A physician reflects
on a morning spent
By Jeffrey Millstein, MD
As we knocked on the sliding glass door, I heard sobs. I felt a heaviness in the air which I imagined as saline humidity from volumes of shed tears. We entered Room 8 in the emergency room observation unit to meet a family in mourning.
A few hours ago Mr. R., a 60-year-old man, died unexpectedly after coming to the Hospital of the University of Pennsylvania (HUP) with mild gastrointestinal symptoms. Without any apparent warning, he suffered a cardiac arrest, and 45 minutes of advanced life support efforts could not revive him. The emergency room was awash with disbelief, sadness, and a sense of failure—all the usual feelings which beckon for Chaplain Meggie.
That day I was not in my usual physician role. I was an observer and curious student of the craft of communication and providing comfort to the bereaved and traumatized. It is only recently, in mid-career, that I have come to thoroughly appreciate communication as more than an art arising from inborn talent. I have grown to see it as a skill, one foundational to doctoring.
This quest for communication skills, knowledge, and experience has led me to many extraordinary clinician mentors, and the list keeps growing. Venturing outside of Penn Medicine Woodbury Heights, where I work as an office-based general internist, has opened my eyes to the expertise of health care professionals to whom I’ve had little prior exposure. Talking with and learning from other seasoned experts is like experimenting with different photo filters, exposing nuances not previously clear with different lighting. And so I found my way to Chaplain Meggie.
Her full name is Margaret—Margaret Kobb. Originally from Milwaukee, she completed her Master of Divinity studies at the Lutheran Theological Seminary and has been a staff chaplain at HUP for the last five years. She has an intelligent, warm and friendly presence, with an expressive, lyric voice likely refined by her vocal musical training. Her own medical struggles require that she use a device to help her keep her balance when walking. In many of her daily interactions, “Morning Sunshine!” is her signature introduction, full of positive energy.
When we arrived in the emergency room, Chaplain Meggie’s first stop was the nurse manager’s office, where she was welcomed with, “Chaplain Meggie, I’m so glad you’re here.” The nurse manager provided a brief synopsis of the recent events with Mr. R., and asked how everyone was doing. The manager identified which clinicians and staff were involved with the resuscitation. Meggie’s expression alternated between a smile and look of gentle concern, exuding empathy and kinship.
I followed as she made her way around the unit, debriefing the nursing and support staff.
“Quite a first day back from your fishing trip, wouldn’t you say?” She smiled as she pulled up a chair next to a young ER technician, whom Meggie knew was the one who performed CPR on Mr. R. She is a master of injecting just the right amount of lighthearted humor into all of her conversations. And she makes a point to know about the staff’s lives outside the hospital.
“What can you do?” he replied with a shrug and a head shake, and then smiled back. A heart-to-heart debrief ensued. Her language is real, devoid of any pretense, which has clearly helped her gain the trust of clinical staff, as well as the sick and their loved ones.
When we arrived at Mr. R’s room, it was crowded with family—wife, sons, cousins, aunts, and uncles. Chaplain Meggie introduced herself, and then me. She was clearly aware that this space had been transformed into a sanctuary for the bereft, and respected boundaries. And then she said something magical. “How can I best be with you right now?” Not a perfunctory “How can I help you?” or “Can I offer you a prayer?” Her words were generous, sensitive and kind. The family spokesperson said that our mere presence was appreciated, and that they needed some time with their loved one before he was taken to the morgue. “Let’s find you some extra chairs,” she added, saying how sorry she was for their loss, and that she would check back with them later in the morning.
“I have cared for many grieving
families, participated in
hundreds of resuscitations,
and treated thousands of
patients. Effective communication, though, is not an area
where experience necessarily
We did return later, to a smaller group of mourners. They shared stories about Mr. R. and even managed to laugh at some of them. This time we were welcomed into the room and were able to connect a bit more with the family, learning more about this person whose life was not supposed to end that day. I listened as chaplain Meggie offered words of comfort, and helped build enough trust to allow other staff to remove Mr. R.’s body from Room 8, so another sick person could come back and be cared for.
I have cared for many grieving families, participated in hundreds of resuscitations, and treated thousands of patients. Effective communication, though, is not an area where experience necessarily confers expertise. Connecting with people in their most difficult moments requires keen and curious observation and dedicated practice. The experience with Mr. R.’s family illustrates that it’s not just a matter of what you say, but how you listen with humility and curiosity.
Chaplain Meggie often has first-year medical students follow her on her rounds as part of their introduction to patient care. I am farther along in my clinical journey, and I also enjoy the privilege of teaching medical students in the classroom, and in my office. But on that day, I placed myself once again as an observer to find renewal, wisdom, and inspiration.