On Schwartz Center Rounds, hospital staff makes emotional connections

It was an unusual sight for Linda Ryan, a psychiatrist at Bryn Mawr Hospital.

A former patient - a young man who had walked into the hospital earlier this year on heroin and bleeding from a stab wound in his stomach - sat before her looking unrecognizably good. He'd been to rehab, put on weight, and gotten a job. He had come back to thank the staff for saving his life.

His mother, who works at the hospital, sat among the more than 100 staff members who had crowded into a second-floor conference room to listen to her son and a middle-age man who had survived a heart attack.

They had come for Bryn Mawr's monthly Schwartz Center Rounds, a rapidly growing national program that honors a lung-cancer victim who wanted to promote compassion in health care. Fifteen area hospitals now offer Schwartz Rounds.

"I'm just really proud of him," the mother said, obviously moved. "I'm just really thankful. The people here are amazing."

Ryan watched quietly from the side of the room, tears rolling down her cheeks.

"It was just so moving to actually see him in person and see how well he was doing," Ryan said later. "I don't get to see the follow-up of how [patients] are doing afterward, unfortunately, unless they're not doing well and then they come back."

Ryan is a fan of the hour-long Rounds, which focus on patients who touched the staff in both good and bad ways. They may center on the staff's sympathetic emotional reactions to a young trauma or cancer victim or frustration with a warring family.

Behind closed doors, the staff members share feelings many hide from their patients and each other. In turn, health-care leaders hope, the process helps them feel more comfortable with the emotional connection that many patients crave.

"It's refreshing to go back to the core of why I went into psychiatry and health care in general, that we are all there for the same purposes," Ryan said. "It sounds somewhat corny to say we're here to help people, but we are. . . . It reinspires us to go back to work and take a fresh look and stay connected with patients."

The Schwartz Center was founded in Boston by the family of Ken Schwartz, who died of lung cancer in 1995. He had written that acts of kindness from health-care workers had "made the unbearable bearable."

The Rounds began in 1997 at Massachusetts General Hospital. They have since spread to 245 sites in 35 states. Forty new hospitals signed on in the last year. Locally, Albert Einstein Medical Center, Fox Chase Cancer Center, Cooper University Hospital, and three Virtua hospitals use the program.

The Schwartz Center provides training - and lunch - during the first year.

Kathleen McDevitt, a warm, outgoing nurse who directs the pain and palliative-care program at Bryn Mawr and facilitates Schwartz Center Rounds there, brought the program to the hospital three years ago after encountering it at previous workplaces.

Health-care workers often agonize over the end-of-life issues that dominate her specialty. "I knew this was where people feel the most broken," she said. One of the byproducts of the discussions is earlier referrals to palliative care, though that is not the only difficult subject the staff discusses.

She also liked the multidisciplinary format, which breaks down the "tribes" of doctors or nurses or other providers that are so common in health care. "Sometimes we learn from the maintenance man," she said. "Sometimes we learn from the unit secretary." At this month's meeting, Main Line Health chief executive officer Jack Lynch sat on the floor quietly munching pizza.

The sessions are often sad. Bryn Mawr's staff members have talked about their reactions to the death of a colleague they had cared for and the sobbing of a child whose mother could not be saved after a suicide attempt. McDevitt looks for what she calls "Schwartz moments," those that make a case personal for a caregiver.

"We have stories that can be really rough," said Frances Marchant, the physician liaison for the Rounds. "You leave exhausted sometimes."

The December Schwartz session was meant to be hopeful. The holidays can be especially rough for people in health care. Only really sick people come to the hospital in December and some of them die on Christmas. The month can awaken years of bad memories.

McDevitt started a December tradition of bringing in patients who had survived against the odds so caregivers remember the good they do as they brace for holiday tragedies.

This year, the recovering drug addict and a man whose body had been cooled after he suffered a heart attack at home talked to the staff. (Schwartz Center rules preclude identifying the patients.)

"When we give our best efforts, sometimes we don't get the outcomes we expect," McDevitt told the crowd. "In this forum, we have the opportunity to embrace the possibility of hope."

Clarke Piatt, a critical-care specialist who treated the heart patient, said only 8 percent to 10 percent of patients whose hearts stop at home survive. This one left the hospital in a month and is now healthier in some ways than he was before, Piatt said.

To the applause of the audience, Piatt told the patient, "You're not just a customer who comes in. We should be able to have a relationship with you."

The man sat silent while his wife told how she had arrived at the hospital, shaking and afraid he would die. "It was a scary month, but I'm thankful to all of you guys . . . even the lady in the parking lot," the wife said. In the front row, the eyes of a group of critical-care nurses filled with tears. "If it wasn't for you, my husband wouldn't be around."

The nurses praised the man's family for showing them how important love is for recovery.

After the young man told his story, two members of the audience asked his advice for helping their addicted family members.

Andrea Farnsworth, one of the nurses who worked with the heart patient and a two-time cancer survivor herself, said later that the Schwartz Rounds ground her and give her a "sense of renewal."

"It brings you down to the reality of what you're really here for, which is the human spirit," she said.

"I often leave in awe," said Lynch, who comes, in part, to learn what emotional support his staff needs. The meetings also keep him in touch with the heart of the business he runs. "It makes what we do real to hear stories where staff are impacted by the care they're providing," he said. "It reminds me of how challenging our caregivers' roles are."

At the end of last week's meeting, McDevitt wanted the staff to hold onto the feelings the Rounds generated.

"Have an awesome day," she told the staff members as they stood to leave, "and may the Schwartz be with you."

Area hospitals that do Schwartz Center Rounds:

New Jersey

Cooper University Hospital

Virtua Marlton Hospital

Virtua Memorial Hospital

Virtua Voorhees Hospital

Pennsylvania

Abington Health

Albert Einstein Medical Center

Bryn Mawr Hospital

Children's Hospital of Philadelphia

Fox Chase Cancer Center

Hospital of the University of Pennsylvania

Thomas Jefferson University Hospital

Mercy Fitzgerald Hospital

Mercy Philadelphia Hospital

Pennsylvania Hospital

St. Mary Medical Center

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