Bill Garrett

GRADUATE PROFILE

Bill Garrett is an emergency physician in Denver, Colorado. "Now I deal with patients as people whereas before I dealt with people as patients. It is very easy for people who are attracted to medicine, who are very scientific and analytical in their orientation-like myself-to fall into a trap,a mechanism of living and dealing with patients that is very structured. The medical literature decries the doctors who refer to their patients as ‘The broken ankle,’ ‘The headache,' ‘Room 12,' or whatever. But, before the Basic Training that was very real for me. People were patients, diseases. In the Basic Training I began to realize that I wasn't dealing with disease, I was dealing with people who are diseased. I began to identify ways in which physicians could be healers in a different sense than simply giving medication,making diagnoses, prescribing therapies. There is more to healing than making people symptom free.

“Now,I look at my patients as people.I approach them from a more holistic perspective. It's important to me how their home life is, how their social life is, whether they smoke or don't smoke, whether they use drugs or alcohol excessively. I deal with them accountably about all of that. Are they aware of what they are doing, of the impact their actions have on them, that they are the ones choosing those things? I introduce the concepts of choice, of accountability. It's a challenge for me not to be judgmental about it and to communicate in a way that they don't feel like I am judging them, but to make the point that there is a possibility that their symptoms may be a reflection of something else going on in their lives. Many people haven't considered that they may have something to do with being ill, and conversely, with being well.

“When I did the Basic in 1984, I went in there very judgmentalassessing and intellectualizing everything. I can remember sitting near the back of the room saying to myself, ‘I know what’s going on here.’ I sat back there analyzing and figuring out the first couple of days. Then, people's sharing started having an impact on me. I found myself crying or laughing, very attuned to what was going on with each person sharing. When I finished the training I felt like a weight had been lifted off my shoulders. My judgments of people just faded. During one exercise on Saturday, when I just looked into one person's eyes after another's, I had the experience of compassion, of feeling from their perspective more than my own. And I noticed that things like clothing, hair, and appearance just did not matter. A lot of my judgments had been based on physical or material considerations before then. On that day, those priorities were simply eliminated.

“I would say that, professionally, the most significant impact the trainings have had is in my listening to my patients. Before Lifespring, my approach was power oriented. It was: address the patient, establish that I'm the doctor and they're the patient as quickly as I can, assess their symptoms and physical findings so that I can make a diagnosis, make the diagnosis, and then plug that into some formula that says how to treat that condition. I was very successful at treating diseases, but not as competent at relating to the patients as human beings. Since the trainings, I listen to my patients and I use a lot more intuition in dealing with people.

“An example is one of my patients-a woman about twenty-two years old.She was visiting her mother from out of state. She came into the emergency department complaining of abdominal pain. She was lying there on the stretcher writhing in pain and vomiting.I went over and introduced myself and tried to calm her. We ran all of the appropriate tests for that kind of problem. The results were all normal. I sat down with her and said,‘Well,I have all the tests back and they’re all normal. That doesn't mean that there's nothing wrong with you, but I don't know what's wrong with you. Do you have any idea?' She broke into tears. She just sobbed. Now, back before the trainings I probably would have said,‘Now, come on, try to control yourself. Let's figure out what's going on here.' But instead, I just let her cry and I think I even held her hand. I asked her, ‘What do you think is going on?' It turned out that she had come to visit her mother because her husband had been beating her. She was thinking of leaving her husband. Her mother was very critical of her, basically taking the husband's side. While we were talking about it, her pain went away, right there in the emergency department. She recognized that her abdominal pain was a reaction to much more significant things in her life than a health problem. Well, before the afternoon was out, her mother and her husband and she and I sat down and talked. We addressed this problem of physical and emotional abuse and discussed how they were really not loving each other and caring for each other. Before the trainings I probably would have paid more attention to the test results than to her as a person.

“Then there was another woman, a little bit older, who came in absolutely insistent that there was something wrong with her. I examined her and,again, everything was normal.I did many more tests than I would normally do in the emergency department-I think because I was really listening to her. I just knew that she was telling the truth, or I assumed it and operated from that perspective. Although there was no evidence from the examination and the tests, in listening to her I was convinced that something was going on. I didn't know what it was and that didn't matter. Before the training I might have just told her that we couldn't find any problem,dismissed her, and told her to go home and come back if it didn't go away. This time, though, I discussed it with her private physcian, and he agreed to put her into the hospital and do more investigation. About six days later she came down to the emergency room dressed in a hospital gown. She walked up, gave me a big hug, and thanked me for believing in her and listening to her. A day or so after she had entered the hospital, they had found a tumor in her pelvis. She had been to surgery a couple of days later to remove the tumor. They caught it before it had spread to any other organs or glands, and early enough that she would be cured.That case shows the difference made by listening to people, by taking into consideration that they do have the capacity to know their level of health at any given time. That has had a dramatic impact on my relationship with my patients.

“Another way that there is a difference in my practice is in dealing with death.I deal with a lot of death in the emergency room. Very frequently it's unexpected death. I work in a community that is relatively young-25 percent of our patient population is less than fourteen years of age. We consequently see a lot of sudden infant death syndrome. Some time after I did the training, a seven-month-old child was brought in dead. The parents were understandably distraught. My way of dealing with this in the past was to build barriers and to shield myself,protect myself and my emotions,and not to share those with anybody. Death was simply a fact of life-it was part of my job to deal with it.I developed my own mechanisms for dealing with it mentally at home. That resulted in a lack of sensitivity, a short temperedness, and so on. But, when this child came in I actually went to the mother and put my arm around her. I cried with her. I dealt with the real emotional, human part of medicine. The mother was comfortable enough in that situation to actually put her arm around me and to cry on my shoulder. That never would have happened before. I would have been so rigid and cold and unemotional that there wouldn't have been space for that to happen. It was very significant to me to have this mother be willing to share her grief and to feel comfortable sharing my own empathy.

“In addition to working with patients, I work with a lot of physicians.I am medical director for the emergency department of this hospital with seven physicians working as a team. I'm also the regional medical director for a large emergency medicine company based in Florida, with hospitals in Chicago, Toledo, St. Louis, and here in Denver. Also, I'm the medical director for Adolph Coors Company. There are over twenty physicians that I am directly responsible for at different hospitals. I credit the Basic Training with a change in my management style. Prior to the training my management style was highly structured and rule-oriented. At this point, I am open to possibilities rather than being positioned on my opinion about how it has to be. Creativity and expression of feelings are important to me now. I allow the doctors more of an opportunity to participate in my meetings,rather than just focusing on what I want to get done. That has resulted in the doctors calling me more often to talk and explore possibilities. Before I was very rarely called on by them.

“Also,I have been more effective in dealing with stress and in helping other doctors deal with stress. The opportunity for stress is certainly present in medicine. Before I would cover up my stress, but usually it would still bubble inside me and just show up some other way. Now, I take an action-oriented approach to stress.I recognize it, and do something about its cause. I have been able to help other doctors deal with their stress.In working with other doctors, again,I think it's a matter of listening. I listen to these doctors as human beings; they feel safe being with me, and can really be open and honest, thereby identifying the source of their stress and possible solutions.

“The trainings had an impact across the board:in my practice, my marriage, and my family. I had always told myself that I didn't want to have kids. I had a great rationalization about how they were too distracting from the other commitments in my life, and just not worth the effort. During a revealing exercise during the training, I realized that I was using those stories as excuses not to have children because I was afraid to be a father. There was really something there that I had been covering up and pretending was something else. We now have a nineteen-month-old daughter.

“My wife and I did the Lifespring trainings together. That was a real challenge, but it was a way that we could demonstrate our commitment to honest communication and to sharing. I deal with conflict in our relationship differently now. At one point in time, conflict was the worst thing in the world. I avoided it at all costs. When I was in conflict with someone, something was terribly wrong. Now it's an opportunity for looking, for exploring. Conflict doesn't carry with it all of the negativity, guilt, and anger it used to. In fact, I actually get almost excited about it now that I have the ability to refocus whatever we're in conflict about and put it into a constructive perspective. At one time it was a matter of avoiding or preventing conflict. Now it's a matter of looking at conflict as an opportunity to take some action,to create something different. I would say that through the courses I got to understand for myself what marriage is-and perhaps what marriage is not.

“There have also been very dramatic changes in my relationships with my sister and brother. To put it succinctly, I feel like I have a real brother for the first time in my life. Until we both did the trainingshe finally did them a couple of years after I did-you could describe our relationship as ‘sibling rivalry.' Right after I did the training, I told him ‘You’ve got to do this training. I just want you to do this training.'Well, thanks to my approaching him that way, he had great resolve never to do this training. My sister did the training without much resistance. By now, most of the family has done it. Last Christmas, both of them came out with their entire families. We spent the holidays acknowledging what we were thankful for in our lives, and acknowledging each other. There isn't a chance that we would have done anything like that before. My brother and I used to talk on the phone maybe twice a year. And those conversations were very formal and mechanical. The degree of love and caring that we have demonstrated since the trainings is miraculous.

“Relationships was a huge part of the training for me-relationships with my wife, family, patients,and colleagues. I saw how I would manipulate relationships. I realized that power-being powerful-doesn't necessarily mean being in control. Someone doesn't have to be in control for there to be an effective relationship. In my relationships with my patients, my wife, my little girl, my parents and the rest of my family,there has been a significant shift in my concept of power. There simply is power in relationship, it isn't power over anything. There is power in the people. If there is winning, it is in expressing power not in having power.That has transformed my relationships and my life.