Lasting impressions: Garrett Chan on learning to listen
BY DIANE ROGERS
Garrett Chan
Every doctor and nurse carries at least one patient in his or her head—a memory of a difficult case, perhaps, or of a tragic outcome. And sometimes there’s a patient who simply touches the heart. This is one in an occasional series about the patients they carry.
By enrolling in nursing school at the University of Montreal, Garrett Chan hoped to learn about caring for patients at the same time that he polished his college French. Naturellement.
But Chan hadn’t reckoned on what his Quebecois patients might teach him. His very first charge was a gentleman in his 60s with a long history of severe heart disease, and Chan threw himself into the man’s rehabilitation, walking up and down the hospital hallways with him as he regained strength following his most recent heart attack. During rest stops, the patient would tell Chan about his wife, who had died two years earlier. He would talk about his only surviving relative, a niece who lived on the other side of the sprawling island city. He would often add, mischievously, that he dreamed about poutine—the heart-stopping Montreal delicacy constructed of French fries, gravy and cheese. “And I would then be expected to lecture him about sodium.”
On a Wednesday, two days before his scheduled discharge, Chan’s patient began saying that he wasn’t ready to go home yet. “Being a novice, I replied that the doctors had told me he was ready,’” Chan recalled. “So he said, ‘Okay, if you say so.’”
The following day, Chan’s patient said he really wasn’t sure that he was ready to go home. “But I told him, again, that the doctors said he was doing so much better, that his symptoms were improving.”
Friday finally arrived, and Chan spent time early that morning chatting with his patient, who still seemed uncertain about being discharged. At 10 a.m., when Chan walked past his room and waved, there was no response. “That’s odd,” he thought. On a second pass, the nursing student froze in the doorway, then rushed inside: “His gaze was fixed, and I couldn’t feel a pulse.” Chan ran to find his faculty preceptor, and together they tried chest compressions, then mouth-to-mouth resuscitation. To no avail. In retrospect, the death was not unexpected. But for a novice nurse, it was life-changing.
“I’d been listening to what others were saying, when I needed to also listen to the patient’s voice,” said Chan, RN, PhD, FAEN, who is now a clinical nurse specialist in palliative care in the emergency department of Stanford Hospital & Clinics. “I needed to be more attentive to his fear.”
Looking back, Chan realizes that his very first patient was also one of his earliest teachers. “As I talk with colleagues about their journeys in health-care professions, they’re often influenced by an early experience,” he added. “I now know that what my patient was doing in our conversations in Montreal was what we call ‘life review.’ It’s a therapy we employ, even when there’s little chance of cure, with nurses engaging patients in talking about and understanding their lives.”
Chan’s patient/teacher in Montreal? “He was telling me a bit about his wife, his niece, his favorite foods—his life. He wanted to talk about those things.”
Thirteen years after that seminal “life review,” Chan is dedicated to treating the distressing symptoms of patients receiving end-of-life care. He’s particularly concerned about acute dyspnea—difficulty breathing.
“In palliative care, our first intervention for people with dyspnea are opioids, such as morphine,” Chan explained. “I’ve found that there’s a variable response to morphine, and I’m wondering if there might be a genetic component.”
This summer Chan pursued that question as one of 22 fellows selected to attend an intensive, two-month genetics institute at the National Institutes of Health. But for all his interest in translational, bedside-to-bench research, Chan said his focus remains patient care.
“My attraction to nursing was always to be present and relational with patients,” he added. “It’s about helping patients cope with illness and maximize health.”
Office of Communication
Share this via...