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Episode 56 & 57: Cultivating Compassion with Critical Care Physician, Dr. Rana Awdish

For part nine of our No Barriers Alchemy Series hosts Erik and Dave interview Dr. Rana Awdish. Rana is a critical care physician operating on the front lines during COVID-19 at Henry Ford Hospital in Detroit, MI. Her own serious illness in 2008 has informed her belief in the power of compassion, sacred listening, and community. As medical director of the Care Experience for the Henry Ford Healthcare System, she is training staff to practice empathy in critical care. 

She completed her medical degree at Wayne State in 2002 where she was inducted into the Alpha Omega Alpha national medical honor society, her residency at Mount Sinai Beth Israel in New York, and her fellowship training at Henry Ford Hospital where she serves as the current Director of the Pulmonary Hypertension Program. She is a fellow of the American College of Physicians and The American College of Chest Physicians and was inducted into the Gold Humanism Society in 2019.

She was named Henry Ford Hospital’s Critical Care Teacher of the Year in 2016, and the National Compassionate Caregiver of the Year by The Schwartz Center as well as Physician of the Year by Press Ganey in 2017. Her articles have appeared in the New England Journal of Medicine, the Harvard Business Review, and the Proceedings of the Mayo Clinic. 

A New York Times book review called Awdish’s book, In Shock, based on her own critical illness. “the one I wish we were given our first year of medical school, alongside our white coats and stethoscopes.” Her book has since been integrated into the curriculum of medical schools and universities across the U.S. and Europe.

Additional Resources:

» Hear an extended version of our interview with Rana here.

We’ve created the following Tip Sheet to guide your learning experience.

Download the full PDF version here.

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Episode Transcript

Rana: That's really where the beauty is, is you have to get through those layers of suffering, and just on the other side of that is all of the meaning and all of the beauty and all of the connectedness. And I feel like this time that we're all occupying is a time to really reflect on that so that there is meaning in this, and it's not wasted time.

Erik: It's easy to talk about the successes, but what doesn't get talked about enough is the struggle. My name is Eric Weihenmayer. I've gotten the chance to ascend Mount Everest, to climb the tallest mountain in every continent, to kayak the Grand Canyon, and I happened to be blind. It's been a struggle to live what I call a no barriers life, to define it, to push the parameters of what it means. And part of the equation is diving into the learning process and trying to illuminate the universal elements that exist along the way. In that unexplored terrain between those dark places we find ourselves in in the summit exists a map. That map, that way forward, is what we call no barriers.

Dave: Today's conversation with Dr. Rana Awdish is about learning to listen and find empathy with people who struggle, which is something we all need to do better in today's world. Dr. Awdish worked at the front lines of treating COVID-19 patients in Detroit, Michigan, and is the author of an LA Times bestselling book called, In Shock, a memoir based on her own critical illness. She currently serves as the Director of the Pulmonary Hypertension Program at Henry Ford Hospital and the Medical Director of the Care Experience for the Henry Ford Health System. She was named the hospital's Critical Care Teacher of the Year in 2016, the National Compassionate Caregiver of the Year by the Schwartz Center, as well as the Physician of the Year by Press Ganey in 2017. Enjoy the conversation.

Dave: Welcome to another installment of our weekly No Barriers Podcast Series, where we explore this extraordinary moment in our lives and touch on the ways that we can all continue to believe that what's within us is stronger than what's in our way. Special thanks to Prudential and Wells Fargo for their generous support of this podcast series.

Dave: This is your cohost Dave Sharna, and I'm honored to be joined by guest host today, Tom Lilac, who's longtime Board President of No Barriers and author of the book, What's Within You: Your Roadmap to Living Life With No Barriers, Tom, welcome to the show.

Tom: Excited to be here. Thanks, Dave. Well, Rana, I loved your book and I've been inspired by reading some of the recent articles about you, but instead of going through the past right now, I just wanted to ask you, how are you doing in the midst of this pandemic and being on the front lines, as being a leader on the front lines, how are you feeling?

Rana: That's such a generous question. Thank you. The truth is it varies day to day and minute to minute. There have been some really hard days in Detroit. We've been struck unreasonably hard and our hospital in particular has seen quite a few patients and there have been hard days. In this moment, I'm feeling centered and happy and really invigorated by the work, really challenged by it, but in an okay place emotionally.

Tom: Well that's good to know where you're at right now. Maybe you could tell us a little bit about how the hospital is doing overall, what you're seeing in the other physicians, and how might you be assisting them and trying to help to better serve the hospital.

Rana: So with my role its a split role, I'm a critical care physician, but I also direct care experience for our health system. And I'm fortunate in that the care experience aspect of my job encompasses the care of everyone, not just the care of our patients, but of our nurses and physicians and ancillary staff. And so during this pandemic, we started getting cases here in Detroit around March 10th and everything was evolving so rapidly, just things changing almost hour by hour, and we needed each other so much right away. We needed to talk and communicate and really crowdsource solutions and support each other.

Rana: And so I got in the habit really of just going physically to every ICU that was caring for COVID patients and rounding on my teammates, when I wasn't rounding on patients, and checking in, asking, what worries you the most today? What is the next way you're worried we're going to harm a patient? What do you not have enough of to protect yourself? How's your family? And that evolved into a more formalized daily presence in those units so that we could understand the needs as they shifted.

Tom: That's great.

Dave: That sounds amazing. These are somewhat universal things that we probably all could do a little bit more of. I love how you started by saying how you were feeling in this moment, because I think all of us are struggling with the variations and how we're feeling across the moments, and even just those questions you ask your employees, what are you worrying about? What are you not having enough of? These are things that I think are really practical applications to all of our lives.

Dave: So, Rana, can you tell us, for our listeners who aren't as familiar with your book and your story, just give us a quick... Obviously, if you want to go hear the full story you should read In Shock, which is a phenomenal book, but we want to just give some context for our listeners.

Rana: I was a trainee. I was a pulmonary and critical care fellow. So I was essentially completing my medical training. It was actually the last day of my fellowship and I was a good female trainee. So I had tried to time a pregnancy so it would coincide with my graduation. So seven months pregnant. And I had just this excruciating onset of abdominal pain that ended up being a tumor in my liver that I didn't know I had, had burst. And it was a tumor that was made up of arteries. So when it burst my entire blood volume just cascaded into my abdomen and I literally bled to death. And that was at my own hospital. That's where I was cared for.

Rana: That first night in the operating room, I had my whole blood volume replaced multiple times over, my kidneys shut down. I had a stroke. I went on life support. I had one of those moments that people talk about where I felt like I left my body. And that coincided with when, in the operating room I had actually arrested.

Rana: And my recovery from that one night and losing the pregnancy really took eight years. I had that first very protracted ICU admission, where I had to recover from all of my organ failure and learn to walk again and talk and just get back to some sense of my identity. And then year after year, we'd find sequella of that initial night that needed to be tended to. So I had to have half my liver removed. We found another tumor. And through all of that, the medical care was astoundingly good. I survived unsurvivable things. I was in awe of what my colleagues were able to do.

Rana: I often said if I had received myself as an admission that night, I don't think I would've survived. I didn't have the clinical skills to keep myself alive. But what was shocking to me was all the aspects of care that we neglected. The way that we didn't see the value of attending to suffering, that we didn't understand how to help someone contextualize their patient experience in the context of their life story, to make sense of their identity. It was just not compassionate. And I also saw what a hard time my physician colleagues had giving me bad news. We weren't trained in how to do that. And so all of those experiences really culminated in me deciding that when I went back to medicine that that would be my focus, that I would learn, myself, how to have better conversations, that I would work to be better and more compassionate and present for my patients in a way that I hadn't been, because I'd been so focused on the medicine that I had equated the medicine with healing when they're not at all the same.

Dave: How do we have those conversations better, as human beings?

Rana: I think, especially for physicians, we're so used to being of use, we've told ourselves a story that says that unless we're treating someone, we're not useful. And the paradigm shift that we all had to make was one that says your presence is healing. And we all know that intrinsically. When we have a bad day and we talk to a friend, it's unlikely that our friend does something to fix the situation that we're sad about, but just by witnessing it and saying, gosh, I can imagine that was such a hard day. I care about you and I want to continue talking. And I don't have the answers, but I want you to know that I'm here as much as you need to talk about this, I'll listen. That's healing. And we don't value that enough.

Rana: We're so rushed and we're so achievement oriented and checklist oriented, that just telling ourselves that our presence matters, and our humanness matters, and the active listening is, in of itself, a sacred witnessing act that other humans need, is, I think, all we can do for each other.

Tom: That's great. Can you talk about a little bit of that process of just not wanting it just to be for you not wanting it just to be the toolkit for Rana, but this is a new paradigm shift for all.

Rana: Until it's built into our medical education, we're just going to have to seek it out ourselves. And so we train to teach it, and it was more than just learning how to have these conversations, more than just learning, how to say we're in a different place now, it was actually forming a community and a space for us to share what was about what we do. And the more we talked about it, the more we were able to talk about it and the more we were able to support each other and coach each other through these hard conversations.

Rana: So it became this fabric of who we are, which is why when this virus came, we were mad because everything we had built felt like it was being systematically dismantled by this virus that was isolating us from our patients, making it impossible to have patient and family centered rounds. Family wasn't there. Oftentimes we couldn't speak to the patient because they came to us already on a ventilator.

Rana: And I think something in our core identity as an organization, really said we still have to reconnect to our core mission of doing this compassionately, regardless of what obstacles this virus puts in our way. We're going to figure out how to do this.

Dave: It strikes me that some of these very principles that you're talking about apply to how we all should be caring for each other in this moment. And I'm wondering if you could talk a little bit about that.

Rana: A lot of, I think, the distress that people have right now are things that can't be solved. None of us has a solution, for the most part, for our neighbor's unemployment or food insecurity at scale, or systemic entrenched racism. These are hard things that are happening. And what this shift has made available for me is an understanding that if I just approach situations with a genuine curiosity and a willingness to listen and really allow my views to be shaped by the people whose first person narratives are emerging in any story, let the person who's experiencing it, let their story be what shapes your beliefs, I really believe we'll start to see our interconnectedness and our dependence on each other, and the value of the people who've been all around us that were invisible to us, if we're honest, until a few weeks ago, and that all of that can mean that we come out of this stronger and more connected and more of a community than we went into it, if we allow ourselves to truly see.

Dave: I love that beautiful picture, you've painted. You mentioned, you even called it, I think you called it, the practicing the art of sacred listening. And as you describe the byproduct of that kind of listening, it does feel sacred. It feels like something you would be inviting into your life. Some extra sacredness and acknowledging with the beauty of what maybe hasn't been recognized before. So thank you for sharing that Rana.

Tom: I think that one of he gifts throughout your whole experience, that I think you may have touched on in the book, is this notion of you were grateful for having, not suffered so much, but you were grateful for what you learned from the experience. Can you talk a little bit about what some of those gifts were that you took out of your experience?

Rana: Yeah, it gave me so much more than it took away. I so clearly saw that what mattered was connection, and what mattered was those small moments, a nurse taking time out of her shift to bathe me and having that human touch. Someone reassuring me when they weren't sure that I could even hear them, but valuing my humanity enough in that moment, even though I looked like a body in a bed, to say, I'm going to communicate with this person like they're my sister. Those moments really opened up for me an awareness of what we value as a society and what's actually valuable. And I wouldn't give that up for anything.

Dave: COVID aside, or maybe COVID related, when you look at what you think is important to work on in the next five years, given all that you've gone through and experienced, where do you want to spend your time and energy?

Rana: Burning it down and starting over. I have been struck by how this crisis has really exposed so many of our fault lines as a society, as a healthcare system, as a country. I just can't imagine that we can see all of this and just go forth the way that we were. We have to do a better job of caring for each other and dismantling some of the hierarchies that are really keeping people down. And I believe that we can do it if we all see the goal, if we all see that we can all be better for it.

Rana: And this is such a historic time that we've all sustained the same trauma. There are such rare moments in history where an entire society experiences a trauma together and the transformative power of that, of us all being able to have a frame shift at the same time and see things for what they were and what they weren't. I think if we capitalize on that, we could do anything.

Dave: Yeah. I agree.

Tom: One final thought, or question, that I wanted to pose to you is Dave has talked a little bit about our work and our philosophy. Our motto is, what's within you is stronger than what's in your way and it's something we try to live by and having a lot of life experiences that you've both really were close to death in, and also ones where you have helped others who were close to death, I was wondering if you might offer up any reflection that you have on that motto as it relates to your life experiences.

Rana: Yeah. I love that motto. I'm going to need a lot of t-shirts with that motto. I think there is nothing that's more true to me than what's within you is stronger. But certainly what my experience has shown me through all of this, whether it was my own illness or attending to my patients and helping them to navigate their own critical illness is that that's really where the beauty is. Is you have to get through those layers of suffering, and just on the other side of that is all of the meaning and all of the beauty and all of the connectedness. And I feel like this time that we're all occupying this intermission before our life begins again, is a time to really reflect on that. What we've learned, what we've found within us, what maybe we wish we had more of within us that we can cultivate now going forward so that there is meaning in this, and it's not wasted time.

Dave: Well, Rana, this has been a wonderful conversation. Can you tell our listeners where to go to learn more about you and your work so that they can dive deeper?

Rana: I have a Twitter problem, so you can find me on Twitter, ranaawdishMD and rennaawdishmd.com for where I am, or where I'm speaking when that all starts again.

Dave: Awesome. Well, another terrific conversation. Tom, I just want to thank you for bringing Rana onto the show. I'd love for you to reflect on what we heard today and tease out something that stood out for you.

Tom: Well, I think that for me, there's always this need to listen. There's always this need to be empathetic. There's always a need to find that space where you can understand where someone else is coming from, but not stop there. Then to take action, to do things that show that there is this connection, that show that there's understanding, and ultimately to make life better for you and for the others.

Dave: And that idea of attending to suffering and how important that is, not just in end of life, as she was quick to point out, but all of us are suffering. As I know, Tom, the book you're working on is partly about that. We all have suffering. It's not on the outside most of the time. We put a different facade on and part of our role as human beings and part of our responsibility is to attend to other people's suffering.

Dave: Well, if you're interested in the conversation and would like to see any of the details that were mentioned herein, please go to nobarrierspodcast.com for our show notes. You can also download there our tip sheet, where we take some of the key points that Rana identified today and we apply them to our own lives. Download a page or two, it's something you could start with right away today.

Dave: As always, we appreciate you listening. We appreciate you sharing this podcast with others. If you are interested in joining our virtual No Barriers Summit, we encourage you to do so. You can learn more at nobarriersusa.org.

Dave: The production team behind this podcast includes Senior Producer Pauline Shaffer, Executive Producer Didrik Johnck sound design, editing, and mixing by Tyler Cottman, graphics by Sam Davis, and marketing support by Megan Lee and Karly Sandsmark. Special, thanks to the Dan Ryan Band for intro song, Guidance. And thanks to all of you for listening. We know that you've got a lot of choices about how you can spend your time, and we appreciate you spending it with us. If you enjoy this podcast, we encourage you to subscribe to it, share it, and give us a review. Show notes can be found at nobarrierspodcast.com.

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