Practical daily research

I offered my hand to the old man in the consult room. He grabbed it with the hand that had done compressions on his wife of six decades. He worked to slow his breath. I worked to find my next word. I was in the place between platitudes and prayer and presence and profoundness and sheer uncertainty.

And I thought about research. Not the research that reports the tiny percentage of people of a certain age who survive following CPR. Not the research that reports on brain damage following the loss of oxygen from cardiac arrest.

I thought about the practical research that chaplains and others do every day, a simple three phrase process:

Here’s what we do.
We think it helps.
Let’s find out.

I asked him what happened. He talked through the morning and I listened and looked at him.

When he mentioned calling his church, I made a note. And I said, “would you like to pray right now?”

He talked about being at a loss.

He talked about the steps he had done to get his wife to the ER room where, as far as I knew, a team was still working hard to get a pulse started.

He mentioned a family death that had been hard, “But this is harder.”

We took care of phone calls. Additional family came. The pastor came. I left the family to take care of the man.

I reported back when they had a pulse.

I reported back when the physician gave me the next steps of testing.

I went back to my office, to the rest of what was going on in my day, though very aware of this room. After a bit, when the scans should have been done, I headed back to the ER. The physician was ready to visit with the family, and so I joined her.

She started where they always start, where I had started,

“Can you tell me what happened?”

And the family took over.

“What’s happening now?”
“What’s her blood pressure now?”
“What happened?”
“What did the scan show?”
“That’s a good BP.”

The doctor asked the next question: “Has she expressed how far she would like us to go in treating her,”

And the family took over.

“Oh no.”
“Are you wanting to stop?”
“I have to decide now?”

There was a level of intensity that surprised the physician and me. There were conclusions being leapt to with a speed and resistance that was different than other rooms.

We got the family to the patient’s room. We watched more family tension. We watched more family emotion. I was glad the pastor was present. I went back to the office.

I was doing my charting, thinking about the intensity, talking with my colleagues, wondering about the situation. Until a coworker said about an unrelated case, “I don’t know what it’s like to lose a child.” And I suddenly remembered what the man had said: “We lost a grandson. He was 20. It was something in his blood.”

And I understood the tension in the consult room. I understood the intensity of the grandson’s parent, the other ways of family members moving in the room. Remembering that one fact, “This is a family that has faced a difficult hospital death together”, would have softened how I interacted with the family. It would have given the physician a starting point of compassion which may have made our usual script feel less combative, allowed her to move to the point more quickly.

Here’s what we do.
We think it works.
Let’s find out.

That last statement is where research actually happens. When we do what we always do and we ask ourselves, “Does that really work the way we think?” There is a humility that comes, a learning that comes, when we look at the process inside and out in an effort to discern how we could be more effective, how we could be more helpful, how we could adjust our “here’s what we do” just a little.

This is the kind of research that can become a major study, with sample sizes and protocols and literature reviews and statistics. All of those are helpful in growing a discipline of study.

But it can also happen in a room with a man who is afraid for his wife. I can pay attention to my own practice, my own interactions with husbands and wives, parents and children, moments of excruciating difficulty. In each of those moments (or immediately after) I can ask myself, “What am I learning that will help me with the next one of those moments. What questions can I ask myself and others? What can I learn about attending to bits of information and infusing them back into the care all of us provide?”

Listening for facts and patterns is research. Bringing a principle into a specific conversation to see how it helps is research. Affirming the physician following her conversation with the family because I want to see if I can help docs get better in those moments is research.

But leaving off the phrase “let’s find out” is not research. “Here’s what we do. We think it works” without the humility of testing and refining and clarifying is not research. It leads to criticism of families: “Why do they always interrupt me?” “Why can’t they be comforted the way everyone is supposed to be comforted?” “Why can’t they let me be the expert on their pain?”

Practical daily research can happen every time I walk into the building, desiring to help.