Brush with death drives doctor to fight for patients
The searing abdominal pain came on suddenly while Dr. Rana Awdish was having dinner with a friend. Soon Awdish was lying in the back seat of the car racing to Henry Ford Hospital in Detroit, where she was completing a fellowship in critical care.
On that night nearly a decade ago, a benign tumor in Awdish’s liver burst, causing a cascade of medical catastrophes that nearly killed her. She nearly bled to death. She was seven months pregnant at the time, and the baby did not survive. She had a stroke and, over the days and weeks to come, suffered multiple organ failures. She required several surgeries and months of rehabilitation to learn to walk and speak again.
Helpless, lying on a gurney in the hospital’s labor and delivery area that first night, Awdish willed the medical staff to see her as a person rather than an interesting case of what she termed “Abdominal Pain and Fetal Demise.” But their medical training to remain clinically detached worked against her. Later, in the intensive care unit, she overheard her case being discussed by the surgical resident during morning rounds.
“She’s been trying to die on us,” he said. It made her angry, she said, because she was trying desperately not to die. “I felt he was positing me as an adversary. If my care team didn’t believe in me, what possible hope did I have?”
Awdish survived and returned to her work at Henry Ford Hospital, but her perspective was indelibly altered. In her recently published book, “In Shock,” she describes her through-the-lookingglass experience as a critically ill patient. The ordeal opened her eyes to communication lapses, uncoordinated care and at times a total lack of empathy at an institution that says on its home page that health care there “should be built around just one person: you.”
The health system has embraced many of her suggestions for change.
Currently, she splits her time working as a critical-care physician and as the medical director of care experience for the Henry Ford Health System. In the past five years, she and three colleagues have developed a program to improve empathy and communication with patients, called Clear Conversations. At retreats that typically last two days, Henry Ford Hospital staff practice having difficult conversations with improvisational actors who act as their patients. The program also trains providers in fundamental patient communications skills and offers realtime physician “shadowing” to provide feedback.
Awdish regularly speaks about her work around the country at conferences and medical schools, “trying to capture the students a bit upstream,” she said.
“To listen to our patients with a generous ear does require a willingness to relinquish control of the narrative,” she said in her book. “Our questions allow for the possibility that we do not already know the answers. By not dominating the flow of information, we allow the actual history to emerge.”