I’m Here: Compassionate Patient Care with Marcus Engel [Podcast]

Posted on March 8, 2023 by Nate Regier / 0 comments
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There’s a human being at the other end of the stethoscope. It might be a normal Tuesday for you as the caregiver, but for the patient it might be the worst day of their life. Join Dr. Nate Regier’s conversation with patient experience expert, Marcus Engel, who shares lessons he’s learned about compassionate patient care starting after he was hit by a drunk driver, almost died, and lost his eyesight.

What’s In This Episode

  • What happened to Marcus, how it changed his life forever, and how he has used that experience to serve others.
  • The two most important words you can say to another human being who is suffering.
  • How do you “be here” with others in today’s busy and distracting world?
  • The three most compassionate things you can say to another person.
  • In light of limited resources, how can leaders create more compassionate systems and cultures?

Compassionate Patient Care Highlights

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Read The Transcript

Voiceover: Are you tired of the negativity and drama? Are you trying to make a difference only to be drained by people problems? The world needs more compassion, not just more civility and empathy. We need in the trenches compassion that struggles alongside people instead of against them. We need a radically different way to engage for breakthrough results. And now here’s your host, Dr. Nate Regier.

Dr. Nate Regier: As soon as he finished speaking, I rushed back to the exhibit hall to tell my colleague Aaron about what I had just experienced. I couldn’t hold back the tears as I recounted anecdotes from his story. I was touched not just by the power of his near death experience, but by the poignant examples of his caregivers practicing compassion in the most scary and vulnerable moments. Compassion that helped to transform pointless, agonizing pain and suffering into an amazing journey of recovery and purpose. His story illustrates the transformative power of compassion, and so much of it connected with our work with Compassionate Accountability®. By the time he made his way into the exhibit hall for a book signing, I was near the front of the line. When I approached him with the two books I’d purchased, I was taken by his kindness and presence. After I introduced myself, I popped the question, “Would you consider being a guest on my podcast?” He didn’t even skip a beat. “Of course, I’d love to.” So here we are.

On this episode, I’m honored to welcome Marcus Engel, a professional speaker and author whose message provides insight and strategies for excellent patient care. If you’re a healthcare professional or in any business that depends on strong trusting relationships, I guarantee this conversation will be worth your time. Marcus’s keynote presentation, The Other End of the Stethoscope, has been witnessed by tens of thousands of healthcare professionals and his books are used in scores of nursing and allied health programs, to teach the basics of caregiving with compassion. Marcus has authored four books. He holds a BS in Sociology from Missouri State University and an MS in Narrative Medicine from Columbia University in New York. In 2017, Marcus was awarded an honorary doctorate from the Philadelphia College of Osteopathic Medicine and is currently an adjunct professor at the University of Notre Dame, where he teaches medical students the “art of being with.” Marcus lives in Orlando, Florida with his wife, Marvelyne, and we are so delighted that he is “being with” us today. Marcus, welcome to On Compassion.

Marcus Engel: Well, it is a pleasure. Thank you for that incredibly kind introduction and story. I’m always excited to connect with anybody who’s working in the same space of compassion. So thank you for the invitation.

Dr. Nate Regier: You are so welcome. Hearing you speak in Orlando last November really impacted me, as you can tell, and even now, just recounting the experience gives me what my daughter calls, “I’m getting the feels.” Just getting emotional thinking about it, and I so appreciate your generosity and passion for sharing what you’ve learned about compassionate patient care. So I’m just going to jump in with three back to back questions that all go together. What’s your story, Marcus? What happened and why are you here on this earth right now?

Marcus Engel: Wow. The deep philosophical question there, right? Why are we here? Why am I here? This was a little bit more of a physical reality for me. A little bit about my story. Currently, I’m 47 years old. I live in Orlando, Florida, and I am totally blind. So if you’re watching this on video and you see my shades, I’m not just trying to look cool. I am totally blind.

And a little bit about my story. So I grew up a normal kid, grew up in Ferguson, Missouri for the first 10 years of my life. And then when I was in the fourth grade, my family moved to a little rural town where both of my parents grew up about an hour outside of Saint Louis. So I’m a country kid at heart. I kind of went from the suburbs to a farm, being a 10-year-old kid, and I lived a good normal life all through my growing up years, had good parents, good community, good church community, grandparents nearby.

And then when I was a freshman in college, I took off for college, like so many 18 year old kids, and I moved to Springfield, Missouri to start my freshman year at Missouri State University. And about six weeks into my freshman year, came home for the weekend, met up with some friends from church camp, and then that Saturday night, my friends and I, after a St. Louis Blues hockey game, we were driving home and the car, which we were riding in, we got struck broadside by a driver with a blood alcohol concentration of well over twice the legal limit. So that auto accident not only took 100% of my sight, bilateral vision loss, total bilateral vision loss, but I also received what is called a LeFort III fracture, which primarily says that everything from the hairline through the chin has been crushed or is broken. So, literally, I broke my face.

And I guess why I’m here now, my life was so close to being lost right there in the street. I mean, the first moments after that crash, I’m laying in the street face down. I can remember the taste of blood and the horrible, horrible pain, as you can imagine. But I don’t remember when a paramedic made the incision in my throat, what you call in the medical world, the crike. I don’t remember that. And laying in that street just a few miles away from a level one trauma center to have to do such a procedure should kind of give us little evidence about how close to death I really was.

I don’t remember all of that, but I do remember arriving to the emergency room at what was then Barnes Hospital. It’s now Barnes-Jewish Hospital in St. Louis, and they pulled me into the emergency room that night. And I remember clearly that every time I would come out of shock and back into consciousness, or if I would wake up from, whether it was a morphine sleep or if it was natural sleep or shock, when I would come back into reality, just as you can imagine, the world was dark and painful and awful and scary. And the only kind of comfort that I got in that moment was the fact that there was someone who was holding onto my hand and that person just… I knew her name. Her name was Jennifer, and she said, “Marcus, I’m here.” And those two words, as she held my hands, those were the most compassionate words, and those were the best words that I think could have been spoken to me. And I think those were the best words that we can speak to another human being when those people are suffering. So, that I believe is my work – to remind the world that simple human presence, it’s the greatest gift we can give another human being.

Dr. Nate Regier: Man. Wow. Just so powerful. And in that message, “I’m here,” I remember when I heard you say that the first time, and you have a book with by that title. It reminded me of the word compassion, which comes from the Latin root, meaning “suffer with,” “struggle with.” And so often we think that compassion means to go alleviate the suffering, take away the pain, fix the problem. We can’t always do that. And in that moment, that nurse wasn’t fixing things, wasn’t making it all go away. Jennifer was just there with you. I wonder if you could comment on just the power of presence in those moments.

Marcus Engel: I think of it so simply as… Hopefully those of us who grew up with a good family life, as a child we get scared, we are afraid, or we’re injured or we’re hurt, whatever it is, and the parent takes the child in and says, “I’m here.” That’s what gives that child so much compassion to know that there’s someone that’s there that’s looking over them. It’s a safety thing. It’s a feeling of safety and security. And to think that all of that emotion can be distilled down into two words, that’s what I want to remind people of, that we all have that power.

Jennifer, you said she was a nurse. She actually was not a nurse. Jennifer was a 20-year-old patient care tech who was actually moonlighting in the emergency room. But, even with her young self, she didn’t have years and years of education under her belt. And she didn’t have a whole alphabet soup after her name, but she knew that those two words could provide such great amounts of compassion.

Dr. Nate Regier: Wow. And if you haven’t had the privilege of hearing, my listeners, if you haven’t had the privilege of hearing Marcus speak in the keynote that I heard, you walked us through your story, you walked us through the journey, you walked us through the process of recovery, stopping at key points to share a lesson. And that was the first thing, but there was more. Would you care to highlight a couple other key takeaways or lessons that you distilled from that experience that you teach healthcare providers?

Marcus Engel: Yeah, it’s not just healthcare providers, right? Because we don’t have to be clinicians to be able to provide presence and compassion. That’s just what we do as human beings, right?

Dr. Nate Regier: Right.

Marcus Engel: And I don’t have any clinical background whatsoever. I have a Master’s in Narrative Medicine, which kind of goes into compassion, very much is tied in with compassion and presence and perspective, but any of us can do this. Any of us can be present when another person is suffering.

I’m very authentic, I hope, and real with my audiences because this is not a pretty experience. You can imagine the horrific site that my caregivers had to look upon when taking care of me. As a patient would be called total care. I was immobile, I couldn’t see, I couldn’t hear, I couldn’t bathe myself, I couldn’t feed myself, I couldn’t breathe on my own. I was on a ventilator and they had to do a lot of care of me. And I was not always such a great patient. I was an angry young man, as you can imagine at this time. And I took out a lot of my frustration and anger on those people around me. I used that story to remind people of the lesson that I learned very early on whenever I was trying to go through the emotional and mental regrouping, I suppose, after trauma when a counselor said, “hurting people hurt people.”

And I had dealt and probably still do, deal with a lot of guilt about the harm that I caused people during my recovery. People that just wanted to help me. And I have to remember that myself, I too was hurting. But I try to use that story to illustrate, especially to clinicians who are at the bedside, that, look, family members, they’re hurting too. And if they get uppity, if they get demanding or a lot of it’s just because they’re so scared. And when we’re scared, we sometimes go into fight or flight mode and fighting is sometimes all we can do and all we can do with our mouth, for a patient or a family member.

Dr. Nate Regier: That’s a different statement. I’ve often heard hurt people hurt people, and that’s more about the cycle of violence through generations. But you’re really talking about how this is a way for us to gain some empathy and some compassion for people that maybe say or do things that appear hurtful or inappropriate, that they’re hurting too. And that we need to understand that everybody is carrying something, struggling with something, dealing with something that we might not understand.

Marcus Engel: Hurting and pain and suffering is part of the human experience, right?

Dr. Nate Regier: Right.

Marcus Engel: Every one of us is hurting in some way, at some point in time. And I believe that’s what we get to do as human beings is to come alongside others and try to alleviate the suffering of others.

Dr. Nate Regier: Well, being present is wonderful in theory, and that Jennifer was very special in that moment and unique and had a gift. For crazy busy people who don’t have time for touchy-feely soft stuff. We got work to get done. How do we get over that hump? When we were talking earlier, you were talking about how our world is crazy. There are so many distractions, everything pulling us away from being with each other, even though that’s what we need so much. How do we do this?

Marcus Engel: I think that’s why we have to do it. We do. It’s not just touchy-feely, it’s hard science. There is the science of compassion, and that’s some of what I get to teach to my pre-meds too. There is beneficial science behind this that says, whenever I act more compassionately, more empathetic, it’s not only good for that person, it’s also good for me. It’s good for the giver, not just the receiver. So it’s essentially creating a win-win situation. So I say, “We don’t have time for it? We don’t have time not to.” If we want to create better environments, we have to be the ones who intentionally go out there and practice being human with other humans, listening and being present. It doesn’t take that much time. It just takes some acknowledgement and awareness of being in the moment.

Dr. Nate Regier: I appreciate you saying that about it’s not… It doesn’t take as that much time. One of my favorite books about this topic is Compassionomics, written by Stephen Trzeciak and Anthony Mazzarelli, and they talk about the research on what are the barriers that providers perceive to being more compassionate. And one of them is, well, I don’t have time for this. It takes too much time. And the reality is no, it doesn’t. I’m curious, what particular strategies or techniques do you teach your pre-meds about being present? Are there any things that you could share with us that my listeners could do?

Marcus Engel: Some of the things that we’ve already talked about.  Using those two words, “I’m here.” I say that they are the three most compassionate things that we can say are, “I’m here.” “Me too.” And third –  this one I actually learned from my guy who works on the curb at the Orlando Airport – “I got you.”

Dr. Nate Regier: I got you.

Marcus Engel: I got you. That’s that security that we feel when somebody… “Look, I got you, I got your back, you’re okay, you’re safe.” And I feel like that is just some of the most compassionate language that we can use. And then we also take time to really reflect on what does that mean? And sometimes it means stopping to make eye contact. Sometimes it means letting the other person talk without interruption, trying to walk in awareness of non-judgment. Non-judgmental awareness is my favorite definition of compassion. Non-judgmental awareness.

Dr. Nate Regier: I was going to ask you your definition. Thanks for sharing that.

Marcus Engel: Yeah, that’s my favorite. Because again, I like to get down to the nitty-gritty, and if you can get it down to three words, “non-judgmental awareness” and boy, whenever we sit around and try not to judge, it’s hard. We’re constantly judging that my seat doesn’t feel comfortable or it’s too hot in here, or I’m hungry and we can’t. We just got to be in awareness.

Dr. Nate Regier: Yeah. Could you summarize… You mentioned the science that we do this because it works, it has an impact. What is some of the notable scientific research that you share with your students or you share with your listeners about why should we be here with people? Why should we practice compassion?

Marcus Engel: I think we have to practice compassion for ourselves as well. And so with the narrative work that I’ve done, it led me to the work of Dr. James Pennebaker. And Pennebaker is a social psychologist who did some of the first studies on using writing as a reflective therapy. And so all I do, whenever I’m working with clinicians and others in healthcare and not even in healthcare, this goes across the board. Whenever we write about our experiences, it’s giving our brains time to process more of that story. And so using practices and techniques that I learned at Columbia through the narrative medicine program also go into it because we’ve got to have some compassion for ourselves. We’ve got to try to work out some of our own things so we can help other people work on their things.

Dr. Nate Regier: So much of when we work with healthcare providers, we do a lot of that as well, is that often a lot of the miscommunication or drama or struggles that providers have come down to them not having compassion with themselves. They’re not treating themselves with a non-judgmental awareness, and the judgment that they have on themselves or the lack of awareness about what’s going on leads to stuff. So I appreciate you focusing and helping us remember it starts and also includes us.

Marcus Engel: Got to, right? It’s got to.

Dr. Nate Regier: Yeah, so thanks for sharing your definition of compassion. We define compassion… I mentioned this to you earlier when we were speaking. We define compassion as the practice of demonstrating that people are valuable, capable, and responsible in every interaction. And we call these three words, the three switches of a compassion mindset, value, capability, and responsibility. And as I was reading the two books that I got of yours and hearing you speak, I heard you mentioning, without maybe using those words, I heard you talking about how there are interactions that uplift and affirm our human value. There are interactions that affirm our capability, and there are interactions that also affirm our responsibility within that healthcare experience. I’m curious what connections you might see in the work that you work do.

Marcus Engel: Ultimately, to go back to one of your original three questions of why do I do this? I think those of us who have truly been hurt, we want to try to keep that from happening to others. I think those of us who have truly been injured, whether it’s physically or psychologically, we have a great amount of empathy for how much that hurts and we don’t want other people to suffer as we have. And I think that also gives value to our own experiences. So why do we do this? Ultimately, for me, I wanted to help remind nurses and doctors and bedside folks just to remember that that is a human being there at the other end of the stethoscope. And that it might be a normal Tuesday for a doctor or a nurse, but that’s very well the worst day of that patient’s life. And if there are little things that you can do that help that patient feel held and affirmed and that they’re safe, really, isn’t that why we all chose these helping professions anyway? Isn’t that what we all got into this for in the first place?

Dr. Nate Regier: Yeah, I’ve read the research about what is called compassion fatigue, but I really think it’s empathy fatigue. We carry so much pain with us, but research showing that when the burnout… Often burnout is one of the symptoms of depersonalization, backing away, distancing myself, kind of insulating myself from connection, and that the research actually shows that real compassion, leaning into the relationship, at being present actually is an antidote for burnout. Kind of the opposite of what you would think. What have you seen with providers that are on the verge of burnout and are so drained by dealing with this kind of… With patients like you every day? This is hard, hard work. It’s terribly difficult.

Marcus Engel: It is, and it takes a lot to… I think 21st century, second decade, western culture these days, there’s a lot to deal with. I mean, we live in a very overstimulated world with a ton of exhaustion on the heels of the pandemic, et cetera, et cetera. So those who are doing a really good job, keeping an eye on their mental health, what are they doing to do so? I see some of my favorite physicians that are friends and colleagues through education, et cetera, that are taking time to actually be intentional with their meditation practices and with their therapeutic journaling and writing, and also understanding that there is a limit of what we can do within the confines, right? Accepting that there are limits is something I think all of us have difficulty with, but I feel like so many doctors come out of medical school and very, very quickly, or even while they’re still in medical school, are seeing the difficulties of healthcare and saying, this is nothing like what I thought it was going to be.

It’s the system. I think there’s the stat that says that nearly 70 or 80% of what we call compassion fatigue and burnout can be linked back to systemic issues and, unfortunately, those seem like those would be low hanging fruit to try to help build up more compassion and more human understanding and empathy, but sometimes those are not the things that are high on the priority list for administration.

Dr. Nate Regier: Yeah. Well, you see it all. You get to experience all kinds, and you probably understand the pros and the cons of our western medical system. What would you say are some of the lowest hanging fruits systemically that administration could tackle right away to improve compassion in the patient experience?

Marcus Engel: Boy, if anyone could wave a magical wand and come up with millions of more dollars and millions of more healthcare professionals to fill the roles that are needed, that’d be great. What do we do in the meantime since nurses don’t grow on trees and everyone is always working within budgetary limitations? Be a good leader and being a good leader, well, then I think often means being a good listener. Listening to your people, listening to the complaints, even if you cannot do anything about it, to be present, to be there. You don’t have to do anything beyond be there.

Dr. Nate Regier: Well, that is a challenging and hopeful message for leaders who think that they’re already doing too much and they just need to keep doing more and more to fix the problem. Wow, that’s fantastic. I recently read an article in a nursing journal, a study that’s starting to imply that this leadership culture that you’re talking about can have a bigger impact on issues of retention and burnout and all of that, and then all the crazy things we’re trying to do, like throwing more money at the problem or big incentives or all these different kinds of things. So it’s great to hear you say that, compassionate leadership.

Marcus Engel: Compassionate leadership, I think is what everybody wants. We want compassionate leadership. We want compassion for our fellow human beings, but systems. So what do we do? We be intentional, right?

Dr. Nate Regier: Yeah. Marcus, to help us wrap things up, I remember so many moments that you shared in your story during your keynote. Is there maybe one more moment where something… There was an interaction with someone that was caring for you, that was powerful, that made a difference for you in that moment, that maybe represents a lesson or a strategy that others of us could practice, that you’d be willing to share?

Marcus Engel: Sure. This is one of those ideas of personalism too, and I think that when we are practicing personalism, we are also practicing compassion. We are taking a view of an individual as a whole person. So I had lots of surgeries, as you can imagine. I’ve got enough metal in my head to set off alarms and such, not literally, I think because it’s titanium that it doesn’t alarm, but yeah, a lot of surgery, hundreds of hours of facial reconstruction. And I had one of what my family still calls my first big surgery, which was one that equaled about 25 hours, and after… Yeah, big surgery, multiple teams of doctors working on me for shifts. And following that surgery, I went to a different ICU in the hospital, and one of my caregivers was a nurse named Barb. And Barb, she so personalized her care for me because even though I was… Clinical people may understand this even more, right? I cannot see at this point. I cannot hear. Everything I hear sounds like I’m deep underwater, it’s very blurry. I can’t smell. My sinuses have been completely crushed. My head is swollen up. I’ve got this eyelid sewn shut, jaws wired shut. Just absolute – one of the worst traumas, physical traumas, I think a human being could suffer. And Barb was not intimidated by that ghastly sight in front of her, and she specifically asked me, even though I could not speak, she specifically asked me, “Do you want me to call you Marcus or Mark? Which name do you want me to call you?” And I thought, what a beautiful act of humanity to be able to look past that awful sight and to see the person inside.

Dr. Nate Regier: Wow. Powerful. That’s something we can do to any person in any relationship, is look past all those things that we might be distracted by, that we may put conditions on their value because of those things and see through to that valuable person. What a wonderful thing to leave us with.

When you’re working with… When you’re presenting, when you’re sharing, when you’re teaching, are there any common challenges or barriers that people face inside to be able to go there, where you’re asking them to go?

Marcus Engel: About compassion or part of the story or how do you mean?

Dr. Nate Regier: What are some of the things that people need to deal with or overcome on their inside in order to go there and be with people in the way that you’re advocating?

Marcus Engel: It takes a lot of self-examination, right? And we don’t do nearly enough of that in society these days, I feel. We don’t do nearly enough self-examination, and it does take some doing to get past our own teachings. The things that we were taught that maybe we found out later were not exactly right. It takes some examination of our own selves and our values to be able to be sure and intentional that we are actually living out those values.

I understand that people are humans and nurses, docs, anybody who’s working with patients, it can be a normal Tuesday. It can be just a normal Tuesday, and you can start walking through it just like you do. We’re all prone to do at times when we get bored or burnt out, but to remember that human beings around us, everybody is suffering, and the more we can do to show presence and personalism, that’s what we get to do.

Dr. Nate Regier: Thank you. Wonderful message. Is there anything you’d like to leave my listeners with? Anything you’re particularly passionate about these days or maybe kind of one thing you don’t want us to forget from your work or from our conversation?

Marcus Engel: Well, there’s a lot of stuff I’d love listeners to be able to take away. I’d love to give you some extra listening too, and check out my podcast, which is called “Compassion & Courage: Conversations in Healthcare.” Side note, you don’t actually have to be into healthcare to enjoy this, but I try to talk to people about what are their experiences of being with… What are the experiences that you’ve had where you felt the presence of another person, or you have provided that caring presence? And when we stop and take some time to reflect on those experiences, maybe we can emulate them more in our practice and in our life.

Dr. Nate Regier: Well, we’re going to put those links in the show notes. We’re going to put your books in the show notes and ways for people to get a hold of you. What would be the best way, if somebody wants to learn more about your work and get ahold of you, where should they go?

Marcus Engel: Just my name, MarcusEngel.com. MarcusEngel.com will get you right there. I also feel like I’m just put here to help other people, so if there’s anything I can help you with at all, please reach out.

Dr. Nate Regier: Well, you’ve helped me. Without even knowing me, you agreed to be on the podcast and share this message. Thank you so much.

Marcus Engel: Sure.

Dr. Nate Regier: It’s been a real pleasure having you here and getting to know you, Marcus. You’re a remarkable human being and you see the remarkable human being in everyone. Thank you for that. Thanks for who you are and what you’re doing in the world.

Marcus Engel: Sure thing. Thank you, Nate.

Voiceover: I hope you enjoyed this episode of On Compassion with Dr. Nate. If you found new hope or guidance for your life, will you share it with your tribe? If you know someone who could be a great guest, please let us know. Are you ready for a practical way to bring more compassion to your organization? We have a solution. Visit www.TheCompassionMindset.com. Check out the show notes for links and contact information and remember to subscribe, rate, and give a review on iTunes. Thanks for listening. Until next time, keep your compassion mindset engaged.

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