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Collaborative Triumph Part 3

Posted By Tina Schermer Sellers, Lisa Zak-Hunter, Thursday, December 18, 2014
 

 

This is the last of a three part series on real stories from real people who have experienced collaborative triumph.

Story Fourth

Several years ago I remember being thrust into the center of a spiritual conflict brewing in the community around a patient of mine.  A patient I will call Betty was dying of metastatic breast cancer with metastisis to her brain.  She had a strong faith and believed if she doubted her healing, she would not be healed.  Because of this she would not allow anyone around her to discuss the possibility of her death.  The disease however, from all indications, was progressing and she was in the transitional care unit because she refused hospice. Her friends from church would come visit and they would talk about when she would get out – denying what they all feared.  This had been going on for a week.  Her oncologist who desperately wanted her to sign a DNR, came to me in a fit of panic, cornered me and said, “Tina, you have to do something!  She must sign that DNR! I refuse to code her!” Knowing I could not breech the subject without violating her mandate, I wracked my brain trying to think of what to do.  Finally I asked her husband, “Is there anyone she would tolerate the ‘both/and’ conversation of God-only-knows-when-and-if?”  He thought about it for a while and then said, “Our pastor.”  I said, “Great.” Let’s get him here tomorrow at 2.  I will call a meeting with the oncologist, you, me, and your pastor in your wife’s room.  The pastor will lead in the both/and conversation and we will take it from there.”  The next day, the pastor said the most beautiful thing to her about how we all need to be prepared because none of us knew the mind and heart of God. But someday, he would welcome us and say, “Well done, my good and faithful servant.” Was she ready whether that time was soon or far away?  

He honored how they all believed in God’s great power to heal and they trusted God’s wisdom.  She was riveted on her pastors eyes and he on hers.  After this, the oncologist who had been caring for her since her first dx 6 years prior, came alongside her bed and got nose to nose and in the most tender tone he spoke of how much he loved her and how he had loved caring for her.  He spoke of how he believed in God’s healing too, but if God was to call her home now, he did not want to have to code her.  How he thought it would break his heart. Tears ran down his cheeks as he spoke.  There was not a dry eye in the room. Her husband came in next and spoke of how much he loved her too.  Even in the anguish, there was a freedom in his love and tears that we all understood.  Unspoken that day, but held in the collective anxiety of our treatment team, was awareness that this dear man had lost his first wife to a tragic car accident twenty years prior and had watched her be coded.  He was scared to death to have that experience occur again. He too had been feeling caught between wanting to honor his wife's desire for absolute solidarity and his need to discuss what he most feared.

Even in the anguish, there was a freedom in his love and tears that we all understood 

 

This honoring of faith, meaning, complexity and connection was medicine at its finest and it showed the power and leverage of relationship to heal.  The pastor was the only one of us practitioners in the room who was versed in this kind of conversation and who had this leverage with the patient.  In fact for the oncologist and I, this conversation of faith, love and death was all rather taboo.  But we took the lead of the patient and what it meant to honor them all, and the complexity that was presented, and came up with a creative solution that walked us into that particular necessary taboo conversation.  That was one of the first of many conversations of faith, love, community and health to come in my career.  But preparation for this type of conversation was not in my training!

We can see the human drives of sexual bonding and spiritual understanding across history and culture. They both have innate power and defy being put in a box. They are unwieldy forces at times.  And yet both beg us as practitioners, to acknowledge their core place in the human experience and to find our own comfort in order to walk honorably with our patients on these poignant journeys.  

 

Tina Schermer Sellers, PhD is a recognized scholar in the integration of health into a multitude of areas represented in family and career life.  As a behavioral scientist, licensed family therapist and certified sex therapist, she specializes in helping to craft relationships and lives that flourish. Dr. Sellers draws from over 20 years’ experience as a teacher, professor, consultant, trainer and clinician.  Founder of the Northwest Institute on Intimacy, she also is a clinical professor at Seattle Pacific University in the School of Psychology, Family and Community and the University of Washington School of Medicine.  She lectures nationally and internationally on subjects of sexuality, spirituality, integrated health, family life and career.  She lives in Seattle, with her beloved, Gary, and together they have four children. 

 

Story Fifth

Anne was in her mid 50s when she was referred to me for care. To her long-time primary care physician (PCP), she was a very friendly and compliant patient. She had struggled with mild depression for years, which her PCP had managed with antidepressants. During one of her medical visits, her husband of almost 40 years, Mark, stressed his worry over her depressive symptoms. Historically, Mark was known to the clinic as ‘worrier’. The PCP was his physician as well and noted there was something different that day about Mark’s concern.


Throughout the time I worked with Anne, her PCP and I worked closely to update each other on psychotherapy progress and findings from medical tests and consults. In our primary care clinic, it is customary for behavioral health to send progress notes and speak to the PCP; we also share an EMR and patients are aware of this. Without this close collaboration, her PCP and I believe Anne’s concerns and crises would not have been handled in a timely and appropriate manner. Neither of us would have had the ‘full picture’. 


  


During therapy, Anne began describing a surprisingly deep, dark depression. This had been ongoing since her teens and she experienced daily suicidal ideation. She felt emotionally numb, disconnected. She insisted her life had been good, and felt guilty that her depressive symptoms were so severe and overwhelming. She felt guilty that she had not told her PCP that the antidepressants had not worked well for years. At first, she wanted to focus on ‘getting Mark off my back’. Mark was invited to session and I addressed his many questions about an accurate diagnosis, prognosis, treatment, and his role. He was clearly concerned and felt left out of this part of her life. Their dynamic followed a classic pursuer-distancer relationship; when depression was strong, she became quiet and reclusive, this terrified him and he repeatedly asked how to help. Anne became overwhelmed and withdrew further.


Anne did not want Mark to return for a while, so we regularly discussed different ways to address their dynamic and include him in treatment, while respecting her desires for privacy. She then very tearfully and hesitantly disclosed she had been abused in multiple ways in childhood. Mark was aware and supportive, but they did not discuss it. Over the next few months, Anne was further diagnosed with posttraumatic stress disorder (PTSD), and we agreed that a referral to psychiatry and a PTSD specialist could be helpful. Eventually she revisited this with Mark. To her surprise, he had not remembered and was overwhelmed. She brought him to our next session so we could address the impact her disclosure had on him and their relationship. 

 

Anne openly wept in gratitude over the degree of care we were providing 

Following this visit, Anne’s mood steadily improved. However, she developed new physical symptoms including GI problems, dizziness, and headaches that became increasingly debilitating and interfered with her functioning at work. Her depression worsened. Her PCP was concerned, since his work-up on her was negative. We called a team meeting including Anne, Mark, the PTSD specialist, her PCP, and me. At that meeting, Anne openly wept in gratitude over the degree of care we were providing, spoke frankly to Mark about ways he can continue to support her, described the current depth of her depression, and apologized to her PCP for not being more open about her well-being. Although we hypothesized her physical symptoms were more psychological in nature, her PCP scheduled further testing and consults to rule out anything organic. Her PTSD specialist and I agreed to continue with supportive care until she was more prepared to work through the abuse. Mark also voiced greater understanding after getting a ‘bigger picture’ of what was going on with her and identified specific ways he could support her. 

 

 

After that meeting, Anne quickly began coming out of her depressive episode. Her GI symptoms persisted for a while and eventually were more manageable. Her tests came back negative, and she continued to meet with her PCP on a regular basis for other health concerns. Throughout treatment, she gave high praise to us for collaborating so well together, felt well-supported and understood by all members of her care team and noted that Mark was more and more appropriate in helping her. She slowly became more open with him about her past and symptoms. He ‘backed off’, as she had originally requested since he felt more connected to her. Although this wasn’t traditional couple therapy, addressing their concerns in our visits and including Mark on the care team greatly improved Anne’s well-being, outcome, and their relationship. 

 

 

Lisa Zak-Hunter, PhD, LMFT is behavioral science faculty with the Via Christi Family Medicine Residency and Clinical Assistant Professor with the Department of Family and Community Medicine at University of Kansas School of Medicine-Wichita. She earned her PhD in Child and Family Development, specializing in Marriage and Family Therapy, from the University of Georgia. Her main clinical, teaching, and research interests lie in the realms of collaborative health care and increasing biopsychosocial understanding of mental and medical health conditions. She has a particular interest in adult eating disorders.


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