About Empathy

Even when an Advance Care Plan is in place, Dr Maria Muraca learned that unforeseen circumstances can come up. Maria was the Power of Attorney for her father, Michele, who died one year ago of idiopathic pulmonary fibrosis. Maria is a family physician, as well as an advocate and teacher of advance care planning. She is here to tell us about her personal experience with her father’s changing advance care plan and how that has shaped her discussions with patients and health care workers.

Doctors for Protection from Guns https://www.doctorsforprotectionfromguns.ca

RESOURCESIndigenous Cultural Safety Training Program https://www.sanyas.ca Indigenous Health Primer from the Royal College of Physicians and Surgeons of Canada https://www.royalcollege.ca/rcsite/documents/health-policy/indigenous-health-primer-e.pdfHarvard Implicit Bias Test https://implicit.harvard.edu/implicit/user/agg/blindspot/indexrk.htm

Stacey (Greenberg) is here today to tell us about her father who lived with Multiple Sclerosis in a long-term care facility since 2014. During the pandemic, Stacey had limited contact with her father and he was sadly isolated from his loved ones in his final days due to COVID-19 visitor and caregiver restrictions. Although he did not die of COVID-19, there were significant changes that impacted his daily life.

For more information on Andrea’s work: https://andreawarnick.com

Get to know our hosts https://www.aboutempathy.com/about-hosts

This is Part 2 of 2 episodes on Medical Assistance in Dying. Part 1 is a discussion with doctors who provide the treatment.

This is Part 1 of 2 episodes on Medical Assistance in Dying. Part 2 will feature an interview from a patient.

Gill Deacon has returned to Here and Now which can be heard weekdays 3-6pm, on CBC Radio 99.1FM. She has written a memoir Naked Imperfection, and a national best-seller, There’s Lead In Your Lipstick.

Emotional or existential distress is not as easily noticed in patients with serious illness. Dr. Jennifer Moore is a palliative medicine consultant, specializing in dignity therapy. Claire Suarez is a physician’s assistant working in in-patient oncology and is trained in meaning centered therapy. Irene, Dori and Giovanna reference Harvey Chochinov’s work in dignity therapy and how it uses questions to help discover meaning in patients lives. Asking: “What has meaning for you?” “What is the most meaningful for you?” “What had meaning before your illness?” “How has that changed?” “How has that impacted you?” “What keeps you going?” LInk to Dignity Therapy: http://www.dignityincare.ca/en/toolkit.html It is discussed how imparting meaning is not helpful for the patient but we can ask questions and actively listen. This exploration needs to be a journey of self-awareness. Patients can feel stuck in a situation, and showing kindness can help their experience.  Patients may shy away from talking about meaning, but it can be helpful to explore. It doesn’t need to be an hour-long conversation; it can be many short conversations. The hosts end the season by talking about how the psychological condition can impact physical condition so treating patient, as a whole is important. Helping treat the priority of conditions directed by the patient can establish a therapeutic relationship of trust. Ask questions that go beyond the physical state.

When faced with serious illness, patients and caregivers take on new roles. Those who work in health care are in a unique position when becoming a caregiver for a loved one. Melodie cared for her parents in their final days. Her health care training as a nurse helped her to receive information from the doctors and pass it on to her family, but Melodie found it very emotionally difficult. Only dying a few months apart, Melodie felt a tremendous sense of emptiness. Her siblings kept close communication to help each other during the grieving period and Melodie allowed herself to rest. Looking back, Melodie really appreciated the health care providers shared encouragement and asked about their wellbeing. Dori, Irene and Giovanna talk about the importance of checking in with the patient’s caregivers. The importance of finding balance to include both the patient and caregiver in conversation is discussed. The doctors are reminded that patients should give consent about what is shared with caregivers, even in situations where there is a language barrier. Melodie’s story brought up many personal feelings for the hosts caring for their own families – both the pressures and the privilege of having a medical education.

When faced with bad news, it can be difficult to speak to others leading to interactions that are inauthentic. Euphemisms, platitudes, and missed efforts, can patronize the patient and put distance in the relationship. Mike lives with metastatic colorectal cancer, and receives palliative care from Dr. Irene Ying. When Mike found out that his cancer was incurable, he felt a sense a freedom. No longer having to focus on every up and down of his treatment, and the relief of not searching for alternatives, Mike shifted focus to quality of life. Mike appreciates family and friends who are able to ask sincere questions and be present for his experience. His health care team keeps open communication and give straight forward evidence, which makes Mike feel secure. Irene, Dori and Giovanna elaborate on how it is important to know a patient’s preferred way of receiving information: varying from subtle to stark honesty. The doctors discuss how the uncertainty of illness can be the most difficult element of treatment; the fear of the unknown. The hosts reflect on history taking methods to make each patient feel taken care of. The doctors talk about how authentic relationships bring a closeness to the people involved. The heart of empathy is connecting with another person in a genuine understanding of what someone is going through.

When caring for a loved one with serious illness, caregivers focus intensely on the patient. Without checking in on the caregiver, the health care team may be overlooking the importance this has. Laurelea was the caregiver for her husband Steve. As Steve was diagnosed with terminal kidney cancer, he had to stop taking antidepressants to start treatment of his disease. Laurelea describes the mental darkness that Steve experienced, and how it was difficult for her to find the support needed. Since the death of her husband, Laurelea continues to advocate for system changes to provide psychosocial support for patients and caregivers. Dori, Giovanna and Irene describe practical solutions for treating the patient as a whole person and acknowledging the caregiver. The doctors talk about how treatment of disease differs from providing good care; the consideration of psychological, social, emotional and spiritual conditions. The hosts discuss how the vocabulary and imagery of “fighting” can make a patient feel responsible for the outcome of their illness.

Dr Daphna Grossman is a palliative care physician at North York General Hospital in Toronto ON. Describing her journey to palliative care, Daphna speaks about the role of mentorship. Her care is rooted in kindness and compassion to alleviate any possible suffering. Daphna believes the impact on health care providers is two sided: enriching or exhaustive. In order to provide the best possible care, Daphna describes the practices that keep her centred and mitigate stress. Daphna wants to spread the message that palliative care is about helping with suffering along the journey with life-limiting illness - not just end-of-life. The doctors discuss how to recognize compassion fatigue and burnout. Giovanna, Irene, and Dori, share their personal strategies for emotional self-care. The episode concludes with a round table about the benefits of the mentoring relationship.

Susan shares her experience of taking care of her Dad as his cancer progressed. She learned the strong will he had. He was a person who didn’t complain, and appreciated the little things in his final days. In hindsight, Susan shares what was helpful for her as a caregiver. Irene, Dori and Giovanna, have a conversation about paying attention to non-verbal cues of a patient and the difficulty when a person doesn’t open up. The doctors talk about their own experiences with caregiving for long-term illness and how that shapes their healthcare practice.

Aviva describes both the relief and fear of completing active treatment for marginal zone lymphoma. Survivorship, life after disease, has been an emotional journey that Aviva manages using writing, humour, meditation, and outreach as a patient advocate. Aviva talks about perceiving hope as relational - something she can move towards through interactions with others. She hopes that health care providers will hear her story and see patients as a whole person. Aviva’s memoir is titled “Lost and Found in Lymphomaland”.Dori, Giovanna, and Irene talk about the concept of Survivorship and what kinds of physical and psychosocial issues can arise post treatment. The doctors discuss how hope can be framed and re-framed to be realistic at each stage of life, with or without disease. The pressures of the patient is included, when the hosts describe how to be helpful to a patient. The whole person approach is important to gauge the well-being of each and every patient.@AboutEmpathy on Twitter

On their 22nd wedding anniversary, Sholom discusses the palliative care of his late wife, Erminia. Erminia made the graceful decision to transition to end of life care - motivated by spirituality. Sholom appreciates the care for his wife and talks about his gratitude practices. Giovanna, Dori and Irene discuss whether empathy can be taught and how it can enhance therapy. Gratitude is talked about as a response to grief, and as a recognition for the lessons learned. The three doctors have a conversation about the lasting impact patients have when a personal connection is made.

Giovanna, Dori and Irene describe what you will hear on the About Empathy podcast. Subscribe to About Empathy to get a new episode each week and please tell your health professional, your colleagues and your friends about our show. You can visit our website aboutempathy.com for more information.