January 27, 2012
By Claire Edmonds, PhD
Mary Smith, along with her husband Jerry, has been coming to your practice for a dozen years or so. They are both recently retired, and during their appointments often talk about their recent travel adventures. Mrs Smith has called for an appointment because she is having pain in one of her teeth. Your receptionist has been able to slip her in before your afternoon appointments. It has been a busy morning and the afternoon is also very full. You walk into the examination room and Mrs Smith is in the chair, your nurse hands you her chart. You approach her with the usual salutations, tip back the chair as you pull on your gloves and mask. As you begin to ask her which tooth is causing her problems, you can see that there are tears in her eyes. In fact she looks pale and drawn. Concerned, you ask, “How long has your tooth been troubling you?”. She wipes her eyes, “Oh no doctor, I’m sorry, it’s not just my tooth, Jerry passed away last month. He had a heart attack…”
Stop the action.
Suddenly you are in the psychological arena, that tight interpersonal space between the dental professional and the patient. This is a charged space that is complex and challenging, particularly in the midst of a busy practice. Let’s open up and take a closer look. Let’s be honest, your first reactions are likely to careen from “oh no, that’s so sad, he was such a nice guy…” to “great and I have about 5 minutes before my afternoon schedule is totally blown…” to “what on earth do I say to her…I hope she doesn’t cry”. Most people do not know what to say to the bereaved, the great fear is that you might make it worse, igniting a cascade of tears and grief. Using our magic camera, let’s take a moment to check out what Mrs Smith is thinking. She may be feeling embarrassed and out of control. Grief is considered one of the most powerful emotions that we can experience. People coping with loss and grief may feel like they are on an out-of-control roller coaster. Feelings can be triggered by seemingly innocuous events. Pain, medication and stress all exacerbate this lability. The last thing she wants to do is “lose it” in your chair. However, whenever she tells someone about her husband’s death, she launched back into a place of grief, fear, sadness and even symptoms of post traumatic stress, relieving the experience in her mind and her body. If we could read her thought bubble, it might contain something like, oh no, here it starts again…
Now, back to your own thought bubble. There may be your own cascade of reactions from sympathy and shock (gee he was only a few years older than me…) to the very practical concerns about how to manage this delicate and emotionally charged situation. If we could take our magic camera even further inside of you, we might find your heart rate and respirations have increased, your hands are damp and your eyes are dilated- the classic sympathetic nervous system response to threat; it’s fight or flight. Unfortunately there is no where to run to and the other option, well it just isn’t. In spite of the pressure of the accumulating appointments running late and your fear of saying the wrong thing, there is only one thing to be done: surrender. Surrender? Yes, resistance is futile, the ball is in play, you can’t go around it, the only way out is through. Let’s find an analogy from your own profession. What happens when you are working on a tooth, a routine procedure and suddenly something goes wrong (not being a dentist, it makes me squeamish to even think about it), but perhaps a tooth falls apart as you are filling it. There you are. You are it, you are on, it is up to you to work it through. Fortunately, your training kicks in, you become focused and clear and start working the problem. If you have years of experience, you may even enjoy this alert state of attention and, of course, the pride as you fix the tooth to the delight of the owner. When you were coping with the problem, other things fell away- you knew that your patients would have to understand if you had to take longer helping another patient. You knew your staff would help you as you needed it. You stepped up and hit it out of the park. But first you had to surrender.
Surrendering into this moment with Mrs Smith means that you pull down your mask, rest your hands in your lap, and subtly take a deep breath. You might want to become aware of your weight in your chair and come back to the feeling of your breath flowing in and out. You are grounding yourself, surrendering into this moment in which taking care of your patient involves a different set of skills. Good work, just surrender and let it unfold…
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