Our Life Stories: Dr. Deirdre Heersink

Today I have with me in the studio a fellow family doctor and also leader at Maine General Health up in the Augusta Waterville area. Dr. Deirdre Hearsy, thanks for joining me today. Well, thanks so Much for having me. It's a very nice opportunity. Yes, you and I have known each other for a bit in actually multiple kind of layered roles and side by side experiences and um, I love this project that you just spent quite a bit of time on actually. It was definitely a learning curve. You can think something is gonna be a kind of easy, cuz you have an idea, but then when you get to the doing it reveals some complexity. So certainly this was, um, a really great project and I can tell you a bit about Yeah, so this was life stories. Yeah. So, uh, you know, just for context, my position for Main General, currently I'm the medical director for their rehab and long-term care at Gray Birch and we also work at Main Veteran's Home. But prior we had a different facility we also covered at and uh, it's a unique care setting. I, you know, trained in family medicine and did family medicine for a period of time and also some hospital medicine. But moving into this position about five years ago, I've learned a lot about this sort of special place of providing care for people with rehab and long-term care because it is this environment that is this space sort of in between the hospital and home. And for some people it's a transitional space where they're just getting rehab and returning home. And for another fairly sizable really the majority of folks they may end up needing long-term care because their care needs exceed what they can get either from their family or relatives or other supports in the community. And when you're providing care for people who it's 24 7, generally lifelong care, um, the relationships that are formed between the staff and the the residents are just so layered and rich. Um, something I didn't realize before taking this job was the number of people who never get a single visitor that live in long-term care across the country. The rate is about 60% of people in long-term care never receive a single visitor. And I think that is, uh, you know, a situation that people obviously don't plan for. They aren't assuming they're gonna be in a situation where they're gonna have a, a health vulnerability or a care need that makes it so that they're not able to live independently and maybe are very separated from their previous loved ones and through losses or whatever, different reasons. So the relationship with the care team, I think is those people become their family. And certainly in Covid that family was, you know, leaned on even harder because we had, you know, no visitors that were allowed for a prolonged period of time and a lot of restrictions the residents were not allowed to leave. So you kind of had this lockdown like we all experienced in our homes, but not in your home. And um, with people that are caring for you that you have different levels of relationship with. And you know, through that experience we did definitely lose some staff, lose some residents. And on the other side we ended up in this situation of having quite a lot more sort of agency and traveler staff, which is a challenge because it ends up leaving the people that are getting the care being cared for with people that may know a lot less about them. And uh, so yeah, certainly within the pandemic one of the things we, you know, witnessed was, uh, you know, the knowledge people had about the residents they cared for for a long time helped them care more sort of with level of detail than they could if they didn't have those relationships. They really knew people very well of like what their favorite drinks were and would bring them in. We had, uh, one, one guy who really loved blue Gatorade and you know, people were like, maybe that will be the, the secret sauce that like helps him revive through this illness. So those little details that kind of people that really know, you know about you really do make a difference both to your quality of life but actually to your um, like literal survival actually. Cuz I think these small things are kind of these touchstones that kind of can reawaken people a little bit sometimes when they are brought back to kind of the sense of being cared for and known. So in our, you know, post pandemic phase, we were, you know, challenged with tons of ta staff turnover because when we have our traveler staff, they're generally only coming for like a 90 day time. And then that ends up, if you're rotating all of your staff every 90 days, it gives you not a lot of time for your staff to really get to know your residents. So we kind of saw this moment of feelings we were losing, um, that connection between our staff and our residents. And, uh, I ended up seeing a, a video for a online award ceremony through Not Impossible Labs that if anybody hasn't seen that I would check out their website and uh, you can view their award winners. They have some very interesting projects that they've done. But this was just good timing. It was like February of 2021 that I happened to see their online awards and they had this company called Memory well that was talking about their process of trying to help capture life stories so that care teams could know the residents they were caring for with more detail. So that when I heard about their, you know, process, I was interested, but the challenge between that sounds like a good idea and actually doing it was, uh, I didn't think it would be super complicated. I was like, oh, well we should just make that happen. And the, the making it happen was, uh, a good experience but also it just revealed a lot of details that you had to work through. You actually, you ended up writing a grant to support this work and you ended up doing kind of a, almost a bigger project than maybe you had originally anticipated. Yeah, I kind of thought it would be pretty straightforward and just, oh, we could just engage with this and everything would just, uh, how, how easy, right. But, uh, I definitely have to give major kudos. The, you know, philanthropy department at Maine General was very supportive and, uh, Ashley, one of the folks in that department really helped with the, the process of figuring out who to, you know, apply to the grant for. And the main Health Access foundation was our supporters for this. So we did get a grant and did a pilot with, uh, the goal of offering this, the, the process that they do oftentimes for memory well is they have their own writers call and phone interview residents and then they will, you know, write up the story for our residents, the challenges of sort of some cognitive impairment or hearing impairment. What we, you know, opted to do is engage with some volunteers through our health program, which is our like elder life volunteer program through the hospital for delirium prevention, which is a wonderful program and Maine General is really invested in it and has long roots in it. And it's, it's a wonderful program. Started out of, I think Harvard with Dr. Sharon in iui if people don't know her also, she's fabulous and uh, presented actually at the main geriatrics conference this past May, um, up in Bar Harbor and she's just incredible. But, uh, so that worked out really nicely cuz we were able to find a way to engage volunteers with our residents. And I think the engagement for that was both more positive for both our residents but also for the volunteers. And it has forged some relationships which have been ongoing and these people have been returning and visiting with people that they've previously interviewed. So it sort of has this ripple effect of relationship building that lasts beyond just the capturing, so to speak of the stories. But, so their original process would be that they would phone interview somebody and they would write this um, story and then send the the story to them. So we made some modifications with that process and um, I think it was nice cuz it really enriched the, the patient experience in a, a way that I hadn't anticipated fully. But, and I'm just interested in understanding the, I think how you ended up getting to a place of, um, watching something as a program and saying, oh that seems like a good idea to actually fully implementing what ended up being a pretty good size program that you subsequently, um, recently presented on Grand Rounds about, um, you believe will be on the BBC in an upcoming, um, episode and you brought in a Colby, um, undergraduate to work with you on this. So I think I'm just, just overall, I mean what you've done with this work, um, while you are still a practicing physician and medical director and also the vice president of our medical staff now, I mean I, I think we can't really understate how much effort you put into, there's Definitely more time than I was originally expecting. I think the very first colonel was really just people being open and supportive to the concept and the very first thing I just self-funded a couple trial stories to see how would this work? And I think the very first story I did, um, was a, with a gentleman who has since passed. But I think the experience of, first off just spending the time with him to hear his story, recognizing the really kind of very tough life experiences he had had, um, his complete willingness to be utterly frank about some really personal details. And really when I left the interview, I felt, um, a little worried honestly that the writers would not be able to take that discussion that was, you know, 40 minutes or so, um, and make it into something that you could put on someone's wall so that the staff could have a little bit of a deeper sense of who this person was. And when I got the story I was like, wow, I can't believe you were able to take the truth that was in this experience that was shared between these two people and capture that, but with a nuance that sort of shades some of the, the moments that really are just really, really need a little more subtlety and need, need a little privacy around them. They were able to maintain this privacy but still shine a light on like the heart of the core of that person in a really artful way that was like, oh this is, this isn't just a resume, you know, this isn't like a list of what did you do in your life or something, this is kind of a human connection that then you're hoping you draw out some, um, some little gems that like really ring true about that person. Um, that was incredible honestly. And that I think has been something I've seen in all of the stories. And one of the things that was actually very interesting when the BBC came to do this podcast and they filmed one of our volunteers interviewing one of our, um, residents and at the end of the time that they filmed this interview, I met back up with them. They were just, they had fallen in love with this person. They said, oh my goodness, dot is just so amazing her story, you know, because the same thing, it's like when you spend a 40 minutes asking somebody about childhood memories and you know, the, the questions that we've worked through and developed over time, some of them, you know, had to be changed or added. You know, I think we've evolved the questions that we ask and you know, volunteers don't always ask all of the questions. It's really a guided conversation but um, you know, it really um, gets people talking about things that they haven't thought about or talked about in a long time. And I think particularly at this phase of people's lives, that ability to like go back into your memory about all these other chapters of your life, there was something one of the, you know, residents said when she was interviewed later as part of our pilot to reflect on, you know, what the experience was of. She said, well when you come to a place like this, it's easy to forget who you are. But when I saw my story reminded me of who I am. And I think that is the thing that's for all of us seems scary about the idea of living in an environment that we don't have a lot of control over because really no one wants to give up autonomy, but is also this sense that you'll lose yourself in this kind of, you've gotta be very careful that you don't turn long-term care into an extension of a hospital experience where it's a chest pain in room five. Like it, it should never really be that way. But there are certain environments that, you know, we need to be succinct, we need to be problem focused. You know, your um, favorite kind of Gatorade is maybe not gonna make the list, but when you get to this is where you're gonna live out the rest of your days. We have to find some way to um, on like a fuller picture of all of these individuals and our staff that have been there for a long time. Each get different relationships with different residents, but the ability to kind of transfer that between people is challenging cuz our way of handing information to each other is sometimes very um, siloed. I think one of the, one of my favorite um, elements of this is the work that you did in the month that you spend with the Colby College, um, undergraduate student who came in and I don't know that he will end up going into geriatrics or family medicine or, but he was so I think, um, drawn in by the stories of the people that he spent time with. And you told me that he learned that one of the residents liked Sudoku and then he ended up going and actually separately bringing back some Sudoku puzzles for this person to um, to do and really this, this sense of the richness that is medicine that isn't always brought to the surface in this current day and age. Yeah, Well it remind me, you know, I know that in medical school I went to U N E and we're very focused in our early training about trying to think about the whole person and bringing in, there was like a humanities and medicine course that we did at some point. But I think one of the ways that you can actualize that is through connection and listening and that is the challenge of having a little bit of time. It doesn't take as much time as we think it would take. I think this student's experience was interesting cuz his previous experience with medicine was being a tech in the ed and this is very, very different from that cuz the, you know, kind of time you're spending with people is a different length of time. And I think that was really interesting for him just to sort of widen his view of what are, you know, different paths that you can take. Um, and I think one of the skills that I think is really helpful from this experience for him because he did uh, interviews with a number of our residents was this process of kind of all relationships are a bit of a dance and you have to meet your partner with what they are doing. And even though this is someone who, you know, English is not their first language, they're, I, I actually had wasn't sure if this project would really resonate with them, I wasn't with their previous experience it seemed really outside their previous experience. But they did such a great job of um, being able to change their approach depending on who they interact with and the person they actually bought Zuku for was a very, um, remarkable case in my opinion cuz it was a person who was in the hospital, had been in the hospital for a very long stay because they have some complicating factors that's making it very difficult for them to have any appropriate place outside of the hospital for them to reside. It's not an easy place to be for a long period of time. And the staff, when I mentioned to them this is what we were gonna be doing, they said, well good luck. I mean she's thrown everyone out of the room and there today and no one can understand a single single thing she says. And he goes in there and I think he didn't hear them say that, they just said that to me after I came out and told them that he was in there doing this interview and he was in there for 40 minutes and said as they began to, you know, make some rapport and take time that she was able to express herself. Like originally she was very um, too wound up and distracted and kind of um, moving around the room and not able to kind of articulate herself. But as they spent time together she sort of settled in and that I think spoke a lot to his ability to kind of change his approach based on who he was interacting with, which is actually a really important skill no matter what you do. It doesn't have to be a medicine just in life being able to like react to somebody else's comfort and change your pace based on what they can handle. So actually I think for students it would be a really good experience for them to all do some of these cuz it is uh, um, it feels a little uncomfortable to do cuz you're asking people and some of the things people are telling you. We had another one that really struck me where we had a new help volunteer who was going to be coming and his very first interview, you know, he, they have a little training process that they can go through with memory, well they have the questions in the hospital. The health volunteers are oftentimes interacting with people as part of their work that are at risk of delirium. So he's not a person who has not had, you know, experienced talking with different folks who are um, you know, kind of have some cognitive impairment or risks, confusion, those kinds of things. But he came to our facility and he went to do this interview and the resident that he was interviewing was, you know, they were trying to get their rapport going and he, the the resident said, well I had a really, you know, difficult time growing up, um, you know, I w wasn't always doing good things, something like that. And he said the interviewer was trying to make him feel at home and he said, well at least you didn't shoot anybody. And he said, well actually I did and I served time for it. And then somehow they actually were able to really get past that forge really great, um, connection and he continued to come back and visit that gentleman for every week until he passed away. And uh, I don't know that you would've, uh, you know, it's uh, I guess anytime you create a relationship with somebody, you don't know how long it will last or how much connection you may actually feel with that person, but um, it is, uh, the thing I've liked about doing this is a pilot, this program normally is something that people can pay out of pocket to do and there's maybe some places where it's included through certain opportunities, certain places, but for the most part it is something that people, families, or themselves can choose to purchase privately. Um, in our pilot we were able to offer this to anyone that was interested and you know, there was not any barriers of if you have these resources or you don't. So in some ways it's, you know, that same gentleman actually that told that story about that he had served some time said at the end of his interview something like, nobody's ever spent the time to hear my whole story before, you don't know what this means is this, you know, such an important thing you're doing. So I think it is, uh, that's been my, you know, amazement is there is no one that you'll meet that won't have things that they tell you that can stick with you and surprise you and humble you and just kind of give you a lot of, um, perspective. There's a lot of grace in the people we're working with cuz they're all every day living in an environment that terrifies almost everyone to think about living in. I think what you're, you are describing just kind of um, hearkens back to something that I felt really significantly when I was first, um, in medicine and this is the sitting with people and understanding that their willingness to share their lives and they're putting their trust into that relationship was such a deep, um, it was such a overwhelming blessing And, and for me I felt almost entirely undeserved. Like who am I to receive this person's story and who am I to kind of, um, be worthy of this trust and carry this relationship along? And I, and I think it's interesting to me that you chose to do this project that speaks to that as something that you and I, a program that you and I went through the, the Hanley Leadership Institute. So this is a leadership program for um, physicians and other practitioners and you said this, this idea of kind of narrative medicine as they're calling it is so important to medicine as it currently stands and has always been so important. I'm going to put this in in this leadership um, track, which is fascinating because I think a lot of people these days think of medicine as how do we get all the patients through and how do we make sure that they're cared for in a quality way? And you are saying yes and yes and I would like to have us remember that these are are kind of, all of us are human beings and how do we continue to touch into that as people in the medical and health professions. Yeah and I think, you know, it is this thing that we certainly recognize that it's important and then there's this challenge of like how do we maybe create a little space for it? Because I think there is lots of people connecting with our residents or patients and getting some pieces of this, but then it is just the nature of our record that it is basically takes things and then sts them away. I always think we're sort of like squirrels hiding nuts from each other. But you know, there is an opportunity I think to make our record, you know, be again something that, you know, sounds like there is opportunities to do this in some places maybe ahead of others in doing this, but have some of those things be part of people's snapshots. You could have a little bit more, for example, like with age friendly health systems, there is this goal to have the four msms and the sort of lead of the four msms is what matters most to you. That's just a really hard question to add into your review of systems after, you know, do you have a fever or, you know what I mean? It's just hard to figure out like, are are you a smoker? What matters most to you? Like I I struggle a little bit with how um, to kind of make the space to really collect that. Cuz if somebody asks me that I, I don't think I'm ready to just give you a one liner, it's, it's really hard. Um, so I think um, you know, this project partially was also noticing that for our staff their burnout rates were higher than ever and maybe higher than people other places. Partially I think cuz number one the work is hard. The reimbursement I don't think is enough, you know, and I think the loss losses when you have these long-standing relationships are more intense for those folks cuz they might have known these people for months or years. And so the kind of uh, when you're losing residents that for the staff that have been for a long time, that is really a lot of emotional connections that they have with these folks. So this was partially also thinking about, you know, I'd been on Ombudsman call listening to direct care workers about kind of what is their why and I think across the board their why is, you know, about these relationships and the about caring for these individual people and if you have so much turnover that can be hard to sort of, um, pass forward, um, invest in, maintain, you know. But I think that little kind of kernel of love is like a very important little fire for us to tend, um, cuz this isn't really work in the normal sense of work. It's a little bit of a vocation. So trying to, you know, tend that a little bit, you know, but it's uh, tricky to find ways that our system will think that that's important. Like because they need to have a way that they can say, ah, it's important because of some something that we can, um, see or, you know, take note of. So that is, uh, the little bit of the chick trick. But I would say I did bring some of our PI pilot results down to um, amda, which is the American Medical Directors Association in March and there was a lot of interest from um, like different health insurance companies and um, through like the Moving Forward coalition, I think there is interest in figuring out how to do something like this on a scale. And I think there's probably some opportunities, maybe someone out there knows things about, you know, how we could use technology to help us do this too. So you could have these conversations and have some of the work be started for you so you have a, something that you can fine tune. Cuz I, I think the, that, that seems like something I would wonder about. You know, everyone's excited about chat G P t I don't know if that's just like an opportunity to uh, put it to work for the, uh, growth of compassion, but I don't know, that sounds like, uh, something I don't know enough about. And it ultimately sounds like if you don't know enough about something, you should make sure someone who knows something about it is more thinking about the, the pros and cons of that actual reality. But One of the other things that came up, um, so you happen to do a grand rounds on this, and I think it was literally the next week, um, Dr. Dan Vick and I did a grand rounds on something called diagnostic overshadowing. And this is something that we did as a result of the joint commission and some standards that are being brought forward, which are essentially saying that people who have various, um, vulnerabilities as you've termed it, um, might get either a delayed diagnosis, the wrong diagnosis, um, and it's, you know, tech it's been people who have maybe cognitive issues, maybe they can't think the way that, that the rest of us, we think that we think, um, or they don't communicate the same way. And so as a result there are actually delays in care, there's cost to the patient, there's cost to the system. So what you brought forward was you said, is there a connection, you know, can we actually help create a connection between the story and, and not going down the path of diag diagnostic overshadowing? Is there a way that somehow we can prime both sides, the people who are doing the story sharing and the people who are hearing the story that can actually help from a health standpoint. Because I think that that you, you've identified something that's very important. You know, if you go in and you have, I, I don't know how much time you have with a patient, you know, I think many practitioners and family medicine on the outpatient side, you're talking, you know, 10, 15 minutes maybe and how do you get like the really important stuff that could really actually help people's health, um, and do it also while you're finding out do they smoke? Do they have, you know, have they gotten their preventive screenings done and you're dealing with people who have pretty significant long-term chronic needs. You probably don't have that much time with them either. So how do you prime both sides to kind of g give and receive the information so that it is meaningful? Yeah, I mean I think that's a really, you know, ideally when we have a ability to have a relationship with somebody over time we can grow that right? And if it can be somewhat consistent, but there are certainly challenges that we face of just ultimately the, you know, the amount of people that are doing the work versus the amount of people that need the care. We have a big mismatch and that's, you know, was in the making was certainly accelerated by covid for both sides of that equation as well. So it is gonna be this tricky thing and I think, you know, everyone that has had children probably has had that experience of, and this is gonna sound a little like an odd way to think about this, but you know, if you're trying to get your two year old to put their shoes on quickly, it will take twice as long. So if you just allow the time that it will actually take for them whatever their time is to feel like I had a transition, I now don't feel rushed and I can do this, it actually is faster. And I think this is a problem of the way we provide medical care a little bit too, is that really we have probably so many people all, um, you know, under such time pressure that the experience is, I don't think anyone's listening to me, you know, because each person is, you know, but if we actually added up all of the hours, all of the, all of the conversations, you're repeating the same half told story to seven people, instead of getting like a little bit more time to give the whole story to one person. I think that that is challenging. And I think some of it is if people did know here's what I already know about your story, that might also help a little bit because I think again, the way our records are, we have little bits and pieces all over the place and so then you do sort of feel like there's, you are not sure as the receiver of healthcare, if people have the whole story and if we don't know people's baseline, we can't orient in any way to like, how is today and we can see a person today and think we know what their baseline is because we sometimes can't imagine that it's that far from where they are today. And I think that's the thing of experience when you've worked for kind of a long time Ian, when you've seen people in different contexts, you're like, you know, that's partially why when somebody brings in a picture from home from, you know, a week before you can be like, oh, okay, I I I'm, I was like losing track of our baseline because I didn't realize like last week, that was your last week. That is, I think, um, you know, I don't know, there's probably a limit to how quickly we can communicate and I think we're just gonna have to keep figuring out what that is. And for some people their story is complicated and their way of telling it is complicated. Um, I don't remember the number you might like, what's the average amount of time that like a doctor listens to a patient before they interrupt? I think it's like seven seconds or something , it's like crazy. It's abysmally short is one Short. Yes. And so I think that's certainly probably too short, but I guess, you know, this is this challenge if we're trying to sort of also make sure that we aren't missing things. So we do need to help, you know, shape and navigate the conversation to make sure that we're, you know, getting all of the things that are important. So we do have the whole story cuz sometimes people, what they're telling you, there is a piece of the story that they, they might not have noted and you have to say, oh anything like this to bring it into the conversation. But that's gonna be a trick for us to sort of, um, tinker with. Maybe there's people that already have like spent a lot of time looking at like, what is the optimal amount of time to like have exchange or is there some way to even set context, um, to help, you know, bring us through more on the same page. Cause I think that's what everybody's looking for is feeling like they're connecting and they're being understood. Yeah, and as you've said, I mean it it might be start with time and also, um, are there ways of communicating that make it more or less possible? I mean we're, we're taught motivational interviewing for example. That's just one of very many different ways that we could be communicating with people that we're collaborating with on their care. And um, I think understanding just how important that is, it's not just about what we're gathering from people for our information, but it's about how we're gathering it and it's, there's a whole skillset around that. And I think about where you and I are, you know, there's a lot of people who are, who are later in their careers who have now retired as a result of covid. There