiff for bringing about her own death, and juror distancing:

"After a day and a half of deliberations, the jury of four men and two women returned its verdict: Wyckoff and the individuals working there had not been negligent.

The jury did not seem to identify with Ms. Seelig."

As I have written and spoken before, the decision-maker must have some connection to your client.  The decision-maker does not need to have lost a sister or daughter or loved one to death.  The decision-maker does not need to have experience with medical malpractice.  But that decision-maker must be reminded of the values of safety, trust, and vulnerability, taught the medical rules including the simple four-step process of differential diagnosis, as well as the hospital rules of charting, monitoring, and vital signs. 

So often these cases turn on the inevitability of the outcome.  Apparently, Wyckoff Heights Medical Center was just the place.  Excerpt.

"In 2007, when Ms. Seelig was a patient, the state ordered Wyckoff to hire a management consultant to improve its governance and finances. Five years later, it is still struggling. The Brooklyn district attorney has been investigating allegations of mismanagement. A three-month investigation by The New York Times, the results of which were published in March, found a history of insider dealing and positions being given to people with political ties. The hospital officials involved denied any wrongdoing. The hospital does not carry malpractice insurance." 

One thing is for sure: if we have not yet gone to an emergency room or a hospital for treatment, we know someone who has.  One day we will most certainly be there ourselves. 

Here's the rule: Do not go to any hospital alone.  If you must, let someone know where you are going and when and why.

Several years ago I created a website for Vincent DeAngelo, an accomplished, highly-regarded medical malpractice attorney in Hartford, CT.  Mr. DeAngelo insisted that his website provide critical information to the public in five areas of potential medical malpractice: Vbacs, emergency rooms, medication errors, hospital infections, and nursing homes.

Click here to access DeAngelo's educational website complete with detailed downloadable pdfs you can read to learn more about these areas and information to take with you before going to the hospital.  

Our moms were right when they told us not to go swimming alone.  From the grave Sabrina Seelig is reminding us not to go to the hospital alone.

Narrative Medicine And The Cross-Over To Law School And Law Practice.

What do internists, especially ones practicing narrative medicine, have to tell law students and lawyers? Quite a lot.  And all it will take is 39 minutes of your time.

Rita Charon, MD, PhD. a nationally renown physician, writer and educator as well as Executive Director/Founder, Program in Narrative Medicine College of Physicians and Surgeons, Columbia University is at the top of the game of Narrative Medicine.

Click here to attend the Department of Medicine Division of Medical Humanities presentation "Narrative Medicine: Accuracy, Evidence, Allegiance, Joy" as Dr. Charon discusses the importance of the medical narrative as a tool for physicians to better understand their patients and themselves, and it's role in training a new generation of doctors.

What is so fascinating to this former pediatric nurse, life-long storyteller and litigation consultant is the cross-over between Dr. Charon's ideas on the dividends of narrative medicine and those that can be reaped in law schools and law practices.

Highlights with my comments in [brackets]:

*    Medicine must go beyond the bounds of knowledge with differential diagnostic brains.  That kind of fact-based thinking is inadequate to the task.  [Likewise, our reliance on "the facts and only the facts" gives us a distorted view of what happened to our clients and what matters to them.]

*    Illness unfolds in stories.  The thing that is amiss in the body tells the self that there is something the matter and eventually that story comes to the attention of the healthcare provider who will turn around and tell it to a colleague.  The idea being that the telling and retelling should lead one to know what to do.  [How do you see yourself in the internist's shoes?]

*    Medical stories are a matter of ongoingness.  A doctor's duty is to develop a sense of story that takes into account devastation, loss, grief, magnitude of hurt and pain.  [Our clients are in the same boat - and we are there with them.]

*    The big question: Are you available to receive the story, to “co-hear” the narratives of illness, to train yourself to know accurately and fully what the patient expresses to be more effective in care?  [For lawyers, are we available to hold the space for the client so we develop different skills interviewing our clients, determining what the problem is and how to remedy it?]

*    You must learn to heed the story, learn from the story, learn the skills to recognize it, stand in the gathering of the story and work with the patient and family - to experience what the patient and family go through and for the patient to learn what the healthcare people experience.  [Who here has often desired that ability to co-hear with our clients and our clients families?  We are walking parallel roads with these internists.]

*    What are the dividends?  We find this practice helps improve cohesion of healthcare teams, minimize burn-out, increase empathy, encourage taking on the perspective of another person, feeling a growth in affiliation with their colleagues and others, listening attentively and less defensively, recognizing the unique dimensions of colleagues, using parts of the brain that had gone fallow, and recognizing that stories are total storms rather than the typical pattern of beginning, middle and end.  [What would you give for similar practical and human dividends in your practice?]

*    Narrative medicine helps medical students and doctors stop squandering evidence by learning to retrieve it in narrative, grasping the patent's story in words and learning to plumb the meaning of the evidence.  [For lawyers that meaning will carry over to the trier of fact.]

*    When doctors are fortified with the competencies of listening, curiosity, empathy, imagination their practice changes, they make authentic contact with the patient cleared of biases and other fsact-gathering screens.  [All anyone wants is to be heard, even for a moment.  After you have given the client the chance t tell their story you can go back and collect the data you need for the lawsuit.] 

Dr. Charon's makes this introduction to every patient: " As your doctor I face you so you can express to me what you are going through in words - please tell me what you think I should know about your situation."  She sits with her hands in her lap and absorbs what happens.  By inviting the account she can learn without shoe-horning the patient into her own fact list.  [Beginning with law school we can encourage the development of attentive listening. It wil flow over to practice.  Imagine th transformations.]

I invite you to spend 39 minutes and change your practice with practical and human dividends.
                                   
















                          

Nurses Hold the Space for Patients, Families to Tell Their Stories.

I am delighted to have been invited to join Kathy Hansen's blog, A Storied Career!

Just in case you missed us, over the next several days I'll be re-posting the interview she conducted with me and began publishing on April 9th.

Here's the second post

It Was My Own Damn Fault.

 

Thank you to Brushy Mountain Bee Farm for the Master Beekeeper Suit image.

Some of the best stories begin with, "It was my own damn fault."

For a beekeeper ("beek" for short) this time of year can be wildly uncertain.  One day it's 85 degrees and sunny - then overnight cold winds come down from Canada dumping snow in the mountains and rain on the lower levels.  The hives have been quiet over the winter months but now they are beginning to ramp up along with the blossoms.  Swarms will begin soon as the stronger colonies outgrow their homes and look for roomier digs.  We wait and watch.

My plan was just to tend the bee-yard: weed around the hives and add oil to the paint cans that hold the frame stand legs to keep out the ants.  It was too cool to get into the hives. At about mid-40's Fahrenheit the scout bees go out looking for nourishment.  At about the mid-50's range more foragers go out.  And by the time the mid to high 60's hit the foragers can be in full flight swing. 

But beeks ideally need a day that's in the sunny 70s with no breeze so the colony does not get chilled when you go inside the hive box.  Even when you get good weather, take care.  If the previous days have been cool and cloudy (as ours were), the bees can be as cranky as toddlers penned up without TIVO.

There's a small gap where my beesuit zippers to the veil.  Just enough for a honeybee body to get through if she's looking.  Then she and I are trapped in there together.  With more of the colony swarming around it's a good idea to just walk away until they lose interest in me - but there is still the matter of getting to the honeybee (or bees) who are inside.  And taking off the veil is not an option.  Having learned my lesson the hard way I slap a small piece of duct tape over the hole when I plan to work the hives. 

This is where I get to: "It was my own damn fault." This day I broke all my own rules:  I left off the piece of duct tape to cover the gap.  I made a spur-of-the-moment decision to quickly work one hive.  I did not fire up my smoker ahead of time.  I don't like using one but it's a nice idea to have it lit and ready in case you want to calm cranky bees.  The weather was not the best.  The bees were cranky.  And they let me know it.

I can't blame them that a few facial stings later I look like a Shar-pei with mumps.  It was my own damn fault.

TIPS: The price of experience: Be prepared.

If you are going to court, be prepared.

If you are going to the hospital, be prepared.

 If you are making a meal, be prepared.

And when you screw up because you were not prepared, the responsible thing to do is admit it, make apologies or mea culpas (if needed) and move on.  Life is short and sweet as honey. 

Talk To The (Virtual) Hand - Use Your Body To Express Yourself.

How often have you heard someone say, "I always talk with my hands"?

Talking with our hands is universal.  Like giving the "thumbs up" sign of approval - except in Iraq where the soldiers were told that it means something different.

Human beings are expressive beings.  A post in Science Daily, "Body language of both speaker and listener affects success in virtual reality communication game" reminds us how much our body gestures mean to get our story, our point, our idea across to another person.  Excerpt.

"New research, published Oct. 12 in the online journal PLoS ONE, finds that the lack of gestural information from both speaker and listener limits successful communication in virtual environments."

Research participants used avatars to express themselves.  As the participant moved, so did his or her avatar.  Scientists discovered what should be apparent: "... in addition to the body language of the speaker being important, the body language of the listener impacted success at the task, providing evidence of the need for nonverbal feedback from listening partners in successful communication."

TIP:    Know your body and how it moves.  Use it for the expressive tool it is.

TIP:    Practice gestures you might have seen someone else use effectively to learn if they are a fit with you and your communication style.

TIP:    Get your hands out of your pockets, let go of the lectern, and show your story as well as tell it.

TIP:    Employ a professional storyteller skill: listening is the most important skill we have.  How can we listen while we are telling?  We attend to the body gestures and expressions of the listeners to know if they are with us.

TIP:    Body gestures are reciprocal and progressive - use what comes naturally to human beings.

Fortify Your Narrative With The Precisely Chosen Visual - And That Goes For PowerPoint, Too.

Morgan C. Smith commented on today's post, "When The Judge Says, You Have 5 Minutes For Your Opening Statement" by reminding me that a few well-placed visuals are key to your presentation.

He's right.  A picture IS worth a thousand words.  And, it must be the right picture, the precisely chosen picture.

The master of few words, Seth Godin, blogged on this very point today, "The atomic method of creating a Powerpoint presentation," as follows:

"The typical person speaks 10 or 12 sentences a minute.

The atomic method requires you to create a slide for each sentence. For a five minute talk, that's 50 slides.

Each slide must have either a single word, a single image or a single idea.

Make all 50 slides. Force yourself to break each concept into the smallest possible atom. If it's not worthy of a slide, don't say it.

Once you have 50 slides, do the talk in practice. Remove slides and sentences that add no value or don't move you forward.

Now (and only now), start consolidating slides. If two or three or four slides work together as one, then go ahead and make them one. You've got molecules now, not atoms.

At this point, you can either get rid of slides altogether, keep them as is or lump them one more time into bigger ideas. But no (!) bullets please. What a waste those are.

There's more here: Really Bad Powerpoint."

Congratulations To Tracey Dellacona!

Tracey Dellacona and I like to say we are "Sistahs."  We are both RNs, JDs, and out-spoken - among other virtues.

Tracey has a new professional website.  Click here to visit it. 

Every good wish, Tracey, for this next chapter!

12 Tips To Get Ready For A Hospital Procedure: Read & Pass It On

The following information from the American Diabetes Wholesale is so important I am sharing it with you so you may share it with others:

"How to Prepare For a Hospital Procedure
by Roberta Kleinman, RN, M.Ed., CDE     September 7, 2011

Hopefully, most of you will not need this information about hospitalization/surgery in the near or far future, but having it available may be helpful to you at some point. Print a copy and keep it in place for future reference. Hospitalization and possible surgery can be overwhelming for anyone, but going in with diabetes can make it even more challenging.

An increase of complications can occur due to your blood sugars - high or low - with a greater rate of infections. Being prepared and knowable can help alleviate the anxiety to some extent.

1. Tell all your doctors about ALL medications, vitamins, and supplements that you are currently taking. Do not skip any, even baby aspirin and OTC medications. Interactions can be a big threat.

2. Make sure everyone who walks into your room has washed their hands. Include your family and friends. Do not feel intimidated if you are unsure and need to ask. Infection rates can be high with resistant strains of bacteria.

3. Check out the hospital online to see if they perform a large volume of the procedures that you are having and what their complication/infection rates are. This information can usually be found free online. The same applies for the surgeon doing the procedure - have they performed many of these procedures? Research by word of mouth as well. Is a second opinion needed before this procedure is done?

4. Meet with the anesthesiologist prior to the procedure to talk about agents they will be using. It is routine for them but not for you. Talk about any side effects or problems you had during previous surgery - nausea, vomiting or pain. Feel free to ask questions.    
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5. Make a list of questions so you do not need to remember them. During stressful times, we tend to forget. Have a support person with you.

6. Speak up when you are given medication if you have any doubts or questions. Think about the drug, the dosage and the route. No question is silly. Did you have it before or is it new? Call if your IV is beeping and no one is checking on the drip rate. Do not be afraid to ring the call bell.

7. Insist that everyone check your wrist band; ask your birth date, prior to going for a test or therapy, before you are given medications, blood or IVs.

8. Check to make sure a surgery site is marked before the procedure and be clear about what is happening. Read all the pre-op papers carefully. You never want surprises when you wake up.

9. Some people have allergies to IVP dye used for tests and certain medications like penicillin or sulfa. All this should be on your chart but you can always remind them. Metformin, an oral diabetes medication, should be stopped a few days before and after your test, if IVP dye is used, to protect your kidney function. It never hurts to remind the staff of any of these things.

10. Bring your own meter and supplies. You may test more frequently or be on a different schedule than they are and it may make you less stressed (stress will increase your blood sugars). Have glucose tablets by your bed side for low blood sugar so you do not have to depend on someone bringing you juice.

11. Try to have a family member or friend with you as an advocate, in case you are tired or upset. This will be comforting to you and the staff.

12. Discharge planning is crucial. Know what is expected of you at home before you leave the hospital. Have your medications and prescriptions ready when you go home as well and all follow up treatments and appointments written down.

Being sick and in the hospital is never fun, but being prepared will make you feel more in charge of your own recovery. Hospitals have multiple safety guidelines in place, but being aware is your best defense."

Simplify The Science In Medical Malpractice Baby Cases

That's what I was saying to my clients as they were walking me through a very sad case that ended with the death of what was supposed to be this family's first bouncing baby boy.  I have a strong and advanced background in clinical nursing and yet my eyes were glazing over with all the Power Points nitpicking the plethora of possible nuances in the fetal monitor strip readings.  If this was how I felt pre-focus group research, how would the participants react?

Simply speaking a fetal monitor strip is, in the immortal words of trial lawyer Russ Herman, "It's the baby talkin'."  The fetal monitor calculates and records the fetal heart rate on a strip of paper which can be interpreted to learn how the fetal heart is responding to stress while in the mother's womb.  Most often the fetal heart monitor is used during the mother's labor.   And it really is the closest thing to "the baby talkin'."

Here's the bones of the story: a mother with no pre-natal issues comes to the hospital in labor to give birth to her first child.  Her doctor is at home "chilaxin" as the kids say now.  The fetal monitor strips show the ObGyn floor nurses that the fetus is having some difficulty.  Calls are made to the doctor.  Calls are recorded in the medical record.  The fetal monitor strips continue to show that the fetus is distressed.  Nothing gets done. By the time the proverbial stuff hits the fan it is too late and the baby is born dead.

What do you do?  You simplify the story.  Get away from being mired in the science.  Let the opposition obscure and obfuscate with arguments about who knew what and when according to what might be interpreted on the fetal monitor strip.

There were only four difficulties this fetus could be having: sleeping; cord around the neck; placenta previa; or an abruption.  There were very simple steps that could have been taken to detect which one of the four was going on and what to do about it.  The nurses did not ask for direction nor did the doctor provide it. 

The story we presented to the focus group research participants was one they could understand, relate to and decide. The malpractice issue was presented as four possible options ordered from worst to least. Each option had a simple, single choice to exercise to determine if this was the stressor or not.  Each choice was linked to the healthcare provider who could carry it out and save the baby.  

The fetal monitor strips played a part - as the voice of the baby talkin' which the nurses had detected.  But rather than make the science the focus of the story, it became about choices that could have been made, that should have been made and were not made.  

The case was settled - and very well settled - the day before trial.   

TIP:    Know the science of your case.

TIP:    Simplify the science in your case.

TIP:    Tell a story that respects the science but is not lost in the science.  

 

What Price A Mother's Anguish?

No matter how many focus groups one facilitates nor how many cases one tries there is one abiding difficult and perplexing question: "How do we (the decision-makers) figure out and then decide what pain and suffering are worth?"

Over time lawyers have arrived at certain formulas or bracketing exercises to help corral the jurors toward a verdict.  We seem to agree that giving the decision-makers some markers is valuable.

William Glaberson writing for the August 24, 2011 NYTimes, "After Stilllbirth, Courts Try to Put a Price on a Mother's Anguish," reveals that the dilemma is one shared by the high courts in New York.

Two women each lose their baby at term.  They sue their respective hospitals for medical malpractice. They received damages for emotional distress.  The damages are half a million dollars apart.  Excerpt.

"These two cases are among the first to move through the legal system after New York’s highest court changed state law in 2004 and allowed mothers to sue for their emotional suffering when they claim that medical carelessness caused a stillbirth. With their different price tags on elemental maternal loss, the cases offer a rare view of the legal system’s first computations to set a new value on this singular type of suffering.

They also shed light on the often macabre computations that lawyers make in trying to fix a dollar figure. As these cases represent uncharted territory in the state, the grim comparisons have gone especially far afield. Lawyers sought, among other analogies, to compare the trauma of a stillbirth to that of being attacked by a dog or to a passenger’s spending nine minutes of anguish knowing a plane is going down."

Does the higher verdict establish a floor for future awards in New York?  Some seem to think so.  And yet, it is not about the money - in place of a baby to hold.  It is about recognizing that our courts offer legal recourse for damages that may not be physical in nature.  As one of the women said, “The case helped me have a voice,” she said. “If it wasn’t for that, things would have been pushed under the rug.”

It is worth reading through the second page of the article to learn a bit more about the horrendous appeals process and the strategies used by the attorneys to help the decision-makers relate life experiences to reasonable compensation.

For this litigation consultant who stresses the importance of identifying, shaping and delivering the right story using language with power, passion and precision, these case outcomes show two things: (1) resilience in the face of odds; and (2) the value of spoken recourse to the petitioner because: "There is no greater burden than carrying an untold story." [Zora Neal Hurston]