As It Happens

After near-death experience, doctor calls for greater empathy with patients

A Michigan doctor publishes a call for improved emotional care for patients, after her organs shut down in her seventh month of pregnancy.
Rana Awdish, M.D. (Henry Ford Hospital)

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In 2008, Dr. Rana Awdish suddenly went from tending to patients to becoming one herself.

She was seven months pregnant when a tumour on her liver ruptured. She nearly bled to death in her own hospital.

That experience — and her long recovery — has now led her to question some basic assumptions she made as a physician.

My more emotional needs, my need to be seen as a person, my worries were a little bit more clumsily dealt with. And I saw myself in those failures.- Dr. Rana Awdish

In the latest issue of the New England Journal of Medicine, Dr. Awdish writes a very personal call for change in the relationship between doctors and patients.

Dr. Awdish tells As It Happens guest host Helen Mann about how close she came to dying in 2008:

RANA AWDISH: As close as I could've come and still be here to talk to you today. I really had multi-system organ failure with kidneys, liver, lungs, blood — all shutting down. And my mortality was close to one-hundred percent. 

HELEN MANN: What measures had to be taken to save you?

RA: I had emergency surgery that night. I was seven months pregnant, so the baby was evacuated, already dead. The surgeons and anaesthesiologists involved in my care had to  transfuse me almost forty pounds of blood products. If you think about it, I left the operating room forty pounds heavier than I'd gone in. So, really, I was dependent on a lot of people who helped me get through that. The surgery couldn't identify the source of the bleeding so I was taken back to the intensive care unit, where I remained on life-support for a number of days.

If I tell someone, 'You scared me,' that's an admonishment. That's not what the patient needs.- Dr. Rana Awdish

HM: An event that momentous would be life-changing for anyone. But did you at any point think that this was going to teach you something about being a doctor?

RA: You know, right from the beginning I saw how my perspective as a physician was truly oriented to the disease. It had been oriented to the disease, rather than to the patient carrying the disease. And that was something I saw reflected back to me in the physicians who were carrying for me. They were very adept at handling the disease. But my more emotional needs, my need to be seen as a person, my worries were a little bit more clumsily dealt with. And I saw myself in those failures. That medicine is really targeted towards training people to deal with disease and we don't do as good as a job training our physicians to tend to the complex emotions that accompany illness.

HM: Can you give us some specific examples of where doctors spoke with you or treated you in a way that they could've done much better?

RA: Yeah . . . one that really stuck out for me was a few mornings after that event where I nearly died, I overheard myself being presented by the rounding team in the hallway. The resident was discussing the events overnight and what had happened. And I was listening with curiosity when I heard him say, "She's been trying to die on us." And I thought, "Argh. I'm not trying to die. I'm actually trying very hard not to die." And I was angered hearing that. But then I recognized myself in that statement. I recalled saying similar things around patients and to patients. I recalled telling a patient, "You know, you really worried me last night. I was scared I was going to lose you." As though my feelings were what mattered.

I hope that I'm a better doctor. That what I went through has helped me to understand how our patients suffer.- Dr. Rana Awdish

HM: So what message does that send to the patient then, as someone who's been on that side of it?

RA: The patient, I think, can feel very blamed in those situations. So if I tell someone, "You scared me," that's an admonishment. That's not what the patient needs. We need to support the patient through their illness. I also had physicians tell me, "You know, that was a really hard night for me." That seeing me so sick had an impact on them. And at first I thought, "Well, am I really the right person to be venting to about this?" But the truth is that medicine doesn't have a lot of safe spaces for physicians to deal with those emotions and the trauma that they go through as well.

HM: Are you a better doctor now after your near-death experience?

RA: I feel I have a better understanding of what I as a patient needed. I'm more attuned to the emotional cues in the room. I hope that I'm a better doctor. That what I went through has helped me to understand how our patients suffer. And how I can help them come through that.

This interview has been edited for length and clarity. For more on this story, listen to our full interview with Hannah Simpson.


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