She was seven months pregnant and out to dinner with a friend when the pain in her belly became unbearable.
Dr. Rana Awdish — then a doctor in the intensive care unit at Henry Ford Hospital in Detroit — abruptly found herself in a life-or-death role-reversal.
Her mind spun about her baby’s health as morphine was pumped into her veins to control the pain. Even with a dose that would be fatal to a healthy person, the pain was still blinding.
Awdish heard doctors talking about her blood values. She knew she was bleeding out. She would die if they could not find the source and stop it. The baby would die, too.
An obstetrical resident wheeled a portable ultrasound machine to her bedside to check the baby.
"From the first grainy images, I could see the small ventricles still and pulseless — like a four-chambered pool filling with slowly falling snow," Awdish wrote. " 'There's no heartbeat.' The words cascaded out of me on a torrent of agonized breath."
Upon hearing Awdish declare that her own baby girl had died, the medical resident performing the ultrasound asked: "Can you show me where you see that?"
In that single painful moment, early in her new book, "In Shock: My Journey from death to Recovery and the redemptive Power of Hope" (St. Martin's Press, $25.99), Awdish lays the foundation for many similar encounters during months of hospitalization that left her feeling at times unheard, disrespected and emotionally raw.
In that time, she found deep insight into the myriad ways in which modern medicine fails patients and doctors, too.
When she returned to work following her extended illness and other hospitalizations, Awdish set about trying to heal what ails the hospital system with brutal honesty about her interactions with her doctors, nurses and medical students — both as a patient and as a fellow physician.
"I started speaking about what happened" at seminars, classes and workshops, said Awdish, 43, of Northville. "I found myself compelled to give the real patient perspective.
"I think my primary motivation really came from realizing that if I had these experiences as a physician in my own system, that I had to give it a voice for all the people who couldn’t. I know a lot about medicine. I know how the care team is supposed to work. I know how my body should respond to therapy. I know what the ideals of communication should be. And so I had at least a barometer and some agency. And it felt like something we needed to be talking about."
And so she did.
She talked about how doctors weren't aware that she could hear them when she was sedated and on a ventilator. Awdish recalls clearly what they said: “We’re losing her. ... She’s circling the drain," and later, a doctor telling her family, “Her body has survived, but we’re not sure at what cost.”
She talked about the way physicians often fail to truly listen when patients tell them about their pain, jumping to conclusions about drug addiction and prolonging their suffering.
The more she talked, the more doctors listened, and the more they wanted to know about how to do better.
They also began to address their own struggles as the people who have to deliver heartbreaking news to families day after day, and discuss ways to cope with their own grief and acknowledge their own emotions in an environment intentionally designed to be clinical and detached to protect doctors from feeling too much.
She began to hear their stories, and recalled the suicide of a medical resident for whom the pressure was just too much.
Awdish's honest feedback led to systemic change within the Henry Ford Health System, said Kelley Dillon, director of physician communication and peer support.
Awdish, the director of the pulmonary hypertension program, was given the added title of medical director of care experience for the health system, leading a team of people in a new department charged with improving communications in a way that boosts the patient experience while also supporting physicians.
Dillon teamed up with Awdish to develop training tools to help doctors learn how to better interact with patients. Awdish's insights are now part of orientation for every new employee at Henry Ford, Dillon said.
"Truthfully, in medical school, they don't learn this," Dillon said. "When they heard her experience, they looked at me and said, 'OK, well, how do I fix this?' "
Role-playing sessions were set up for small groups of doctors so they could work through different scenarios they might encounter in a hospital setting and learn new strategies for dealing with them. Dillon created a set of best practices and shadowed doctors, offering valuable feedback and suggestions for better conversations with patients.
Since then, patient satisfaction scores in for the hospital system "have steadily been moving up and up and we have not seen an upward trend like this ever, specifically in the physician communication quality set of questions," Dillon said.
"From the moment we started this program, there's been a steady upward climb in the inpatient physician communication scores and the outpatient communication scores."
Earlier this month, Awdish won the Physician of the Year Award from Press Ganey, an organization that measures patient experience and performance analytics for hospital systems. She also was named the Compassionate Caregiver of the Year by Schwartz Center for Compassionate Healthcare.
"How my hospital has approached this blew me away because I really had to enter into this with this agreement to myself that I would be honest and tell the story as it happened and accept whatever repercussions came with that," Awdish said.
"In my head, those repercussions included being ostracized out of medicine. ... I didn’t know where it would fall and I had to be OK with whatever it was. What ended up happening has been one of the great surprises of my life.
"Everyone has sort of said, 'Yeah, that is how it is. Why haven’t we been talking about that? I’m so glad we’re talking about that. Let’s talk about it more. Let’s be more transparent. Let’s crowdsource the solutions with our patients and the trainees and the senior physicians.'
"And to work at an organization that can embrace a failure and transform, I am more proud of us now than I think I’ve ever been. ... To have that modeled at a level of leadership where the instinct could have been shut it down was really inspiring to me. And it really makes me grateful that this happened here and that they’re willing to transform with me."
Awdish spent every Saturday for a year writing the story of her journey through catastrophic illness as a doctor-turned-patient; St. Martin's Press published her book
"I knew that what I experienced changed me, and I knew if people could experience that alongside me, maybe it would change them, too. And so, it was more than just wanting it to be a good book," said Awdish, who lives in Northville with her husband, Randy, and their now 6-year-old son, Walt.
And though she set about writing the book for her students, who are doctors she teaches in her communications classes, she realized the story has wide appeal.
"I think we all know on some level that we’ll all be affected by illness in our lives, but it’s hard to look at that when you’re well," Awdish said. "My hope is that this would be a resource for anybody that — whether they’re a patient now, whether they’re the family member of a patient, whether they hope to go to medical school one day.
She encourages people to think about what kind of patients they will be before they end up in a hospital environment, and to remember that they have voice and power even when it feels like they might not.
"Decide what kind of patient you choose to be," she said. Ask questions. If you don't feel you're being heard, speak up and ask again and again.
"To own that and have it worked out ahead of time would be so powerful," Awdish said. "If anyone should be an empowered patient, it should be a physician, but immediately, when you’re in that role (or patient), you become disempowered. The struggle, the feeling that your voice has value, if I felt that, imagine. It’s endemic. Anything we can do to empower patients, I think is so meaningful."
And by bringing some of the ugliest moments of her own brushes with medicine to light, Awdish hopes that her words will also bring empathy to the field, and keep others from having to endure the same struggles.
Dillon said it's working.
"It has to begin with compassion," Dillon said. "We want to treat our patients with compassion, we have to treat our doctors with compassion.
"When we make it about coming alongside them, about giving them the support they deserve and that they should have had all along in medical school, it can transform health care, truthfully. I really believe that."
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