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How does a personal fight for life in the ICU impact a survivor-intensivist’s approach to patient care? Dr. Rana Awdish, author of “In Shock”, shares intimate experiences in and after her ICU stay.

Episode Transcription

Kali Dayton 00:38
Hello, and happy new year! Ending 2022, I am filled with gratitude for such an incredible year of growth and progress in the mission of creating awakened walking I see as I have been honored to work with some powerful clinicians that are leading their teams through astounding revolutions and their practices. Throughout the next few months. We’ll be hearing from some of those teams as they share their journeys and give reports on the changes that they’ve experienced. So stay tuned. The podcast audience has grown throughout the world that there is an awakening to the reality of our sedation, mobility, culture, and the tides are changing. Hang in there. Keep pushing from wherever you are. 2023 is going to be full of a lot of change and achievements. This episode, we’re going to come back to our why I am thrilled to have this special guest and survivor who I have learned so much from Dr. Oddish. Thank you so much for coming on the podcast. Can you tell us about yourself?

Dr. Rana Awdish 01:32
Sure. My name is Rana Awdish. I’m a pulmonary and critical care physician in Detroit, Michigan, Henry Ford Health Care. And I’m also a patient in speaker and writer about my own health care experiences and the experiences of my patients as well.

Kali Dayton 01:50
And you wrote the book, “Shock”, not “In Shock”. It’s just “Shock”, correct?

Dr. Rana Awdish 01:56
It’s “In Shock”.

Kali Dayton 01:57
“In Shock”. And I’ll put a link to it on the blog. And I invite everyone to read it or listen to it. I listened to it over audible, I loved hearing your voice on it. Thank you for writing something so intimate and vulnerable. And real insight is powerful. And I don’t want to give too much away on the podcast interview. But that’s everyone’s homework for this episode is to go or take in the book, “In Shock”. But I would love to just do a quick little summary of your journey and then dissect some of the insights that you shared from the patient perspective. That’s okay. Tell us a little about a little bit about what led you to be in the ICU as a patient and what that was like?

Dr. Rana Awdish 02:39
Yeah, happy to. I had just finished my pulmonary and critical care fellowship training. So I was at the end of what felt like an endless journey to become an intensivist. It was actually the very last day of my training, I was out for a celebratory dinner with my friends. And I was also seven months pregnant. And I had just this excruciating abdominal pain that came on in my right upper quadrant. And it was it was just unlike anything I had experienced as pain before I just knew that whatever it was, it was going to kill me. And so we got a hold of my husband, he rushed me down town to my hospital. And from there, it was sort of a cascading series of events. I got admitted really in hemorrhagic shock. We didn’t know it at the time, but a tumor in my liver had ruptured. And so I had lost almost my entire blood volume into my abdomen. The baby I was carrying couldn’t survive that there was not enough blood flow. So I had fetal demise. I was rushed into the operating room and went into multi system organ failure. My kidneys shut down, I had a stroke, I ended up on the ventilator. It was quite an ordeal. And I very much nearly died that night. It’s only through the great skill and grace of the teams of people who were taking care of me that I even survived to get to my ICU on the other side of it. But that was just the beginning of course of a really years long recovery and then more surgery followed by more recovery and more surgery that went on for a number of years.

Kali Dayton 04:36
And even knowing and obviously I met you a little while ago knowing that you survived but listening to your story. I just I was sweating it out. It was it was an incredibly intense journey and you captured really well in your book and I appreciate that you give such intimate insight into in the ICU. It’s almost like you know, a book could just be about the ICU stay but it really important was the capturing of what it was like after the ICU and the journey after that, which I think, at least I personally didn’t really understand what that was like until I heard from survivors, we have such a narrow focus in the ICU. And I feel like you really gave a good insight into how that narrow focus impacts our interactions in the ICU. What was it like?

Dr. Rana Awdish 05:24
Yeah, yeah. I, I appreciate you saying that because I too, as a, as a provider, if I discharge someone out of the ICU to the floor, I was like, success. Yay. We did our job. And they’re well now. And I had no sense of the recovery that came after that. And I really left the hospital. You know, after that first acute illness, right from the ICU, I was discharged, I didn’t go to the floor. So I was still needing oxygen, I could barely walk with a walker, I had fluids still around my lungs, this kind of flocculated, pleural effusion, I was very deconditioned. And I had a lot of anxiety from so many experiences of nearly dying. And so going home to my mom’s house, which is where I was discharged to because I couldn’t go up and down stairs that we had in the house that I shared with my husband. And also just because moms take good care of you. For the most part. It, it really felt like so much of my recovery still had to happen on the outpatient side. And that I was kind of left to figure it out. You know, I had a schedule of medications I was supposed to take because I had a huge blood collection in my abdomen, and it was very painful. I had all sorts of electrolyte derangement. So I was getting blood drawn basically every day. And all of that felt like it was falling to me. And I remember one, one experience in those early days of just trying to walk from the kitchen to the foyer in my mom’s house. And being so short of breath, that I remember thinking, I understand why people when they’re older, are ready to leave their bodies, like my body felt so difficult to inhabit, and so weighty. And that was just the physical side of it. You know, the nights were so difficult being afraid to fall asleep, being afraid not to be monitored after being monitored so closely for so long, being afraid of the nightmares. That was a whole other piece that I had to recover from.

Kali Dayton 07:53
And I imagine I feel very much the same when you’re, you’ve worked in an ICU environment and you were safely cared for in an ICU environment, and then you’re left to go home knowing that things can change so quickly, because of your vast experience. That’d be very anxiety provoking. And the nightmares that you had, what were those rooted in? What, what do you feel caused that?

Dr. Rana Awdish 08:20
I think it was, it was a very, like, physical kind of nightmare where my body would remember not being able to breathe. And probably I was still deciding at night. So my brain was making up stories of why I couldn’t breathe, to match what my body was feeling. And so they were always nightmares about drowning. Being underwater, trying to breathe and just feeling my lungs filled with fluid. Most of my nightmares had to do with drowning.

Kali Dayton 08:55
Oh my gosh. I’m not even sure what to say that that sounds like pure trauma.

Dr. Rana Awdish 09:02
Yeah, and it’s so wild that I am not even kidding you when I tell you that it was like eight years later, the first time someone said to me, “Do you think you had PTSD?” And I was like, “Why would you say that?” Like, “oh, I don’t know, nightmares, trauma, the experience you had.” And I was so resistant to that label, because I felt like I had survived something. And that was really important to my identity, that kind of resilience. And it felt like somehow if I also had that experience of trauma that it was diminishing, what I had been able to recover in a way which was a silly way to think about it. And I’m so grateful that you know, the pandemic has been horrible, but at least it’s exposed post ICU syndrome, this sort of pick syndrome. of having PTSD and all of the trauma that comes with the ICU. Just because we’ve had this illness on a mass scale? No, absolutely,

Kali Dayton 10:10
I really didn’t understand post ICU syndrome, especially the PTSD part until I started talking to survivors. So how has and during that kind of trauma, that kind of recovery, impacted how you approach transferring patients from the ICU, or even how you treat them while in the ICU.

Dr. Rana Awdish 10:32
It certainly expanded my sense of what healing means for my patients. It’s not so focused on the medical aspects of the care, but rather, the whole person experience. I see a lot of my role for my patients now as being a kind of translator of their experience and reflecting their strengths back to them. I think there’s so much that we see in our patients in terms of their strength, their resilience, their family support, their drive to recover their tenacity. And sometimes just framing that for them, can help them move away from the post traumatic stress disorder to post traumatic growth, and really seeing themselves in a different light.

Kali Dayton 11:34
In large part, the premise of this podcast is humanizing the ICU, especially in the sense of avoiding sedation and optimizing mobility. So listening to your journey of how you participated in your care, the choices, the autonomy, connected with your family, you were just in the thick of it, even in such critical illness. I, I kept thinking how much we deprive our patients, when we automatically sedate them, especially when it’s not essential, which oftentimes it’s not, how has this journey, changed how you approach sedation practices?

Dr. Rana Awdish 12:11
You know, I definitely came up in the era of people should be resting when they’re on the vent. And this was before a lot of West Aelius ABCDEF bundle was really mainstream. And even after my experience, I remember having nurses tell me, “You shouldn’t have to remember any of that. Someone should have dialed up your sedation. I’m mad that you remember!” Thinking, you know that that’s not where we are anymore. We have to experience these things. So we can participate in our care. It’s always a challenge in the hospital, because we like to control things, you know, is intensivists, especially. And it can feel very much uncontrolled, if someone’s able to move around freely when they’re intubated. And they have all these lines, and you’re not sure how much awareness they are in about the dangers of removing things or pulling lines. And it’s scary, but it’s necessary. It’s necessary in every way. I don’t know that I would have known how necessary. It’s one thing to read about it in an academic paper. And it’s another thing to kind of live through it. And I wish I didn’t need that kind of learning. But it really solidified it for me.

Kali Dayton 13:46
Yeah, that, that nurses comment really exposes a common I would say, myth that we have in the ICU is the less patients are aware of what’s going on, the safer they are from PTSD and from trauma. But now in literature, we see that real memories actual recall, the ICU is actually protective against PTSD, I hear from survivors talk about some of the trauma of missing that time. I’ve never thought about that before when they realize that they’ve missed months or, or weeks of times of their life, they have no idea what happened or they had other experiences that they thought they lived and they didn’t really live but also just the vulnerability of realizing they were not aware of their own body. They were not given choices during that and even awake, you experienced that to a certain level. How did that impact you to be that vulnerable, even with people that you know and you care about and that we’re doing mostly good things? What did autonomy mean to you during that time?

Dr. Rana Awdish 14:48
It really does feel like a kind of injustice that we deprive patients of their autonomy in so many different ways. And I think about, you know, this sort of Maslow’s hierarchy of needs. And even as patients progress through their own recovery and then want to help other people in peer support groups, there’s so much room for agency and autonomy, but not if we’re sedated and strapped to a bed, right? And one of the, the criticisms that I heard about my book was that the timeline was difficult to follow, and that it wasn’t clear how long I was in certain unconscious states. And that was very intentional, because I wasn’t clear how much time I was missing. I wasn’t clear when I would leave and come back what had happened, it was a very real uncertainty for me, and I didn’t feel like it would be true to portray it, as if it were just this linear timeline that made sense.

Kali Dayton 16:02
And that lapse in time bothered, bothers the reader itself. But how much more does it bother a patient to lose their own personal time?

Dr. Rana Awdish 16:13
It is, it’s a real struggle with your own sense of identity to have had things happen to you that you don’t recall, to be told about it almost like a third person, it’s very vulnerable. And, you know, I can experience that as someone who trusted my providers, but I think about my patients who haven’t had good experiences with the medical establishment people who’ve endured abuse or have distrust for very legitimate reasons. What is it like to have those absences? And how do you trust that you were cared for? I think there’s a lot of promise in the patient diaries where, you know, we actually give people a record of what they experienced, but there’s so much more that we could be doing.

Kali Dayton 17:08
Absolutely. And I think I’ve always assumed that if I were a patient in the ICU, that my experiences, my knowledge would help rectify a lot of those things. But you’re a fellow, you had so much experience in the ICU. And nonetheless, it was overwhelming, confusing and traumatizing. When my daughter was in the PICU, I was amazed by how stressful that was, for me just some of the continuous monitoring the sectioning like all these things that I had done as a nurse, but now as a mother, it was different, going home with a car full of equipment, and then just handing me a gastric tube and NG tube and just saying, if it falls out here, replace it. And I’m like, “I’m the mother. Yes, I’ve done this and innumerable times on my patients. But do you really do this to parents that don’t have any experience? Because even I, myself am so overwhelmed.” So it was really enlightening to see, from your perspective, a perspective that I can relate to, you were still deeply impacted by that admission, and even by the the tone of the interactions with the providers that you could understand that their perspective, some of the flippant things that they would say. But now from the other side of the bed, it was it took on a totally different meaning. What was that like for you?

Dr. Rana Awdish 18:27
Yeah, it landed did very differently, there were things that I would hear like, “We’re losing her!” and “She’s circling the drain”, or, “She’s been trying to die on me.” And I would hear these things. And I would know perfectly well that I had said similar things in the past and that I truly in those moments was just trying to rally a team around me to understand the acuity to move faster to understand how desperate the moment was. I knew what my intention was when I would say things like that, but I had no sense of how it would land on a patient, how it would make them even doubt their own ability to recover, to hear themselves portrayed in that way. And it really, as much as it angered me, I also felt incredibly guilty because I had said those same things without an awareness of the power of those words.

Kali Dayton 19:37
And I felt lots of twinges of guilt or in your book because I had very similar approaches or said those things. You know, we inherit so much during our training that we don’t really process we just adapt those phrases, sayings, mentalities, practices. So your book really made me question, what other things do I have automatically do without thinking, because that’s the cultural norm. So it was it was very humbling and just your will to live, but how you had to fight the assumptions of your caretakers, they assume that you were going to die. And you had to almost give them reason to doubt that. Some survivors say that, when they were finally mobilized, that’s when they finally felt like their care team believed that they were going to survive, and that helped them have that hope. But before that, laying in bed, just rotting, essentially, they felt like everyone had given up on them. But when they got up, they felt like they could live because their team felt like they could live.

Dr. Rana Awdish 20:38
It’s so true. And I remember when the physical therapists came in my ice room, and I thought, oh, my gosh, they ordered physical therapy, they’re, they’re thinking, I’m going to need to be able to walk. They think I’m going to live. And that gesture of like faith, it really was the first time that I thought my team believed I would survive it. And it’s bananas to think we have to piece together clues like that, because no one’s having honest conversations. But that’s what you’re doing is that patient, you’re reading everyone’s faces, you’re listening, not just for what they say, but how they say it, how they’re looking at your mom or your spouse, how often or not often they’re coming in the room, their demeanor, when they do, you’re really just trying to figure out what they’re not telling you. In physical therapy was like, Oh, my gosh, they think I’m going to live.

Kali Dayton 21:41
Wow. Yeah, they’re like the, the symbol of hope. Right? Yeah. 100%. And you were that you felt that left on the loop, even without ICU delirium.

Dr. Rana Awdish 21:52
I definitely had a component of delirium I, I was having visual hallucinations that were difficult for me to interpret. And I had difficulty distinguishing between my dreams, if you can call them dreams when you’re sedated, and waking life. But that that was early on, once the sort of benzos I think wore off, that got a lot better?

Kali Dayton 22:23
And how does that impact your approach to benzodiazepines, for your patients?

Dr. Rana Awdish 22:28
I didn’t realize how potentially harmful they were in the ICU for a very long time. And that awareness, really, I will use anything other than that.

Kali Dayton 22:44
Wow. Now, that’s, it’s so good to hear. But I’ll say it again, it’s kind of painful, right. But I appreciate district your frankness. And again, these are practices that we inherit, you inherited those during your training, and but you’re making conscious choices to change that and you’re changing. And I feel like you’re changing the culture for generations to come by doing that, because you’re training people now to do something different.

Dr. Rana Awdish 23:09
And medicine, as you said, it’s such a culture of assimilation, we just want to belong in so many ways, when we’re starting, that we adopt all of these kind of provisional identities, and we just, we try them on for size and see like, how does it feel if I act the way that I see this other doctor acting? How does it feel if I say these things? I hear the nurses saying, Do I feel like I belong? And it’s coming from a place of wanting to be one of them. But we don’t often question if it’s in service of our best selves, if it’s truly aligned with our values and who we wish to be, and how we wish to heal, or even if it’s in service of our patients.

Kali Dayton 23:59
Wow. And I see that principle in so many different ways. You mentioned in your book, how we as clinicians guard ourselves, you said, We’re were raised with this mentality, that connection begets loss, which begets the solution meant, which begets burnout, like we only have so much to give and we give it away, we don’t have anything left. I thought that was such a powerful way to capture what we do in the ICU because we’re in such intense situations that demand so much of us emotionally. And we’re raised with that belief that if we connect with patients, if we allow ourselves to feel and to get and to be present with them, we’ll be burnt out. And yet, now listening to what you were saying there, it makes me wonder if so much of this burnout because of the dehumanization in the ICU during COVID. They were deeply sedated families weren’t There, we didn’t have human connection. So how much of it is physically the demand of what was going on. But then how much of it is the lack of human connection?

Dr. Rana Awdish 25:12
I think we, we often tell people, if you connect, you’ll be depleted, you can’t do it. And we’re telling young, inexperienced people that and the first time they connect and feel loss, it feels so overwhelming, and they don’t have a space to grieve or share. And so they believe it’s true. But what you learn over time, if you’re lucky enough to have longevity in the field, is that those relationships that you build, actually nurture you, and heal you. And if you don’t allow for that, you really deprive yourself of the thing that will give you joy and work and longevity and resilience, but it, it’s not taught in that way.

Kali Dayton 26:04
I saw a little glimpse of it when I worked with the team this summer, when I first went on site, I could just help they were hesitant to do some of the scenarios that I was proposing how to take sedation off how to avoid station mobilised patients, right when we’re just doing simulations. But I could tell that there was hesitation, it was unfamiliar, it was scary. And the assessments were different. And they just kept saying, “We can’t handle anything else.” Or, “What do you even say to them after they wake up?” like there were some of some hang ups and concerns. When I went back months later, and I walked through the halls and patients were awake right in the board, I saw this optimism, this hope, this comfort, this joy. And some of those same clinicians that I did not see initially. And they just reported some really fulfilling stories experiences showering patients on a ventilator. But just the rejuvenation that I saw on them, was not present that first time. And I wish there was a way to really capture the impact that it makes on burnout, personal trauma, job fulfillment, to actually connect with your patients. Some of my most impactful and joyous experiences were even death experiences with patients, when they were saying goodbye when we were able to make that a sacred experience. That is when I walked away saying yes, that’s why I got into medicine, not just to have them roll out the door, but even to die peacefully. It just, that’s who I want to be. And that’s what I was able to be when practicing that way.

Dr. Rana Awdish 27:32
And I think you’re very right that COVID revealed to us what’s lost when we don’t get to have the relationships with the family at the bedside, when we don’t get to be physically present with someone through their healing. We knew I think the cost to the patients, but I don’t think we understood the cost to ourselves.

Kali Dayton 27:57
Absolutely. And I think we still haven’t totally made that conclusion yet. I feel in a lot of ways, or amongst a lot of people, I think there’s still a lot of hesitation to allow families back into the ICU. There’s a perception that it’s easier. And I think that is really tragic. To me that feels like our community is missing out in large part on things that can be so fulfilling. And you said, quote, medicine cannot heal in a vacuum. It requires connection. What did that mean to you as a patient to have connection with your family with the care team?

Dr. Rana Awdish 28:34
If you knew I came into this experience, really believing that the science was what healed that if I had enough knowledge, I could treat people and make them better, and that any time I spent just holding space for suffering or attending to grief was really just getting in the way of me healing people. And it took me so long to understand that unless someone feels held by you unless they feel supported, that the best medicine in the world isn’t going to heal them, it might treat them. But that lack of connection will have an impact. And it really caused me to reprioritize how I approached my patients I want them to feel supported and cared for and known and seem and that their their wishes are a fundamental part of every piece of the plan that I propose, and that their values are embedded in that plan and their likes and dislikes and their hopes for the future and what a good day looks like. And the thought that I could have ever proposed a plan before without knowing any of that is so arrogant to me. It’s so one sided and paternalistic. And that’s medicine, right? Like, that’s what we are trying to change away from, and really integrate who people are and hold space for them.

Kali Dayton 30:15
I’m trying to hold that up against some of our cultural norms. And I see just how that is a different world than what we have grown accustomed to, when we expect and even want and joke about patients being deeply sedated, unresponsive, not moving a muscle, all the memes and jokes about crossing my fingers for an intubated, sedated patient. How do you even make that transition? How do we get there to expect patients to be autonomous, to have their wishes known and respected, have that kind of connection? Again, when clinicians already feel like they don’t have any space for that? They don’t have that even time for it? How do they start going in that direction?

Dr. Rana Awdish 31:00
Fortunately, I think it is very much self propagating. So if you let yourself try it, even a little, the rewards are so great, because suddenly you realize you’re a team, you’re not in opposition to your patient, you’re not antagonistic towards them. You’re a team and you need this other teammate to be just as aligned with you on the plan so that you can both succeed. And those successes allow us I think, to create a little bit more space the next time because you know, you can achieve more if you do it that way. So it’s just taking that first little step.

Kali Dayton 31:44
Yeah, that’s beautifully put. I’ve seen that I’ve been hearing about that from podcast listeners that lighten sedation, try to get a patient to ride a little bit. And then the next patient, it’s getting them set up inside of the bed and they get braver, they get they just see the difference in outcomes, they get more excited, and they get more converted to that process. And I think over time, then it becomes their own expectations for that process of care with their their patients. And their colleagues see that. So it is a process and so infectious, so contagious, right? And then I hope I down the road that we look back into it to how we’re currently practicing in general, and shutter. We won’t even see it as remotely acceptable to happen patients the data just because they’re on the ventilator, because we’ve experienced that deep connection and that fulfillment, we wouldn’t want it any other way. You also. Yeah, absolutely. And you talk about the culture of giving into authority, that is just assume that if someone has more experience, he has a stronger personality, then you just submit to that decision without even using your best judgment or critically thinking through it. And that for some reason struck a nerve to me. I think it’s because that’s what’s perpetuated sedation and mobility culture that you come in, we say welcome to ICU. Here’s how we practice, here’s what we’re going to do. Don’t question it. And when some of these podcast listeners question it, or try to do something different, those with more authority, more experience, even if it’s not evidence, project, their own inclinations into that scenario, rather than being open to critically thinking through that situation. How did that impact you as a patient to know that decisions weren’t being made? Just off of habits or culture?

Dr. Rana Awdish 33:31
Yeah, it’s, it’s very true that the hierarchy in medicine and in nursing, perpetuate some of the worst attributes of who we are. And it’s very risky to challenge that authority when you don’t have the same power. And I feel for our medical students who see things that, you know, don’t feel right to them, but don’t feel that they have a voice to question it. And I tell them, you know, by virtue of you being here, and valuing the patient’s story and spending time with the family, you’re modeling something to us, that we might have lost sight of. And so I do think just by embodying the kind of care that we believe in, we’re setting a different kind of example, and shifting the norm. Silently, right. It’s not a fight. It’s not me against anybody. It’s just this is how I believe I wish to practice. And I’m going to try to embody,

Kali Dayton 34:45
I’m thinking of at the moment when you are on your first shift back as an attending, and you have a patient there with the same diagnosis as you had and the way that she was presented. was very systematically by diagnosed and you ask, “What’s her daughter’s name? What’s the baby’s name?” Again, that may be twinned with guilt, I wonder if I in that situation would have noted that, ask that, knowing that the nurse knew that. But I just thought that was such a gentle way of bringing humanity back into that situation when you could have done a whole monologue about how cold that present that medical presentation was. But just that one question, you brought in a reminder to everyone that this is a human, this is a mother, this is a person in a vulnerable situation without having to say it. What other recommendations would you give to nurses or any part of the ICU team to be able to make that kind of ripple in a situation?

Dr. Rana Awdish 35:48
Well, my goodness, I’ve learned more from nurses than I have from physicians throughout my life, I think the model of care that nursing has that really does care about the whole person in the family, and their emotional well being is so much wiser than how we in medicine, approach patients. And even that nurse who knew the baby’s name, you know, in her next breath, she was figuring out how to get pumping supplies from the neonatal ward so that the mother could still express breast milk. And it’s just my god, she saw her as a mother. And we saw her as a patient with help syndrome. And, again, it goes back to the modeling of the behavior, I think if you know, what’s right, and just and you can frame a person as a full human, for the team. Everyone really benefits from that, and we’ll see the patient differently.

Kali Dayton 36:54
Yeah, I think I’ve seen that exemplified in some of the examples that podcast listeners have shared, where they kind of have to fight a little bit to get a patient off sedation. People are incredulous. There is a sense that the idea and then they see the patient texting on the phone section in their own mouths out and the paradigm starts to shift. And they start to see that as a human. Yeah. But it’s it can be such an obstacle to overcome. And I think it takes a lot of courage that first time.

Dr. Rana Awdish 37:20
Absolutely.

Kali Dayton 37:21
Because of all the things that you’ve mentioned, the culture wanting to fit in, but sometimes it’s the newer people that see those gaps, right? And they need that kind of support, encouragement to questions. I love that you tell your students to bring up their concerns to bring everyone back to a fresh perspective, that’s really humbling humbling for you as an attending to have that approach. And I think hopefully, that’s the future culture of the ICU is that everyone’s perspective, everyone’s voice matters. There’s not this crazy hierarchy that allows for medical errors to happen just because we’re afraid of questioning higher authority. You also talk about being so physically deconditioned not being able to get out of bed and you just you capture so much of the edema, the wood, everything that you had going on? How psychologically that weighed on you? How does that change your approach to early mobility now, with your patients in ICU?

Dr. Rana Awdish 38:21
I definitely was humbled by my body as young as I was. And as fit as I was going into it, to see how much round you can lose so quickly, was humbling, and they think just accentuates the need for limiting that period of being bed bound and sedated. Because we all lose muscle mass, we all lose mobility, we all lose conditioning very, very quickly when we’re ill. So if we can shorten that, on the front end, the recovery will be so much easier.

Kali Dayton 39:04
And how does your team respond to that when you bring in that kind of perspective? Again? What was the culture kind of before? And have you seen a difference in your team dynamics after your experience?

Dr. Rana Awdish 39:15
There is a lot of change. Medicine is slow as a culture, right? It’s like steering the Titanic, you see these little shifts, but the way that I see it most is really when people have a sense of pride that they know they’ve done something that’s in alignment with what I values. So even if it’s as simple as like, well, you know, that patient has a dog at home that they really want to get home to and this is the breed and this is the name and this is how long they’ve had them. They take a lot of joy in telling me these things. They take a lot of joy in saying, you know, even though the patient is on this antiarrhythmic drug and wouldn’t fit into the The automatic respiratory therapy driven weaning protocol, I told them that they could put the patient on CPAP any way, and they’re proud of these small changes, even if we reinforce them really to make a big difference.

Kali Dayton 40:16
And they probably know like, “Oh, Dr. Awdish is on, we got to. These are the expectations.” This is how we’re going to practice the impact that one person can make. To set the tone of the unit is incredible. Again, I’m thinking about two nurses that trained me as a brand new nurse. That’s just the way they practiced. Those were the expectations and I wouldn’t cross them on. I think about Polly Bailey, one of the pioneers the way can walk in ICU, if a patient had come from another facility and was sedated, that second Polly walks in the room, that sedation is better be off already. Right? And not in a hostile way. But just …fixation. Yeah, and someone’s holding us accountable for practices. If it’s culturally normal, or acceptable or even a joke, then why would we ever change it? If no one’s asking questions? That’s how errors get by.

Dr. Rana Awdish 41:10
Accountability is hard and medicine, there’s a lot of deference. And I think deference is the enemy of accountability in some ways. And one of the things I’ve really had to work towards is how to hold myself and my colleagues accountable in a way that still holds them as being whole and complete, and people that I love, but to say, you know, I know you care about this patient’s recovery, and and this will not help them. And so can we rethink about how we’re doing this? It’s challenging.

Kali Dayton 41:52
Absolutely, yeah. You bring in one of the big barriers to is how do you tell your own colleagues that were hurting patients or even contributing to their mortality, that’s a really hard thing to tell people that you work with it you love that you care about, that you are going to work with in the future as well. And when I come in as a consultant, it’s a little bit easier, right? I don’t want, they can hate me, they can turn off zoom calls, it’s fine. But when you are in those intimate situations, how do you advocate for a patient in a bold way? Because sometimes it is life or death, right? If someone’s on a medazepam, drip unnecessarily, it needs to be addressed. But to do so in a loving, tactful way, I think is really tricky. But so and so important. What else would you share with the IC community about bringing these changes to the ICU and continuing to see your patients as humans, in an after the ICU.

Dr. Rana Awdish 42:45
I think the biggest learning for me, truly has been never to take away someone else’s hope that there are situations as medical providers where we feel we know what the outcome is going to be. And we want to prepare people and we frame it. And that’s okay. We always want to share what we know. But if someone’s still reserving hope that that’s not something we should ever take away from them, we can hope for their miracle alongside them. While we also plan for what we would do if that didn’t happen. And we can align with their wishes, even as we we make other plans. It doesn’t have to be either or.

Kali Dayton 43:35
I love that. Yeah, I can see, I am just thinking about lots of situations in which maybe I’ve written someone off and a little bleak my approach and it’s hard to find that balance. But your book gives such an intimate insight into how that contributes to trauma, how frustrating that can be and your outcomes were obviously far beyond what anyone expected. So it’s humbling to realize that we really don’t know. And that human connection, the will to live, and maybe a higher power is what plays into those things equally, not maybe even more so than our medical interventions.

Dr. Rana Awdish 44:13
The patient that I wrote about at the beginning of the book, who was awaiting a lung transplant, I fully thought she was going to die. And I thought it was irresponsible of us to be hoping that she wouldn’t because it seems so obvious to me. And she’s still alive. You know, 10 years later, she’s had her transplant we’re friends. She’s living her life. And I just I saw the hope that she had and in a way couldn’t connect to it therefore resented it because I thought it was a way of saying that I didn’t know what I was talking about and, and she really taught me so much about what’s possible. When we believe and have faith

Kali Dayton 45:04
and I’m sure listeners might think, you know, “the more awake and interactive my patients are, the more complicated this process gets.” I think subconsciously, that’s one of the holdups. It’s simpler to just see them as a body, but I’m on a conveyor belt, do the same process for everyone and get the same outcomes. And yet, we get into medicine to save lives and having that connection allowing patients to spied for their own lives and to hope for their futures is actually life saving. And thank you so much for providing that perspective. And again, the homework for this episode is to read Dr. Audits his book, he maybe got some of the highlights from this conversation but but the full story is where the the meat of it really is. Thank you so much for everything you shared.

Dr. Rana Awdish 45:48
Thank you for having me.

Transcribed by https://otter.ai

 

Resources

Publications by Dr. Rana Awdish ca be found at  https://www.ranaawdishmd.com/

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