EP. 39: LIFE AND DEATH IN 12 HOURS

Nov 30

WITH CHRISTIN THANKACHAN, BSN, RN-BC

An oncology ICU nurse shares poignant patient stories that illustrate what compassion looks like in the midst of life’s hardest moments.

LISTEN NOW

Episode Summary

For all the crucial work physicians do in the hospital, no one spends more time with hospitalized patients than nurses. This is especially true in the intensive care unit, where nurses serve as patients’ conduits with their medical team and perhaps even with the outside world. Joining us in this episode is Christin Thankachan, an ICU nurse at Stanford Health Care who cares for the most seriously ill cancer patients in the hospital. Over the course of our stirring conversation, we ask her to reflect on how she guides patients and their families, with a comforting and compassionate hand, through life’s darkest moments. In addition, Christin shares the unique challenges she has faced as a frontline worker during the COVID-19 pandemic, and how she has maintained hope and meaning through these trying times.

Christin Thankachan is a non-profiteer turned disaster worker turned nurse. She is now an Oncology ICU nurse manager pursuing research in advancing equitable healthcare access for patients with complex cancers. Her current passion project is supporting the timing and quality of advanced care planning conversations in the ICU.
In this episode, you will hear about:
• How Hurricane Sandy pushed Christin towards a career in nursing - 2:06
• The differences between a nurse’s responsibilities in an intensive care unit and a medical/surgical unit - 5:13
• What a typical day is like for an ICU nurse - 7:26
• How Christin finds the physical, emotional, and psychological stamina to care for some of the sickest patients in the hospital - 10:22
• The kinds of relationships Christin forms with her patients and how she strives to elevate the human connection - 13:49
• The importance Christin places on recognizing the fullness of the humanity within each patient - 21:16
• The power of hope for patients facing serious illnesses - 31:50
• What it was like to serve as a frontline worker in the early days of the COVID-19 pandemic - 36:38
• Advice on how to stay connected to the most meaningful aspects of a healthcare profession, even in the darkest times - 40:47
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:03] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to the Doctors Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions. We meet with deep thinkers, working across health care, from doctors and nurses to patients and health care executives. Those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Tyler Johnson: [00:01:04] This is Tyler and Henry, and we are really grateful today to welcome Christin. Thankachan. Did I get close?
Christin Thankachan: [00:01:12] Sure.
Tyler Johnson: [00:01:15] Why don't you say your name right, So we get it right up here?
Christin Thankachan: [00:01:18] Christin Thankachan.
Tyler Johnson: [00:01:20] There we go. And she is an ICU nurse at the Stanford Medical ICU. Some of you may remember back to one of our very early episodes where we interviewed Adjoa Boateng, who is a medical ICU doctor at Stanford. And we recognized a little bit back, actually, that we had never interviewed a nurse, which is a horrible oversight, frankly, on our part. And so we asked if she could recommend a nurse that we could talk to. And Christin's was the name that came in. And so we are really grateful to you, Christin, for being here. And you can just walk us through what is your experience as a nurse? Like, where have you worked for how long and what capacities? And just kind of walk us through that a little bit.
Christin Thankachan: [00:02:06] Sure. Thank you for having me on the podcast. Appreciate being here. So I was not destined to be a nurse. My mother is a nurse. I come from a a family of health care humans and thought I want to be an attorney and do international justice. So did not always anticipate being a nurse, but I worked for a nonprofit in New York City back in 2008, and eventually that led to some disaster management work. And during Hurricane Sandy. Was on the disaster preparedness team in Hurricane Sandy actually turned into a disaster. But during Hurricane Sandy, I was in charge of creating programs for people without access. So that population happened to be oncology patients. So I was doing food pantries, soup kitchens, shelters for patients during Hurricane Sandy that ended up in a partnership with Sloan, all the five major cancer centers in New York City and ended up working with a team of amazing nurses that were also working this disaster. We were four months out in the field, and even though my mother's a nurse, I was so taken aback by these nurses and decided to go to nursing school and said, I want to go into oncology.
Christin Thankachan: [00:03:21] I want to make sure that these patients get the care they need because what I saw was. Under-prepared, missed by the patients. And it was heartbreaking to see patients with cancer who didn't have food, electricity and water. During a disaster. They were hard to reach. They didn't want to go to a shelter, their immunocompromised and vulnerable, and to create programs that better access them. I was like, I just need to get there. And so I thought being a nurse was going to be the way that I did that. And then that led me to nursing as a second career. I did contract work with Sloan, worked at two major hospitals in New Jersey, and then when he moved out here, I said, and that was in 2020, we moved out here. I said, Oh, I have a22 little kids. If I'm going to work full time, it's going to be because there's a specialty oncology ICU at Stanford. And if you put it into the universe, it comes back to you. And sure enough, there was an oncology ICU at Stanford. And that's how I started here, because I love the population and love the acuity.
Tyler Johnson: [00:04:27] And so how long have you been here?
Christin Thankachan: [00:04:29] Since 2020. So April 2020, I started right at the start of the pandemic. So did not think that. That's where we were going to go When I decided to go to work at a comprehensive cancer center in the oncology population. Did not think I would have to mitigate the. Pandemic as well.
Tyler Johnson: [00:04:51] I see. What kind of units did you work in in New Jersey and New York?
Christin Thankachan: [00:04:55] So I have done ortho stepdown, ICU, Oncology surgical ICU, surgical oncology ICU, and then ended up here.
Tyler Johnson: [00:05:08] And how many years had you been in nurse before you came to Stanford?
Christin Thankachan: [00:05:12] Seven years.
Tyler Johnson: [00:05:13] So I think that one thing that might be helpful to a lot of our listeners, those who have maybe had no medical training or are just getting started in their medical training. Talk us a little bit through what is the difference between an intensive care unit and a normal med/surge floor. That's just sort of a normal hospital floor. And then specifically, what is the difference in being a nurse in an ICU versus on a normal floor? Can you walk us through that a little bit?
Christin Thankachan: [00:05:40] Sure. A medical/surgical unit is a lower acuity patient. That means the patients need to be in the hospital but do not require as much care or do not need as much support as ICU. So their vital signs may be stable, but they have an infection that needs IV antibiotics and that might lead them to a medical surgical floor or they're being evaluated for a surgery perhaps. And the difference between that and the ICU is. Something is unstable. It could be. A body part that is unstable. It could be vital signs like a blood pressure that's very unstable, that is low, that requires a higher level of care. So that will lead you to the ICU. So it's different being a nurse in the medical surgical unit versus an ICU, because in the ICU, I'm from the East Coast. God bless California ratios. But on the East Coast, I had eight patients on a medical surgical unit.
Tyler Johnson: [00:06:38] What? Wow.
Christin Thankachan: [00:06:41] Uh-huh. And dual role like charge or precept while I had those eight patients.
Henry Bair: [00:06:47] Sorry to interrupt here. What do you mean by being a charge or a precept?
Christin Thankachan: [00:06:51] So a charge nurse is someone that manages the unit. So if it's a 40 bed unit, a charge nurse will oversee the transfers in, transfers out, general logistics, any problems that may arise. And there are designated as the expert on the unit for nursing.
Tyler Johnson: [00:07:07] Okay, so on the East Coast, you might care for seven or eight patients on a normal floor, here you might care for three or four or five. What about in the ICU?
Christin Thankachan: [00:07:16] So in the ICU, it's a 1 to 2 ratio generally, or a 1 to 1, depending on if patients are very, very sick.
Tyler Johnson: [00:07:26] Got it. Just walk us through a little bit for again, for our listeners who maybe don't have a lot of experience in hospitals or haven't spent a lot of time around nurses, one of the things that you realize really early on that I will say anyway, that I realized in medical school is that for all of the talk that doctors do about taking care of patients, it's actually pretty shocking how little time most doctors actually spend with most of their patients on most days in the hospital. Right. So just as a little bit of background by by way of a point of comparison, if I'm in the hospital taking care like when I so I work on one of the oncology floors, but when I take care of patients in the hospital, we will round in the morning and that rounding in the morning consists of we'll go to see, let's say 15 patients. For each of the 15 patients, My team and I might talk about a patient for ten, 15, 20 minutes, then go see the patient for five or 10 minutes. And then under most circumstances, as the the doctor in charge of the team, I don't see the patient again until 24 hours from then when we round the next morning. Right? Now, the team may be in and out of the room, depending on how sick the patient is and what things are going on and whatever. But it's just to say that it's we don't spend, doctors don't spend that much time. All of which is to say what's really striking about an ICU nurse is that, as you said, Christin, I mean, there are times when you literally you have one patient or other times two patients. Right. But just give us an idea if you're spending- So if you do a 12 hour shift and you spend all 12 hours with one patient, what on earth are you doing for those 12 hours? What fills all that time?
Christin Thankachan: [00:09:06] A life and death fills the time of 12 hours. If I have a 1 to 1 patient, it is fighting against death for those 12 hours. And that means when I get here, if a patient is relatively stable when I get here, I'll start by looking at the orders, looking at the medications, seeing what sort of medications they're on for blood pressure or what we can do to stabilize that blood pressure. But oftentimes we're just jumping in because somebody's blood pressure is very, very low. And we're I start my shift with a code and then my shift with either saving a life or putting someone into a bag. I hate to put it that way. I'm sure there's a better way of saying, but in the 12 hours I hear really it is preserving someone's dignity and fighting for their life for those 12 hours. So when I get here, I'll basically it's titrating meds minute by minute, second by second, do on a screen look at vital signs and say, okay, this is good enough or this isn't. This blood pressure is high enough. This respiratory rate is high enough for a look at a ventilator and say, okay, this patient is co operative with a ventilator or isn't. And oftentimes it's chasing a balance of all the devices that we have, whether it's IV medications, a ventilator, a dialysis machine, finding the balance for that patient to make them stable, to sustain life.
Tyler Johnson: [00:10:22] So this goes along with what I said earlier. But the thing that I have recognized right there is something as much as I hate to admit this, I feel like so much of what we do on this show is me confessing things that I should probably do better as a doctor. But as much as I hate to admit this, there's really some truth to the fact that one thing that's easy about being a doctor is that whatever hard thing is happening in the room, you're only there for however many minutes, right? And then you may be thinking about the patient all day. You may be talking about the patient with the team. You might be putting in orders or writing notes or whatever, but there's a certain degree of comfort in that physical and mental distance, right? Like whatever actual pain, for instance, is happening in the room, you're not there with the pain Most of the time you're back in some other room somewhere sitting at a computer. Right. And I think psychologically there's something easier about being able to remove yourself from the situation when it's hard. But especially as an ICU nurse, there is no distance, right? I mean, you are literally touching the body or something attached to the body of the patient for all intensive purposes, all day long, many times. So I guess I just am wondering how do you find the physical, but even more so, the emotional and psychological stamina to do that, especially when by definition the people that you're taking care of are the very sickest patients in the hospital. As you said, people who are often quite literally teetering right on the brink of death.
Christin Thankachan: [00:11:56] It is a privilege to be in the position I'm in to see people at their worst. It is a calling, and I think being an ICU nurse, particularly in this ICU, I hate to come back to oncology, but I'm an oncology ICU nurse is it is a privilege. People will remember that moment that the 12 hours I spend with them is not just about the machine, not just about the. What I'm seeing on a monitor, but it's about the human in the bed, because a lot of times I'm their connection to living and. I take that as a privilege. Every moment I know that a patient and family is not remembering the medication that I'm putting up, but they do remember the hand that I'm holding or the gentle words that I use or connecting with them and saying, This is really hard. How can I help you through this and that? Serve as a service to humanity, because I think we all deserve that kind of kindness to you. Experience the hard with someone and I'm grateful for the tenacity to do it. It does. It's not easy every day. But it's what I give that patient for that moment. Me last time the rest of their lives or less then the rest of their family's lives. And there's a weight to that. And that's why I can come back every day. You see the value in the work you do, because this is a major coming to the ICU is a major life event for these people. And for me, it's an everyday thing. But for them, this is traumatic and life altering and. Taking whatever piece of that in all the hard finding, the good in it and finding the kindness and compassion in that. Is so valuable. As we either heal them. Or give them the dignity of a good death.
Henry Bair: [00:13:49] So, Christin, one of the advantages of being a medical student working in the hospital is that I have the luxury of time that residents and attending physicians usually do not have during the afternoons after the medical team has finished rounding. I often have hours at a time to spend with patients and to to get to know them deeply. But you are there even longer. You are taking care of the sickest patients when they are at their most vulnerable. They might not even be conscious or may have no visitors, in which case, as you put it, you become their primary connection to the outside world. Can you share with us the kinds of relationships you are able to form with patients in the setting?
Christin Thankachan: [00:14:36] Sure. You know, the pandemic highlighted. You know, the hardness of being alone. And I make it a point in practice to remember the human beyond the body and the bed. And finding something that connects to them. So I had a very, very sick. Page. I'm going to use a patient example. Prior to the pandemic, patients family could not come in to visit. We were not allowing any visitors. And we knew where this was going. A patient was vented. The patient was on life support and resuming these last moments of life. We knew where this was going. We're talking to the family. The physicians and I are in the room talking to the family about. How sick this patient is and how this doesn't look good. What can we do? How did this patient. Want to live. Did the patient want to live for a long time, no matter what with an immeasurable amount of suffering? Or was there a limit? What's the limit? And in progressing through that conversation, the patient's spouse said. My spouse didn't want to suffer and the last wish was going to, Disney said. Oncology patient. Last wish was going to Disney. And I obviously I can't take the patient to Disney. But that was the patient's last wish. And I thought, Well, how am I going to connect Disney to you when I see you? And it turned out and I got to talk to the kids a little bit more on Zoom. We all decided that we were going to withdraw support the next day. So I went home to think about it and talking to the kids.
Christin Thankachan: [00:16:37] The patient really liked the food at Disney. And I was like, Well, what can I find online that will connect me to the food at Disney? So I Googled that night, knew that I was going to have this patient the next day and made an Orange Julius. I don't know if you all know what that is. Made an orange. Julius brought it. Took off all sedation. And the next day came and. Had something as simple as an orange. Julius had the family on Zoom. And said, Hey, I didn't know what else to do, but I found this online. After we debate, if if your family member comes to you, maybe I can put some on his lips. And maybe that's the last thing that that patient can taste is this Orange Julius that was at Disney. And that seems like a small thing, but for them. It was everything to have something that connected them to their humanity, to the patients. Humanity. Even when. They couldn't be here. Was everything to them. I had another patient where and I'm spending 12 hours with. With people, getting to know them, learning about their life story. We had a family visiting from another country. They had come for this big hiking trip. Patient had cancer. In a series of unfortunate events and ended up on life support. But the patient was supposed to be hiking in Yosemite. That was what they were. The whole family was here. That was what they were going to do. Unfortunately, it was a pulmonary embolism. And they. They were here on life support.
Henry Bair: [00:18:26] That's a blood clot to the lungs for those who may not know.
Christin Thankachan: [00:18:29] And I remember seeing this family that was far away from their home. Here. We could only have two people here. And seeing these children, some on Zoom, some in person grieving their parent. And I was I sat there and I said, how can I make this better? I can't. They're going to lose their parent. They're going to lose. They're human. How can I connect them? I can't give them back Yosemite. And I'm a terrible artist. But we in the ICU, we have these glass doors. And I thought, well, I can't take them to Yosemite, but I can make Yosemite here. So, Drew, El Capitan on the on the on the door. And I tried to print out what I could to make it look like Yosemite. The family came and gathered who we could at the bedside and the patient was excavated, which means taking the breathing tube out. And the family appreciated that they were in Yosemite and in his favorite place, sort of right. There's in the tragedy we find the good and finding the good is. How can I remind you of what that person is to you? A hiker in Yosemite.
Tyler Johnson: [00:19:51] One bit of background that I just which maybe most of our listeners will know, but I just want to make sure is clear. One thing that's a little bit surreal about being in the ICU is that we have these incredibly powerful therapies that can artificially sustain the physiologic functioning of the body, right? So whether that's dialysis to replace the kidneys or special medications to keep the blood pressure up or to strengthen the heart when it's weak or a machine to get oxygen into a person's blood when they can't breathe normally or what have you. But a often happens is that you sort of stack these life sustaining treatments on top of one another in hopes that those will bridge the person to getting better. Then, however, if the therapies all combined don't achieve that, don't allow the person to get better, then you can end up in this limbo state where they're sort of stable on multiple life sustaining therapies. But it's clear that there's no way to get them off of them and they have no real quality of life while they're on them. And so sometimes the the nurses and doctors and families have to make the very difficult decision of choosing a time to stop those life sustaining therapies and then allow the person to pass naturally, which I think both of the scenarios that Christine just described were were times when, in effect, they had to choose when the person was going to die by choosing the time to halt those life sustaining therapies.
Tyler Johnson: [00:21:16] But Christin, I want to go back to something really beautiful and provocative that you said and ask if you could give us a few more thoughts about it. You mentioned a little bit ago that much of the most important work that you do in the ICU is about seeing the human behind the body. So I have, I guess, one philosophical and one practical question. It's very interesting to me, and I've actually seen some science reporting around this that this is an intuitive to us, even as very small children, that there is a distinction between, as you call it, the human and the body. But I'm wondering, can you tell us a little bit from your work in the ICU, what has your work in the ICU taught you about the difference between the human being and the body?
Christin Thankachan: [00:22:05] A weighty question for I think in the last year I've put I did a count. I think it was a dramatic number. I either helped directly or touched physically, I think somewhere around 150 bodies into a shroud. So I think in the last few years I've put maybe 150 people into shrouds. So with the pandemic anyway, connecting the human and the human body.
Tyler Johnson: [00:22:36] Like, I'm just it's really striking to me that you make the distinction, right, that you say, even when I can't heal the body, I can still treat the human inside of the body. Right. And I guess I just I would love to hear more because I totally agree with you. And I think this is one of the big things that medicine has taught me as well. But I'd love to hear from you, like, what is the distinction between the body and the human inside of the body, or how do you think about that as an ICU nurse?
Christin Thankachan: [00:23:05] The distinction is. I think much of the time for me in my role, I see the body. As this uncooperative thing sometimes. And I see the. The mind and spirit of some someone as something I can connect to. Because I'm doing all these things for the body that just sometimes. For all the science in the world, still is not. This medicine isn't working. This equipment isn't working. The kidneys are not working. But the mind still does somebody. Its soul still is there. And I think sometimes in medicine in my years of practice. Sort of as a defense mechanism is. Seeing a series of bodies and seeing a series of organs. I might see ten patients with failing lungs and only see them as the lungs that are failing. How can I better treat those lungs? That's not the human experience. The human experience is each patient separately. This patient. John, who has failing lungs, who is a father of six. Who has a wife, has friends that love him. That matters more to me than the lungs that are failing. That matters, too. Obviously, it's my job to sustain those things as much as I can, but it's also my job to sustain the spirit and build the spirit. Not everyone is in the situation we're privileged to be in medicine. The real world oftentimes doesn't see what we see. In terms of vulnerability. You see, if you see someone on a ventilator, you can almost see the defeat in their eyes that they're the one thing that's supposed to cooperate with them is their body. But isn't. We'll have athletes that. The one thing that they could control their whole life was their body. And now they cannot. They're on a ventilator. They're on this equipment. But what I can do is say the spirit that you have that's an athlete is still there. Let me show you how. Let me give you a little bit of hope. When it seems hopeless. And I think that's our calling to give people that connection, that it's not just about this thing that may be failing. It is about who you are. And how I can support that.
Tyler Johnson: [00:25:50] I think that's a beautiful distillation. The more I have thought about doctoring, the more I've come to the conclusion that exactly what you're talking about is one of the most important things that we learn sort of down in the trenches. And I'm totally with you. It's I mean, I've spent many years trying to articulate this or even understand what I think I'm learning about it. And I still don't know. One thing that was really striking to me. There's a famous author, Yuval Noah Harari, who's kind of an avowed atheist, and he wrote this really interesting book called Homo Deus, which I only mentioned to say that he gives this very sort of biologically deterministic explanation of what humans are and how our bodies and our minds work and whatever. But even he is forced to admit that for all of the learning that we've done in neuroscience and everything else, science has absolutely no idea what consciousness is or what it means or where it comes from or what it represents. Right. You know, he calls it consciousness. You called it soul or the human inside, or some people would call it spirit, like we can give it a lot of different names. But but the point to me is that there is something more than just synapses firing and molecules working together and oxygen being carried to the heart muscle and whatever. Right? As beautiful and remarkable is all of those things that I just mentioned are, that's not all that we are. Right? And the thing that actually has been one of the most striking evidences of that to me is in having because like you, I mean, I'm an oncologist, right? So I work with cancer patients in the hospital a lot. And having watched many patients die over the years, one of the things that is the most striking to me is just how different a body is than a person, right? Like sometimes it's separated by 10 minutes where one minute you're like you said in a like in a time when you're making a decision to turn off life sustaining treatment, you might have a person who is there and awake and interacting with you in whatever form that takes one minute and then 10 minutes later the person is dead and it's just a body, right? Obviously, part of that is about physiologic functioning and the functioning of the atpase in the electron transport chain, and we could go into a whole biochemical about it.
Tyler Johnson: [00:28:12] But that doesn't none of that, even if you know all of the biochemistry and molecular biology and everything else that doesn't capture the qualitative change that happens. Right. And I think that that's but ironically, I think more as doctors, frankly, than as nurses, we tend to slip a lot. There's there's some kind of protection. There's like an intellectual buffer of going into the zone where we pretend that it's all just about biological functioning. And I think that one of the reasons that I admire nurses so much is because not all of them, but in general, I think nurses, maybe just because they're there physically present with the patient so much, but have a much more intuitive grasp of the of the humanity, as you put it, behind the body. Right. And like I often find myself having to have like I often feel like nurses are reminding me to remember the humanity behind the body because I am it is so easy for me to slip into this sort of well, it's just all about what's the blood pressure and the respirator settings and the drips and pressers and whatever else. And I think that that's a that's a really important and beautiful truth.
Christin Thankachan: [00:29:23] I have this nickname on. A friend of mine gave his nickname called Kumbaya Christin. And this says it lovingly. But I come into a room and my first instinct. For someone that's unsettled is not the medication. Looking at the monitor, I see all these things and I'll get down to ear level and I go, It's okay. And I'll go. It's okay, sweetie. You're safe. And sometimes just reminding patients that they're safe. When they have a tube in their throat. When their arms are restrained down. Oftentimes that happens in the ICU. They're tied down. They can't breathe on their own. They feel all these things sometimes just saying, It's okay, sweetie, you're safe. I'll look at the monitor and watch the heart rate go down, watch the respirations go down, and something as simple as touch and a soothing voice changes what I would have otherwise treated with a medication. There's. It's important. I think as nurses, it's important to. It's not just about what I can do physically. It is also about what I can do for an emotional connection to that patient, especially when we're talking ICU level care. It just matters. Oftentimes we'll see patients toward the end of life. And I think it's common enough where it's called the surge, and it's when somebody is close to the end of life and all of a sudden they get this surge of energy and they're with it. Maybe they weren't before and they're with it and they're saying, hey, do you see that? That that man, that was my husband, and they're off in another place, but they see their family. They're talking. They're reminiscing with their family and it's 5 to 10 minutes maybe. Sometimes it's a day of the surge of energy and. The person coming back and the family gets this gift of, Oh, my mom is back even for a short time. I didn't think she would. And then shortly after that patient. May die, but they get. They got that. The win of that moment that surge .
Henry Bair: [00:31:50] Christin, earlier, you briefly mentioned hope, the word hope. And I think that I've seen a lot of different ideas about the role of hope in the hospital. I've definitely heard some people, some clinicians view it as something that is, you know, they don't really want to deal with that. That's just too intangible for them to to grapple with. Some people view it as something that. It gives tremendous meaning to patients. I'm wondering, since it sounds like you have been on the ground, you have you have witnessed many times patients struggling with hope or families struggling with hope. I'm wondering if you can tell us what lessons you've learned from witnessing these moments about. What role hope has in helping a patient make sense of where they are in their lives.
Christin Thankachan: [00:32:54] I think hope is a tool that's underutilized in medicine, to be honest. I think when we look at science and technology and we look at medicine, we look at hope as a hope to get better. But there's also value. In hoping for peace. The difference is and why we sort of have this or what I find is a defense against hope is because we see it as a hope to live. When that doesn't always have to be the case. Hope is. I hope I die peacefully. Hope is. I hope my mom doesn't suffer. Hope is. I hope I remember. The last time my family held, I held my hand. And I think the way we view hope as we go through the. Sort of roadway in medicine changes, Right. Outpatient. When you go to your doctor's office, you have hope that a medicine will make your cold better. And when you come into the hospital, you hope this surgery will fix you. When you see your oncologist, you hope this this chemotherapy is going to be it. In the ICU. Hope is fluid. Hope. Hope may have started the admission as I hope I survive. And it may change to. I hope I see my son one more time. And there's value in the change of that. And I think my role is to support that. And not create an ideal behind it. It's not just about the hope to live. It's it's the hope of. Quality. There's the magnitude of that as medicine develops is so important. I'm going to speak for nurses. We just we have to. Look at Hope as a tool. Not as a weapon against us.
Tyler Johnson: [00:34:59] One observation I just want to make about what you've said, and then I'd like to ask you another question. You know, it's interesting to me, when palliative care doctors see a patient, they have like, I think, six domains of patient care that they always comment on. And one of those domains of patient care is spiritual care, whatever that means for the patient, which always stands in striking contrast for me to almost all of the other doctors in the world who, if you say the word spirituality or religion or whatever, right, they want to start talking about beta blockers or whatever their their pet medicine is, right. Because or pet surgery is because most doctors, I think we just have like zero tools for talking about anything in that realm with our patients. But the the thing that's so ironic about that and the thing that fantastic nurses like you continuously remind me of is that you can't not talk about I mean, you can pretend that it's not important or you can ignore it, but that doesn't actually make it not important. It doesn't make it so that like I mean, that's the thing, right? And that's not to say that everybody needs whatever their last rites as they're approaching dying because not everybody wants the last rites. Right? Most people are not Catholic or whatever, Right. It's not about any particular religious ceremony, but it's just to say that that religious or spiritual or whatever I want to call it, impulse, I think matters deeply to most people, whatever that's going to look like. And we as any medical professionals, I think we ignore that at our peril and to the great detriment of our patients.
Tyler Johnson: [00:36:38] One thing that I wanted to ask you. You briefly mentioned before that you arrived at the Stanford Oncology ICU just as the pandemic was starting and have been there throughout the pandemic. And all health care professionals know that the first year or so, especially of the pandemic, especially before vaccines became available, was an incredibly dark time. Right. I mean, I just I think most of us felt like we were just sort of living through being hit by a tidal wave, a new tidal wave every day. Can you just talk to us? You know, I think Stanford's surge really hit in December of 2020 through about February of 2021. We were later than a lot of the East Coast cities. But can you talk to us a little bit about what was it like to be a nurse at ground zero for this area when the pandemic finally really surged?
Christin Thankachan: [00:37:31] Terror is the first word that comes into my mind. I don't mean that in such a way to be everybody's everything is a is a responsibility that we have as ICU nurses. During the pandemic, we were the eyes for the physicians. We were the ears for the physicians where the. The hands for the family. I was in this role where I was unprepared to be everybody's everything. And it just happened over and over and over again. And it was. When I talk about how many how many people have passed, it was the. The terror of not knowing what the next minute would bring or the next patient would bring. My patient went from being stable and breathing to. Unstable, not breathing and dying. And it was that. And we had a. We were well prepared here, but it was. That piece where you're missing all these key players for this. This person in this bed and the pressure of I want to make sure that when I talk to that family that they know even though they weren't here, I did everything for their family member. Even if they died. The last hands to hold them were warm ones. The were the last words they heard were kind ones.
Christin Thankachan: [00:39:05] Despite how I felt about being terrified of The next ventilator. The next Medication I had to hang. That part of it weighs on you. And it was challenging. I'm generally a really optimistic person. Those moments of just the pressure here in these four walls and then experiencing when I left here my two children who were home or experiencing the Exiting, Fighting for lives, Exiting and finding, people fighting about the vaccine, people fighting about masks was so disheartening. As a nurse who saw it firsthand, saw these people struggling to breathe and drowning in front of me and then to leave and have...to walk into the real world of what people were fighting about was disheartening. Because I had to go back to work the next day and do it all again. It was tough. It was tough. And I don't want to walk into the the politics of it, but the job I had have is. To be empathetic. To support someone. And when I had the pressure of just being the only person to do that in that room. Limiting my time because I didn't want to get COVID. It just was tough.
Henry Bair: [00:40:47] Well, Christin, our time is coming to an end. And with the last few minutes we have. I'd love to ask a question that we ask all of our guests, and that's many of our listeners are clinicians early in their careers as well as trainees, whether that's pays MDs or nurses. And over the course of this conversation, you have shared so many moments of when you were able to, despite how hard things were from a medical perspective, you were still able to connect with the patient and make meaning out of those situations. What practical advice do you have for clinicians and future clinicians about staying connected to what matters most for patients, even when things get difficult?
Christin Thankachan: [00:41:44] Two things. The first is any resident trainee that comes to you, to me, I go, You have a choice here. You have a choice to be the chaos or the peace. You can contribute. To the situation in those two ways chaos or peace. It's a choice that you're making. Choose peace. It's what we owe these patients. The other thing I always tell people, even if people who've been here a while, is I have this line that I always use when I go. Do me a favor. Can you remember your why? Remember your what? Tell me why. Tell me why you're here. Tell me why you step into this building. Tell me why you chose to be a respiratory therapist. Tell me why you chose to be a doctor. Valuing that even in the hardest of times, remembering why you are here. We'll carry you through. The most difficult situations. There will be people that are ungrateful for you. And that's okay. Still remember your why?
Tyler Johnson: [00:42:54] Well, Christin, we we really can't thank you enough for being with us. And I will also just say on behalf of doctors everywhere, and I think on behalf of humanity, you know, I honest to goodness, you know, you see all these pictures from V-Day and V-J Day at the end of World War Two, where they were having like tickertape parades and everybody's like out whatever, hugging each other and whatever, because there was an end date. Right? The treaty had been signed and the war was over and whatever. And I wish that there had been a day like that for the pandemic. And if there had been a day like that in my book anyway, all of the front floats in the parade would be the nurses, especially the ICU nurses. I just at a time where most people who took the pandemic with appropriate seriousness, were quarantining in their homes, trying to reduce the spread of infection and trying to keep themselves in their families safe. Nurses were there right in the thick of it. And I mean, I can say that as a doctor who worked during some of those times, it was harrowing enough to put on all the protective gear to go into the room of a patient with COVID for 5 minutes or 10 minutes. But to be the person who's there in the room for 12 hours every day who, yes, is wearing protective gear, but nonetheless doesn't know if they're exposing themselves to potentially fatal viral particles and who's there cleaning out the mouths of and switching the tubes of and doing all of the dirty down in the trenches, stuff that had to get done to take care of those patients. In my mind, you and all of your colleagues will always stand as heroes. So I, on behalf of everybody who all of us, whether it was us directly or those that we care about and love, I think stand in your debt and owe you a great amount of gratitude. So thanks.
Christin Thankachan: [00:44:54] Thank you for saying that. It's kind of nice to hear.
Henry Bair: [00:45:00] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program, notes and transcripts of all episodes at the Doctors Art. If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:45:18] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in health care who would love to explore meaning in medicine with us on the show. Feel free to leave a suggestion in the comments.
Henry Bair: [00:45:32] I'm Henry Bair.
Tyler Johnson: [00:45:33] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.