Nothing but praise

Well, there it is. Our first week at the hospital has concluded and I honestly couldn’t be any happier. My expectations have already been surpassed, and my enthusiasm for the coming weeks has skyrocketed.

Our activities this past week mainly involved becoming acquainted with the hospital’s buildings, staff, and projects. It didn’t take long for Shravya and I to feel the love and warmth of the hospital and its staff. After all, it is called “The Hospital of Love” for a reason. We’ve met many wonderful doctors, nurses, and staff, all of whom are all doing extremely impactful work for the hospital’s patients and the community. I feel very lucky to be here.

Side note- I have tried to restrain my consumption of pão de queijo but have been very unsuccessful so far.

 

Humanization at the Palliative Care unit

On Thursday and Friday, Shravya and I stayed at the Palliative Care unit of the hospital. Palliative Care is a medical approach that focuses on providing relief from suffering and improving the quality of life of patients, most of whom have terminal illnesses. Just like the other departments of the hospital, at the unit’s core is the humanization of care. The hospital has developed several ways to reach this humanization:

Everyone eats meals together.

It’s not common to see patients, families, doctors, nurses, and general staff of a hospital all eating meals together. However, this is the case at the Palliative Care unit. The idea behind these communal areas is to foster support among the different levels of the hospital and to eliminate any sense of hierarchy. Everyone is equal and everyone is there to help each other out.

The layout of the hospital encourages interaction between patients.

To begin with, many rooms in the hospital are shared by two patients. Through this setup, patient’s families interact and provide support for each other. Additionally, regardless of the number of patients in a room, most the rooms have large sliding doors instead of windows. The doors open to a patio which is linked with all the rooms, increasing the communication between the patient’s families and the possibility for new friendships and support networks.

The unit has a multi-professional team to address all the patient’s needs.

Being a patient at the Palliative Care unit is very difficult for patients both mentally and physically. To ensure that the patients are receiving the best treatment possible, the unit has a team composed of doctors, nurses, physiotherapists, psychologists, nutritionists, pharmacists, phonoaudiologists, occupational therapists, musical therapists, social assistants, and spiritual assistants that take care of all the patient’s needs.

Patient’s feedback and wishes are heard and granted.

In hospitals, it’s often difficult for patient’s feedback to be heard and implemented. The opposite is true at the Palliative Care unit. The hospital seems to make efforts to truly listen to the patients and their ideas. Additionally, the hospital fulfills the last wishes of patients (all free of charge) to help the patients pass away peacefully.

 

 

Fun events are organized for the patients.

The hospital frequently organizes fun events for patients so that they can change their routine and try to forget their stress and problems. For example, it hosts a large special breakfast, traditional parties, and takes the patients that are strong enough to the popular Rodeo park and other locations.

The hospital’s efforts for humanization are uplifting and I think there is much to learn from its approach.

 

Meeting Dra. Juliana

During our first two days at the Palliative Care unit, I got the chance to meet and shadow Dra. Juliana, a palliative care physician. Dra. Juliana’s daily routine consists of checking up on her patients staying in the hospital in the morning and conducting consultations with patients who haven’t been admitted into the hospital in the afternoon. From the brief time that I followed her, it struck me how strong and positive she is, as is everyone working in this unit.

Although Dra. Juliana’s work ethic and personality is inspiring, what impressed me the most is the way she interacts with her patients. She remembers everything about them- their medical history, personal background, details about their family, and any conflicts they might be encountering (medical, social, or otherwise). Because of this, she has a strong connection with her patients and is very personal when she treats and talks with them. Whenever we met a new patient, Dra. Juliana would give us a thorough summary of their situation, which really helped us better understand the patient’s feelings and struggles, as well as the family’s situation.

 

The “Circle of Silence”

During these visits, Dra. Juliana also explained a problem she calls the “circle of silence”. The “circle of silence” is when the families or caretakers of a patient are aware of the patient’s medical problems and situation, but they refrain from disclosing this information the patient because they don’t want to hurt or discourage him/her. Although this is very common among families, Dra. Juliana explained that these are very tricky situations to deal with and vary by patient. She told us that this the “circle of silence” is always complicated because she wants to have the support of the patient’s family while still maintain the trust of the patient. Additionally, if the patient desires, she feels morally obligated to inform him/her of his/her condition even though it might be against the family’s wishes (Unlike the US, Brazil doesn’t have any laws requiring doctors to have full disclosure with patients). Therefore, Dra. Juliana must constantly find clever ways to approach patients and their families to resolve their communication issues and dynamic. Likewise, Dra. Juliana explained that she must often read between the lines when speaking with patients since often they say that they want to know what’s wrong with them even though they don’t actually want to know. I recognize that I am biased because of my interest in psychology, but I think these sorts of interactions between doctors and patients are fascinating.

One case I witnessed with Dr. Juliana that stood out to me was that of an older woman who went with her husband and daughter to the clinic for a consultation. The woman has beaten cancer before, but the cancer came back and she is unaware of this. The daughter, however, is fully informed of her mother’s cancer and sent a letter to Dra. Juliana before the visit asking her not to tell her mother anything. Additionally, after the visit, the daughter pretended to feel ill herself so that she could stay a while longer talking with Dra. Juliana (about her mother) and not have her mother suspect that they were talking about her. Even though Dra. Juliana cited this as an extreme case of the “circle of silence”, it is a very present and constant obstacle for her. In this case, Dra. Juliana agreed with the daughter that she would be as delicate as possible with her mother and slowly tell the her about her illness. This is a great example of how Dra. Juliana formed an “alliance” with the daughter (by playing along with her story), but is also trying to be as upfront and realistic as possible with the patient by committing to slowly tell her about her situation.

Before going to the Palliative Care Unit, I had never encountered or thought about these social components of hospitals and patient care. It’s clear there is so much more for me to learn than medical procedures and health problems. I’m thrilled to have discovered this new area of study and can’t wait for everything the at the Palliative Care unit and amazing doctors like Dra. Juliana will teach me.