Bill Moyers talks with physicians, scientists, therapists and patients about how emotional states affect our vulnerability to disease and the recovery process.
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TRANSCRIPT
BILL MOYERS: I’ve had occasion in my life, like many of you, to be grateful for the technological marvels of modern medicine. Like CAT scans and MRI’s, or this angiogram machine at Englewood Hospital here in New Jersey. None of us would want to be without these when we really need them. But at the same time, there are some things these advanced technologies simply cannot do. They cannot make you feel like a person. They cannot hold your hand or take you into their confidence and make you a partner in your own recovery. The difference is important because research in mind-body medicine is showing us that our emotional states affect our vulnerability to disease and how we recover from illness. Our grandmothers knew that. So did old Dr. Sam Tinney in my hometown of Marshall, Texas. When I was sick in bed, even with the measles, his very arrival seemed to make me recover faster. In this program we’ll see how some doctors and hospitals are trying to retrieve that healing presence. They found that when patients are made to feel better, they often get better. It’s what happens when the science of medicine joins the art of healing.
Modern medicine with all its power to cure disease often requires that we surrender our bodies to technology. But a person is more than a broken body in need of repair. There is the experience of illness, how it affects your life and the lives of those you love.
AUDREY TAYLOR: There are some things in your life you have to go through. And this is one of them.
BILL MOYERS: Although Audrey Taylor is about to have open heart surgery, she and her family have been told very little about the risky operation, the uncertainty increases their anxiety.
Mr. TAYLOR: You’re like another number that comes in, you know. And I think if a doctor was a little more caring in explaining things to a patient, I think it would be a lot better. I think a patient comes away with a lot of doubts in their minds.
RUTH TAYLOR: I don’t understand where her blockages are. I don’t know why she is a candidate for by-pass surgery. I would I think feel a lot more comfortable if it could be explained to me. Make me understand.
BILL MOYERS: Dr. Thomas Delbanco directs a national study of how hospitals can improve the way they deal with patients’ individual needs. He says evidence is mounting that the emotional support of patients plays a significant role in their recovery from a major operation. Dr. Delbanco is an internist and a professor at Harvard Medical School.
DR. THOMAS DELBANCO: We’re learning some fascinating things about how we educate people, how their minds work in their illness, how it affects their illness. We’re learning that if you teach a patient to be actively involved in his care, the outcome will be better. That’s a fascinating finding. We’ve sensed it, but we’ve never known it.
BILL MOYERS: If hospitals were to act just on the basis of what you say, how would they change what they do?
THOMAS DELBANCO: Well, I think one of the things we could do is take a much more organized inventory if you will of each individual as he or she comes into us. What you want, what you expect, what your fears are, what your anxieties are, what … you’re worried about when you leave us.
BILL MOYERS: Usually the inventory I fill out is … is have you had this illness before, have you had that illness? Have you ever taken a drug like this or a drug like that?
THOMAS DELBANCO: What we don’t do and what I’d like to see us do is, how is Bill Moyers different from other people? What does he bring into the office or into the hospital with him that will very much affect the way I see him as a person, and will affect the way I care for him? And that’s something that you and I should work on together.
BILL MOYERS: And you want to know that not just out of intellectual curiosity or to respect some idiosyncratic preference on my part, but because what you know can help you help me heal?
THOMAS DELBANCO: Oh I’m sure it makes a big difference. The attitude with which you leave the hospital, the attitude with which you go home, the attitude with which you confront your illness will make a real difference in how you do over time.
BILL MOYERS: Like many patients who undergo surgery, Audrey Taylor had no family doctor to guide her.
Mr. TAYLOR: You nervous?
AUDREY TAYLOR: A little bit.
Mr. TAYLOR: Oh yeah?
AUDREY TAYLOR: Um hmm. Wish it was over.
THOMAS DELBANCO: Has your heart ever skipped beats or anything like that? Oh, always been as regular as a clock.
AUDREY TAYLOR: Never noticed anything.
BILL MOYERS: We asked Dr. Delbanco to follow Audrey Taylor through the hospital experience and to share his observations with us. Re told us that Audrey would only meet her surgeon for the first time the night before the operation.
THOMAS DELBANCO: I kind of view myself as an expert consultant to you. But it’s your … you know, it’s your head and your body. And basically you’re the boss, you know, don’t forget that. And if you feel uneasy at any point, or think that things aren’t being told you that should be, or that you’re being told too much, which you may also feel, or that things are getting on your nerves, you’ve just got to open your mouth and tell us. I mean you’re going to have to feel your way through what’s going to be a big operation and a big experience in the hospital. Okay, so let’s come back to the heart. What did they tell you?
AUDREY TAYLOR: They recommended that I have the by-pass. And I asked if I should have it done right away and they said, the sooner the better.
THOMAS DELBANCO: So how are you feeling about it now?
AUDREY TAYLOR: I’m not that nervous. I’ve had surgery before and I kind of know what to expect. But it’s still scary, you know. You don’t know what’s going to happen.
SURGEON: We have to conclude that there’s significant disease approximately in there. You can see it here on the right.
BILL MOYERS: Audrey’s x-ray reveals extensive disease in the major arteries to her heart. In the past, doctors would have stood helpless as the heart gave way. Modern medicine does save lives, but it can also turn people into body parts on a high tech assembly line.
THOMAS DELBANCO: Technology has distanced us from our patients. I’m so busy trying to figure out what to order on you next, what test to schedule, what consultant to get a hold of, that I’m in danger of forgetting who you are and what you’re about and what you’re experiencing.
BILL MOYERS: But people weren’t talking about mind-body when you came into medicine. That’s a new phenomenon.
THOMAS DELBANCO: Oh yeah, but people were always telling us about the mind. I mean we … we went around our hospital watching the great doctors address people as people. That was the mind. They may not have articulated it that way, that’s right. But this is not new. In fact they used to do it a lot more because we didn’t have all the science that in a sense gets in the way of the mind-body relationship, the patient doctor relationship.
BILL MOYERS: The night before Audrey Taylor is to enter the hospital, her anxious family gathers at the home. Their support may be as important to Audrey’s recovery as the skill of her surgeon.
Mr. TAYLOR: I think it affects the whole family. It’s been tough, it’s been tough.
RUTH TAYLOR: And you dwell on it all day long. You don’t think you are, you just … it’s that gnawing feeling there’s something in the back of your mind that’s bothering you and what is that? You get that knot in your chest and I just can’t wait for the whole thing to be over with.
Mr. TAYLOR: Or you wake up with a sweat, you know what I mean, in the middle of the night. Turn over and you’re in a lather of sweat, thinking about it, you know. All of a sudden it hits you. You wake up and it’ll hit you, you know.
AUDREY TAYLOR: Sorry, guys.
RUTH TAYLOR: It’s going to be a long day, it’s going to be a real long day. And then if I could have my choice I’d like to be in that room, if I thought that I could … my stomach could handle it and … you know, just because I can’t stand the thought of waiting outside and not knowing. You’ve been through it with me and you said it was the worst six hours, because you just don’t know what’s going on in there. And then when a delay comes and you’re not informed and you think … you do, you think the worst.
AUDREY TAYLOR: I’ve been through surgery before and I know what it’s like and I know what to expect. And I know it’s hard, but I’m not afraid. I have some kind of a peace. It’s not necessary, worrying and fearing that the worst is going to happen, cause I don’t think it’s going to. I think I’m going to come out of it fine.
THOMAS DELBANCO: Your mom has what we call arterial sclerotic heart disease, which means that the vessels that feed the pump are damaged. You shouldn’t be scared tomorrow if the operation takes a very long time, or takes less time. I mean it can be very variable in the time it takes. And one of the things I know you’ll be feeling is when “X” time hits and he hasn’t been down yet, you’re going to be scared out of your head. Don’t do that. We may not be able to tell you every half hour how things are going, but we will certainly tell you if there’s trouble. And silence in this … in this case is just basically good news that things are going on … on schedule. In a way it’s amazing, but I find myself just a few hours before an operation still explaining to them why the operation was necessary. I’m translating and I’m teaching. I’m teaching about illness, I’m teaching about the disease that she has. And in that act, I think I’m being reassuring probably and I’m dispelling the mystery. Uncertainty is a terrible illness.
We often are blind to what the families experience, because we don’t see them. We don’t draw them in as quickly as we should. But it’s a tremendous crisis. If I look at the Taylor family, you could argue that it was a bigger crisis for those who were not going into the operating room than for her.
[Dr. DelBanco with family in the post-op room]
Mr. TAYLOR: Hi, Ed. We just got the news, your mother come through it with flying colors. Thank God, right? Yeah. Okay. Fine. Yeah. Come, okay. All right. Yes, all right.
RUTH TAYLOR: How’s Ed?
Mr. TAYLOR: Crying. It’s a hard thing to go through. Very hard. You all right?
RUTH TAYLOR: Yeah, what a relief, huh?
Mr. TAYLOR: Yeah, yeah.
BILL MOYERS: Is there evidence that these techniques, listening to Audrey Taylor, giving her the information that you think as a person she wants, knowing about her personal life, that all this does help in the recovery?
THOMAS DELBANCO: Well, I know that how that heart will feel is not going to be just a function of how well the surgeon cleans out her vessels or replaces them. It’s going to be a function of what she brings to her rehabilitation, what I teach her in the hospital before and after about her illness. We have studies that show that a person who gets a lot of education before the operation about what to expect in the operation, how to manage pain afterwards, what kind of stresses he or she will feel, we have … we have indication now that they will have a better postoperative course. All of that will have a real impact on the eventual recovery and the eventual course of the illness, as will the way the family interacts with the patient afterwards.
Mr. TAYLOR: People’s emotions play a very big part in their recovery. The best things that they did for us as family was keeping us informed. And I think this went a long way in her recovery.
[Parkland Hospital, Dallas, Texas]
BILL MOYERS: Parkland Hospital, a public hospital in Dallas, Texas. Emergency room medicine, dispensed in short intense bursts of adrenaline.
[Emergency Room, Parkland]
Like all public hospitals, Parkland is overburdened and underfunded. And it’s scrambling each day to provide medical care to thousands of poor and uninsured people. [Examination Room, ER]
It seems an unlikely place to introduce the philosophy of mind-body medicine, to meet patients’ emotional needs. But busy Parkland is doing just that, inspired by its Chief Executive Officer, Ron Anderson.
RON ANDERSON: We’ve done very well with science in medicine and I’m very proud of what we’ve been able to accomplish with that, but I do think that people want that healing presence and they want that concern. They know that there’s a mind-body connection.
BILL MOYERS: How much have you been affected by your interest in Native American medicine? I see those artifacts on your wall back there in your office.
RON ANDERSON: I guess, I’ve studied Eastern philosophies, the martial arts, um, have a Christian background as a Baptist and I find a lot of spirituality within the American Native culture that is very compatible for me and for healing.
BILL MOYERS: For healing? I mean you’re saying this in the midst of one of America’s largest public hospitals, you’re in charge here, your responsibility and you say that that has something to do with the way you practice medicine and heal?
RON ANDERSON: Yes.
BILL MOYERS: So what can we learn from them? From medicine?
RON ANDERSON: I’m not sure that they know any of the technology and even the disease theories that we know. They … they know about the spirit of man. They know about wholeness. They try to deal with that. While it’s mysticism, many times it’s also sometimes rather practical. And the one thing that’s wonderful about it is they see the spirit as absolutely part of the body. You don’t separate it. Hello, how are you doing? I love to go around with students and one of the things I like to tell them is that writing a prescription is not the end of the social contact with the patients. I understand we’ve got some … some business to do with your family.
WILLIE DENSON: Yeah.
RON ANDERSON: Mr. Denson is a patient who has AIDS. I felt the students needed to know him as a person and so they understand the illness of AIDS.
…and I just want to be able to be sure that we don’t be a bull in a china closet or anything like that. And … and is there anything special that might help us understand how they’re going to react to this news?
WILLIE DENSON: In so many ways I’m thinking that they do know, you know. But the thing is they’re just waiting on me to come out and say it, you know.
RON ANDERSON: I’ve sensed through the years watching people take care of AIDS patients that sometimes they stand at the end of the bed. And sometimes they … they have their hands in their pocket. I saw you walking down the hall and moving around, so I know you’re on … you’re on automatic pilot here. I think we beat out of our medical students a lot of the compassion and the empathy and things they need to understand the person. want them to be able to make eye contact with him, to touch, to examine, to … to understand and … and communicate with just like they should any patient. Very clear. And having had PCP and everything else, you really can’t tell anything from listening. It’s important to acknowledge personhood. And you know, I think that they’ll be better doctors the next time they care for a patient that has AIDS because of Willie Denson.
BILL MOYERS: So mind-body is … is the art of caring?
RON ANDERSON: I think it’s the art of understanding the person and not just the physiological system. And medical schools we deal with diseases and tissues and organs and body systems. And in medicine, when you put the art in there, you deal with persons. You deal with their families, you deal with communities. And you have to have that connectedness.
BILL MOYERS: Connectedness is a potent medicine in Parkland’s intensive care unit for premature babies. Some of the babies spend months here, subjected to constant monitoring and testing. Tubes run down their throats and into their stomachs. Blood is drawn twice a day. Many undergo at least one major surgery. Technology keeps the babies alive, but equally important is the emotional connection between parent and child. Scientific research has shown that without human contact a baby will wither, it’s normal development stunted. Babies need touching.
[Father with baby]
Having a premature baby can be a shock and many of Parkland’s teenage parents want to run, others turn numb. Parkland’s nurses nurture the parents, so they in turn will nurture their child.
VERONICA SPENCER: We involve the mother as soon as we can get her down here, after that baby’s born.
BILL MOYERS: Veronica Spencer is the unit’s director of nursing.
VERONICA SPENCER: We feel very strongly that a part of this baby’s care is that mother-baby bonding that has to go on. In a term baby, mom … the bonding takes place in the delivery room.
BILL MOYERS: It must be traumatic to her to see her baby teetering on the edge of life, surrounded by all these gadgets, hooked up to a flashing machine like this.
VERONICA SPENCER: I think it’s overwhelming is … is probably the best thing. It’s not real to her. Uh, every mom I think has an expectation of a Gerber baby. You know, that image.
BILL MOYERS: The perfect baby.
VERONICA SPENCER: Yeah and what happens is she’s adjusting to several different things. Number one, this hasn’t gone according to plan. I wasn’t supposed to have this baby this early. Secondly, I don’t have a Gerber baby. This doesn’t look like my idea of what the baby should be. So she has to be oriented to this different concept of her baby.
BILL MOYERS: Is this an example of what Ron Anderson calls … a new approach, a mind-body approach, a patient-centered approach to … to medicine, to hospitals?
VERONICA SPENCER: I think what our medical director and what my nurses and what I believe in wholeheartedly is that medicine, yes, the technical part of it we have to do. But even more than the technical part, or as important sometimes as the technical part is that psychological bonding, that emotional bonding, the emotional relationship that goes.
BILL MOYERS: Baby Davis has been in intensive care for almost four months. His parents, David and Carmen Davis come to see him every day. [with parents] What did he weigh when he was born?
CARMEN DAVIS: A pound and nine ounces. And it … it dropped. It went down to a pound and seven. So…
BILL MOYERS: Wow. Did you think little baby might die?
CARMEN DAVIS: I guess you always have to have that … that side of it and the side that he’s going to make it too.
BILL MOYERS: When you first came down here and saw him David, did a part of you want to run away?
DAVID DAVIS: Yes. I walked out. I walked out, I walked out and I built up my guts, came back in and … and I just stood there and cried. And I tried to get her to come down here.
CARMEN DAVIS: At first I didn’t really want to. I mean I know he’s my baby and everything, but I was just … you know, my parents saw him before I did and he did and they told me how small he was. And I was just kind of scared, you know. Didn’t want to get too attached to him cause something might happen or….
BILL MOYERS: I think I would have wondered if I wanted this baby. You know, is this my life? Is this my child?
CARMEN DAVIS: Yeah, you … you wonder … you wonder that, but when you’re there for them, when you come every day and you make … you let them know that you’re here and that you love them, it makes them get better faster I think. I think that had a lot to do with it. And everybody up here is so nice and….
BILL MOYERS: What did the staff do for you? Tell me about their role.
CARMEN DAVIS: They … they talk to you. They tell you everything, what’s going on. They… they … you don’t even have to really ask questions, they let you know about everything. You can call no matter what time it is, day or night, you can ask on how your baby’s doing. Come in here any time, stay as long as you want. They were … they were real helpful. They just let you … they just … they’re like the second mother in a way.
BILL MOYERS: The second mother?
CARMEN DAVIS: Yeah.
BILL MOYERS: Nurses like Cindy Wheeler have the most direct contact with the mothers.
CINDY WHEELER: A lot of moms want to stand back. They’re real distant to the baby, whether they have the inside fear that their baby’s not going to survive, so they don’t want to make that attachment. And a lot of moms, you kind of have to mold them into being a mother.
BILL MOYERS: Lydia Ruiz is about to see her baby for the first time. The baby was born last night, five weeks premature, unable to breathe. This first meeting may be as necessary to the future well-being of the baby as the respirator that saved her life.
[Ms. Wheeler with Lydia and the Ruiz baby]
CINDY WHEELER: I’ll explain some of the little monitors that … that are on her right now. These little … little leads right here are connected to the cardiac monitor. And it shows us what her heart rate is and what her respiratory rate is. It triggers off if anything happens…. I’m sure It’s extremely tightening tor the mother. They come in and see the monitors. It’s hard to sort their baby out from the equipment. So I try to separate the equipment from the baby. Sure got a lot of hair on her head. She cute?
LYDIA RUIZ: Yes.
CINDY WHEELER: You can inspect her, she’s got everything there, all of her little fingers and toes. I try to keep reinforcing the positive things about the baby. Do you want to see her whole body? I know that you’re anxious to see what’s all down in there. If you keep promoting bad things, they’re not encouraged to fight on for their baby. They’ll even stay more distant. But if you promote good things about their baby they might think, well that baby might make it, I might just get a little bit more closer to that baby. I think that a baby inherently has a sense of who his mother is and that kind of provides a calming effect for that baby. That baby knows that when that person comes, he’s not going to get poked, he’s not going to get prod, he’s not going to get tested for anything. He know he’s going to get caressed and loved and it … I think it’s very important for them to come down and touch their babies. Touching is everything.
VERONICA SPENCER: We’re doing two things. Number one, we are acquainting her with her baby, or introducing her to her baby. But we’re also forming a bond for that mom down here in the nursery, because if we don’t work to form a bond so that she’s comfortable in her environment with us, as well as the environment that her baby is in, she’ll come and visit less often. She won’t be here quite as much. We want to make this mom take ownership of that baby, not just from a physical perspective, but from an emotional perspective.
BILL MOYERS: There are times when modern medicine reaches its limits, when no miracle of technology can save a dying baby. That’s when Parkland’s nurses turn to healing the emotional wound of a mother who must let go of her child.
VERONICA SPENCER: When we know that a child is not going to survive, we make every effort that we can to get that mom down here. If she hasn’t seen that baby, that’s even more important. If we have to put her on a stretcher to get her down here, we’ll do that. We’ll let that mom hold that baby if it’s at all possible. We will try to give her a feeling of actually, you know, holding that baby in your arms, touching that baby, being able to do the normal things that a … a mom does with a … with a regular baby, count all its toes and count all its fingers and … and just hold it the way Cindy’s holding it, because she has to be able to get that baby in her arms, she has to be able to … to welcome her baby into the world, before she can tell it good-bye.
BILL MOYERS: In other words, bonding has to happen before grieving can occur and grieving is important to these women?
VELMA WOMMACK: I do believe so, because it’s … it’s the accepting of what is occurring. Urn, if you never hold the baby, then you never know …. If somebody tells you, well your baby has passed away, well I don’t know whether I believe you or not. I mean you could come in and tell me and I could still question that unless I have actually held that baby, witnessed it, accepted it and allowed myself to … to be a part of that baby, or the baby be a part of me over their life and that’s a big thing…. There’s another part that too that’s so important is that my nursing staff is very close as we said, you know, to these babies. And it’s okay. We … we’ll stand her and cry with you when your baby dies, you know, or when your baby is going to not be there any longer. And it’s okay. We encourage that. It’s … it’s a healing process for the nurse as well as for the parent. It’s okay for her to cry. A lot of these parents won’t cry. They … they can’t.
CINDY WHEELER: I think when they see you cry, they … they realize that we can love their baby just like they can. And I think that makes them feel a little bit better. That I can share in their grief just as they share in my grief, that it wasn’t my baby, but I took care of that baby and … and … I loved him as much as I … you know, I was part of him being here.
BILL MOYERS: I don’t know what you all are. I … you’re more than nurses, you’re more than technicians. You’re more .. ..
CINDY WHEELER: Well, we have more than one patient. We take care of the baby. Our … we have two patients, the baby and the family. And you can’t forget about the family. The family’s ….
VERONICA SPENCER: They’re interdependent.
CINDY WHEELER: That’s … yeah.
BILL MOYERS: They’re part of that whole that you talk about. Ron Anderson talks about seeing everything whole, everything is connected, only connect, he says, that’s what medicine’s about today.
VERONICA SPENCER: That’s what we do is about, Bill, down here, we think.
BILL MOYERS: Jasmine Davis is waiting for her baby brother. She has never seen him before. Today, little David is going home. You remember the first time you held him?
DAVID DAVIS: Yes, it was exciting, cause I waited a long time to hold him.
BILL MOYERS: So do you hold him now?
DAVID DAVIS: Yes.
BILL MOYERS: You let … you let … you let him hold him?
CARMEN DAVIS: Yeah, he holds him. He feeds him. He changes him and everything.
BILL MOYERS: Do you feel that you’ve … you’ve bonded with the … with the baby?
CARMEN DAVIS: Dh huh. I … I know that he knows that I’m here. I was here. I know that he knows that … cause he’s gotten better and … and you can tell … you can tell when we get here, he changes a little bit, his attitude and everything, he changes.
BILL MOYERS: Are you scared today, taking him home for the first time?
CARMEN DAVIS: Oh, kind of. I’m more just wanting to get him home. I’m not even thinking about really being scared.
BILL MOYERS: What about you, David?
DAVID DAVIS: I’m excited. I’m ready to take him home. I just can’t wait till we walk out those doors.
BILL MOYERS: Well, good luck to you.
DAVID DAVIS: Thanks.
CARMEN DAVIS: Thank you.
BILL MOYERS: All … all of you.
CARMEN DAVIS: Thank you.
BILL MOYERS: You were lucky.
DAVID DAVIS: Yes, very.
CARMEN DAVIS: Yeah, we were.
[Davis parents, Jasmine]
RON ANDERSON: We want to look not just at the baby’s first 28 days of life, but we worried about the first year, the first five years. Worried about how that child will be able to integrate into school and into society. All that’s very, very important to do and you don’t want to drop the ball just because of the high tech intensive care, you also have to arrange for the ongoing and comprehensive, continuing care of that child. And that’s why we really made the step out into the community. Many of the diseases Parkland has to deal with are not going to be solved in a test tube. We have to deal with the issues of hopelessness and helplessness.
BILL MOYERS: Parkland has opened seven clinics in Dallas’ poorest neighborhoods. Feelings of hopelessness and helplessness can be as unhealthy as an invading bacteria. The stress of just getting by from day to day wears the body down, making it more susceptible to disease. Medical care often fails if it only focuses on the body and ignores the anguish in people’s minds. Dr. David Smith is the director of the clinics.
Dr. DAVID SMITH: Most disease processes that we see can only get worse if we don’t allow the mind to be part of the healing process, or even a prevention process. In other words, blood pressure, if we don’t think about the stresses that are in a family’s life or that patient’s life and try to deal with those, decrease them, we will have a tough time controlling that patient’s blood pressure.
BILL MOYERS: Are you saying that the community is the best place to practice mind-body medicine?
DAVID SMITH Absolutely.
BILL MOYERS: Not the hospital, not the….
DAVID SMITH Absolutely. The best place to do it is out here in the community.
[Singing in a church]
BILL MOYERS: In the churches, homes and neighborhoods of these communities David Smith has become a familiar figure. Taking word of the clinics and preventive health to where people live, work and worship.
DAVID SMITH I really want to talk to you about a couple of things. First of all, a little redemption ourselves. We’ve not always done things in health care the way we should. We’ve tended to put health care in hospitals that are very difficult for you to get to. They’re not really where you are in the community. And one of the things that Parkland wants to do and that’s really needed in this community is to take health care back out to the people.
BILL MOYERS: Do most of these people see a doctor on a … on a regular basis?
DAVID SMITH No, most of these people do not. Their regular doctor ends up being in an emergency room, which is often a resident, someone in training and is very irregular. Haphazard and they often put things off.
BILL MOYERS: How do you explain the … the … the phenomenon that … that medical care has left a community like this?
DAVID SMITH Well, you know, I think part of it is the incentives are all wrong. The incentives right now are for us to keep health care in a real centralized area. We make it convenient for the providers of care, not for the patients. But we should be taking and reversing that trend, taking health care back out to the community. It isn’t fair.
BILL MOYERS: What are the … the most common illnesses that these people experience?
DAVID SMITH Well, most common things we see, but it does vary by age, are things like stroke, cancer. We do see a lot of diabetes. People come in with big ulcers on their legs because they’re not taken care of well.
BILL MOYERS: The illnesses that you listed seem so physical in nature that I have to ask, what is mind do in the healing process as far as these people are concerned?
DAVID SMITH Well, quite frankly we know that in the healing process of anything from an ulcer in diabetes to someone with asthma, that the mind is very intricately involved with actually allowing that patient to get better or worse. You can actually make yourself more ill. We know there are many different chemical parts of the body that are controlled by the mind, that could put a patient in a position where they’ll actually get worse, even despite the best “medicine,” quote, unquote.
[Doctor’s office]
BILL MOYERS: Dr. Lee Roy McCurley has been treating Mrs. Uvalle for diabetes. The clinics have revived the idea of the old-fashioned family doctor.
LEE ROY MCCURLEY: Tell Mrs. Uvalle that I … I’ve seen her enough to know that she seems to still have something on her mind and I bet it’s her eyes.
NURIA MONTERO: [speaks Spanish]
LEE ROY MCCURLEY: It’s not as simple as problem identified, medication for problem, it’s over. It’s just not that simple. There’s a lot of emotional involvement and there’s a lot of feelings involved in treating patients. Tell him I want him to know that I’m only bringing up the insulin because it was a concern of theirs. However, I’m going to do everything I can to make sure that she doesn’t need to be on the insulin.
NURIA MONTERO: [speaks Spanish]
LEE ROY MCCURLEY: You have to convey to the patient that it’s just as important to you as it is to them that they get better. And once you do that, once you get that going, your … your success rate can automatically shoot up.
DAVID SMITH You have to understand where she’s coming from, what her community is like and build on those strengths. An example that we see very frequently in our Hispanic culture is a lot of them go to lay doctors, or curandero’s, or people that do things that even some people describe as witchcraft. We have to understand that a patient may have a relationship with one of these people, cause if we walk in and say, you know, we know it all, you guys need to get rid of those teas and quit lighting those candles, because we can take care of you, we’ve lost it. They’re not going to get better.
BILL MOYERS: Why?
DAVID SMITH Well, they won’t take our medications. Example, Mrs. Gonzalez recently came in, has high blood pressure. We diagnose it, talk to her about it, but if we dismiss her and don’t understand that she is in fact working with a curandero, we’re going to fail, because she’s going to say, you don’t believe what I believe. In fact we’ve even got to go a little further. It’s even a little slicker than that. We’ve got to know that certain of those teas actually have medicinals in them. One of them, example, is foxglove tea. It contains a medicine which actually will make the heart beat better. It’s called digitalis. We use it. If we know she’s on foxglove tea, we do need to make sure that we don’t overdose her with digoxin.
BILL MOYERS: So to practice mind-body medicine you need to know about her faith, about her family, about her … her culture.
DAVID SMITH Absolutely. We’ve got to know what is going on out in that community. We can’t take the patient out of context, which means you’ve got to have some different kind of health people working with you. We’ve got to have community health aides. We have to have social workers. We have to have health educators who can speak their language, quite frankly, grow up and live in these communities; they’re the most effective people.
BILL MOYERS: People like Lee Roy McCurley?
DAVID SMITH That’s correct.
LEE ROY MCCURLEY: How are you doing there, stranger?
BESSIE DAVIS: I’m doing pretty good.
BILL MOYERS: Dr. McCurley still makes house calls. His presence is sometimes the best medicine.
LEE ROY MCCURLEY: I think the thing that Mrs. Davis has liked about our relationship is that I listen to her. We relate. The relationship is so important, very … very powerful thing, very powerful. I remember the first time you came in, you Was … were sort of surprised because I guess I appeared rather young to you.
CARMEN DAVIS: Well, you did. You remember what I said to you? I told you, I said, are you sure you know anything? You said, I know my patients. He … you said, I’m a durned good doctor and I know it. And by rights, I had really found out that you are really … you are really good.
LEE ROY MCCURLEY: Why thank you, thank you, Mrs. Davis.
CARMEN DAVIS: I don’t have any complaints.
[Mid-Columbia Hospital, Oregon]
BILL MOYERS: In northern Oregon, far from the streets of Dallas, there is a glimpse of what the future of medical care could be. Here along the banks of the Columbia River a whole new vision of hospitals is taking shape. The people who live here are practical and conservative. They make their living from orchards, ranching and timber. For medical care they go to a hospital in a town called, The Dalles. It is typical of good, small town hospitals and is thoroughly state of the art. For the people who run it though, the best technology is not enough.
MARK SCOTT: When you come to a hospital, you’re scared, you’re sick, you’re frightened, you’re in pain, all of those things are running through your emotions. Hospitals are very cold. They’re intimidating. They’re very impersonal institutions from the patient’s perspective.
BILL MOYERS: Mark Scott is the president of Mid-Columbia hospital.
MARK SCOTT: The environment does enhance the well-being of the patients and of our staff.
BILL MOYERS: You think that’s so. You think that….
MARK SCOTT: Absolutely.
BILL MOYERS: This anxiety I feel when I come in as a patient, even I get as a visitor walking into a hospital, that it affects me medically?
MARK SCOTT: Absolutely, it’s a part of the healing process. The curing patients is not just a matter of stapling, suturing, cutting, bandaging, give them a test and send them home. There’s more to medicine than that. There’s more to the healing process than the technological end of health care.
BILL MOYERS: In the fall of 1991, Scott began a major building program, but he wanted more than a renovated and expanded physical plant.
MARK SCOTT: What we’re putting ourselves through here isn’t just a focus on creating a prettier, nicer, less institutional looking facility, but to acknowledge the fact that the physical environment begins that healing process mentally for that patient and for the family member. It brings out those inner resources to … that will assist in the recovery process.
BILL MOYERS: In April of 1992, the new hospital was completed.
MARK SCOTT: We spend a lot of time healing the body. We have health care that’s second to none in this world. But we’ve kind of forgot about the soul, or healing the soul. The arts play a very important part of what we are doing here. Classical pieces of music, storytelling, something as simple as storytelling to take people out of this environment of pain and suffering and healing and smells and put them into a story. And part of what we’re doing here is to begin to give some of our patients a little bit of relief, a little bit of relaxation, mentally as well as physically and the piano begins to do that.
BILL MOYERS: What you’re talking about is the acknowledgement that … that laughter, humor, wit, feeling good are now recognized as a part of medicine.
MARK SCOTT: Hippocrates knew that.
BILL MOYERS: The father of medicine.
MARK SCOTT: The father of medicine knew that. He knew that. And to a certain degree we’ve drifted away from that.
BILL MOYERS: What did he know?
MARK SCOTT: Well, he knew that that worked. That’s one of the things that help people get better.
BILL MOYERS: Healing the soul, he said, is as important as healing the body.
MARK SCOTT: That’s … it’s equal, it’s equal.
[Nurse with patient]
One of the reasons we’re offering massage therapy is to relax and be calm in this very tense environment. Going to surgery is the most tense and frightening experience of most people’s lives. Giving a simple back or a neck massage to relax these people prior to going to surgery is something that we feel is very, very helpful in the healing process.
[Nurse with patient]
BILL MOYERS: Like nurses everywhere, the nurses here perform the familiar duties of modern medicine. But they do more. They’re also the mid-wives to healing. Nurses like Sue Kelly work hard at understanding their patient’s emotional needs. The right human contact they believe speeds a patient’s recovery. Sometimes it’s as simple as holding a patient’s hand.
SUE KELLY: Years ago if I were found caught at the bedside holding a patient’s hand and doing nothing but that, it would have been considered a waste of time.
BILL MOYERS: Why?
SUE KELLY: Urn, because there were tasks and things to do and patient’s were diseases. And they were surgeries, they were … they were hips or they were fractured femurs, but they … personality, the essence of a person… [piano music]
BILL MOYERS: Sometimes it’s not just the hand that needs touching, but the spirit.
SUE KELLY: Finally this is everything I ever wanted nursing to be, this is everything medicine should be.
[Nurse with patient]
BILL MOYERS: Tia Bailey has been a nurse for over 20 years.
TIA BAILEY: What I’m here for is to take care of my patient, whatever that entails. If my patient needs me to sit down for 30 minutes with them, instead of maybe being out at the desk where somebody can see me charting, that’s fine. The rest of it will get done, but the patient comes first. And whenever I do that I don’t feel like I’m going to get in trouble. I feel like I’m going to get praised.
BILL MOYERS: How much reckoning do you give to the emotions of your patients?
SUE KELLY: A lot.
TIA BAILEY: A lot. A lot.
BILL MOYERS: To my fear, my anxiety.
TIA BAILEY: Yes, yes.
BILL MOYERS: Why?
SUE KELLY: Well, all of those ….
TIA BAILEY: It determines your pain control.
BILL MOYERS: Hmmm?
TIA BAILEY: It determines your pain control.
BILL MOYERS: What do you mean?
TIA BAILEY: If you are afraid, if you are mad, if you are upset about something, then whenever I try and deliver analgesia to you, you’re not going to get the benefit that you would if I’ve made you comfortable in your position, your physical surroundings. If I have approached my … if I have delivered myself to you as somebody who really cares if this Demerol is going to help you or not and who’s going to come back and check on you and say, did it help? If it didn’t, let’s try something else.
BILL MOYERS: Are you saying that my negative emotions can thwart or frustrate the positive effects of medication?
TIA BAILEY: Yes.
SUE KELLY: Exactly, and also prevent you from being able to understand what kind of teaching that we’re trying to tell you or what your doctor’s saying. If you’re … in an anxiety level that’s sky-high and you’re afraid and you have no … no place to vent your fears and nobody to reassure you, he comes in and he tells you that this and this and this is what the x-rays and CAT-scans showed and you don’t have a clue what he just said, cause your anxiety level … he might as well be speaking Chinese.
BILL MOYERS: One of the most guarded secrets of medicine has been the personal medical chart, available to doctors and nurses, but forbidden to patients.
[Nurse with patient}
SUE KELLY: Here we share the chart with the patient. That’s a totally unheard of event.
BILL MOYERS: You mean you show the patient?
SUE KELLY: Yes, the patient is encouraged to read the chart.
BILL MOYERS: What the doctor said the night before about me?
SUE KELLY: Uh huh. And teaching ….
BILL MOYERS: You mean I can ask you to show me?
SUE KELLY: Oh yes. You can read it yourself. And then we can help you understand what it says.
BILL MOYERS: David Killian has asked to see his chart daily since he arrived at the hospital with his diabetes out of control.
DAVID KILLIAN: You said he was going to change, instead of the Capote that I was taking….
SUE KELLY: Right, Popardia. It’s real effective. Sometimes we put a hole in it and push it underneath the tongue, but this … this … he says by mouth. We shouldn’t be the keeper of the knowledge about you. And not share it with you. This whole thing is about choices and sharing.
BILL MOYERS: But what are you hoping to …
SUE KELLY: About teaching and learning.
BILL MOYERS: Teaching them what?
SUE KELLY: Teaching you whatever it is you want to know about your body. It’s your body.
BILL MOYERS: I know, but what if the chart suggests that … I’m in desperate trouble? That I….
SUE KELLY: Then you have a right to know that.
TIA BAILEY: You need to know that.
SUE KELLY: You also have a right not to know that if you don’t want to. You don’t have to read your chart and you have a right. You know, it’s your choices. This is about choices.
BILL MOYERS: What’s the purpose of this? I mean what’s the strategy?
TIA BAILEY: Have you ever tried to fight an enemy you don’t know? Most people want that information, that are sick. They want that information. They don’t know how to get it. We can provide that information to them.
BILL MOYERS: Do you see patients for whom it makes a difference if they are actively involved?
SUE KELLY: Oh definitely. And if the families are involved, it makes a tremendous difference.
[Nurse talking to children}
BILL MOYERS: Most hospitals with rigid visiting hours, especially restrict the comings and goings of children. At Mid-Columbia there are no visiting hours at all. Children are welcomed at any time and there is a pullout bed in every room if a family member wishes to spend the night.
SUE KELLY: Traditionally we have kept the families way at bay. You can just visit. You just bring the cards and the flowers and leave as soon as possible. You know, visiting hours are now over, all this kind of stuff. It’s not the way it should be. The patient needs the family. If they need the family to be there, the family needs to be there. Oftentimes the family has needs to be there. They’re scared. They need to have the teaching. They need to have the nurturing of the nurses too.
BILL MOYERS: Oren Johnson’s mother has recently undergone major surgery for cancer. [Ms. Kelly with Oren Johnson]
OREN JOHNSON: She really does love raspberries. And seeing as how it’s been a bad day. I hope that this is going to just suit her palate.
BILL MOYERS: The healing power of a favorite food, prepared and served by familiar hands is a part of folk wisdom. Mid-Columbia provides a kitchen on every floor and encourages family members to prepare meals that will be emotionally nourishing.
JEAN SIMONDS: Sometimes you want to do something for that person because that’s your way of expressing your love or your care or your concern for them. And they give you the opportunity to do that and that really helps you.
BILL MOYERS: Oren and his sister Jean have spent hours with their mother Letha Johnson.
Well, this hospital is unique in the way it invites a family to be a part of the whole process. And that happened here?
OREN JOHNSON: Yes.
BILL MOYERS: You felt they really welcomed you?
OREN JOHNSON: You are invited in. You are really made to feel comfortable. It isn’t … it isn’t like that there is a set hour that you can come and see and be close and then you’re asked to leave. It … there’s never been that feeling. You’re always welcome.
BILL MOYERS: And you think that’s made an impact on how you feel about yourself and your recovery and that’s made you recover better, heal better?
LETHA JOHNSON:Definitely. Definitely. Then to have the support from all your family and your friends and neighbors and … and they are able to come and go mainly as they wish. I’ve had company all hours of the day and night.
BILL MOYERS: Sometimes that’s not so good.
LETHA JOHNSON: Oh, but I like it. I told them, wake me up if I was asleep.
BILL MOYERS: Well, so many hospitals care, but they haven’t yet taken these barriers down. Haven’t yet made the kind of family environment that we’ve seen here.
JEAN SIMONDS: She’s Letha to them, you know. She’s not the person in the room, 306 or whatever. And I have not felt near as anxious with Mom in … in this hospital as I have in past experiences. And I think Oren’s that way too.
OREN JOHNSON: I think when our anxiety is diminished it really has a big impact in terms of how it affects Mother, because she’s going to tune in when we’re real anxious. And vice versa. How all this information is imparted on us, through the staff, through the hospital, through the library, through the nurses. It … it really does impact how we react and I think it really does help Mother heal faster.
BILL MOYERS: Do you agree with that?
LETHA JOHNSON: Yeah, right. And when they’re not feeling good, I don’t feel good.
MARK SCOTT: Being in this hospital is a traumatic experience and we’re trying to soften that as much as we can, to … to try and humanize this experience if … if that’s possible.
BILL MOYERS: What you’re describing is a … a circle of healing, that is, this physical environment, my state of mind as a patient and the state of my body, that they’re all related.
MARK SCOTT: They’re all tied together. And we’re pulling all that back together. We’re pulling all of those pieces back together. We haven’t achieved it to our level of satisfaction, but at least we’re working on it, at least we’re focusing in on bringing all of those pieces together as best as we can in … in this small little hospital, in this little part of the country. That we’re trying our darnedest to … to allow all of those pieces to begin to come together.
You can view more about this series on this website.
This transcript was entered on April 2, 2015.
