Dare to Ask, “How Are You Today?”

Podcast Transcript

Adrienne Boissy:
Welcome to another episode of Studies in Empathy. A Cleveland Clinic podcast exploring empathy and patient experience. I'm your host, Adrienne Boissy, Chief Experience Officer here at the Cleveland Clinic in Cleveland, Ohio. And I'm very pleased to have Dr. Amy Freadling, Director of Caring for Caregivers.

Thanks for joining us today. I'm so happy to see you.

Amy Freadling, PhD:
Thank you so much for having me today.

Adrienne Boissy:
Well, Amy, what a perfect time for us to be talking on the heels of a pandemic year.

Amy Freadling, PhD:
It certainly has been a very challenging and trying year for each and every one of us.

Adrienne Boissy:
Before we dive into some content, tell me a little bit about who you are, where you came from and what makes this work important to you?

Amy Freadling, PhD:
In my present position, I am the Director of the Caring for Caregivers program at the Cleveland Clinic and our role involves employee assistance and support across the enterprise. Counseling, interventions, referral services, on-site support and a number of different duties. This work has been ever changing and even more important than it ever was. The ability to remain flexible and offer support to our caregivers is critical. In terms of who I am, I've always had an interest in helping people and to find ways of making the world a better place. And now more than ever, the type of services that I offer and my team offers have just been so important.

Adrienne Boissy:
I've been thinking a lot and have talked a bit about grief this year because although many of us are feeling differently and we're feeling badly, sadly, happily, loving our kids, being home all day on computers, whatever it is for you. A lot of us are experiencing grief and I want to expand that concept to grief around what it used to be. Grief around things you used to like to do. Grief of who you thought you were before. And I'm curious if that's resonating in your world as you talk to our caregivers and people. Do you have this sense that part of what they're doing is mourning what life used to be?

Amy Freadling, PhD:
Absolutely. I think grief, as we may have known it previously, was typically associated with a loss of a loved one or a loss of a life. And now what we're seeing is that grief is so much more complex and complicated. It's a loss of all things that we previously knew and enjoyed. Routines, freedoms and being able to see people in person. Even in my own life, I would say there are certain things that I've lost. I'm not sure what a date night looks like anymore because we don't really go places. Even my daughter, her favorite ice cream shop closed and she was crying. She was devastated. So, I think that grief is ever present for our caregivers and across our world right now. And what we're hoping to do over time is find ways of finding meaning in our losses and rebuilding in unique and creative ways.

Adrienne Boissy:
So, when I'm at home and my son is upset that his friends won't play with him on his video games, to me, I have a hard time relating to that experience. And my tendency, of course, as an empathic mother who trains clinicians on empathy, is to say things like, "That's not the most important thing right now," or "That doesn't really matter. I understand it seems difficult but it's not." And there's a lot of things wrong with my parenting approach there. I'm curious before we talk about what is effective in helping people through their grief, could you comment on how effective my parenting- No, just kidding.

Could you comment on what isn't effective for teams or individuals to be doing around recognizing and honoring their own grief?

Amy Freadling, PhD:
Yeah, I think it can be very easy at times to discount what a person is experiencing almost as a terminology called comparative suffering. So, the idea that you're suffering is not as bad as others or it is the fact that everybody's lived experiences is real to them. And so, similarly in my household, I may be prone to telling one of my children, "Okay, it's not so bad," but what I've really worked on and been very intentional about is saying, "I hear what you're saying. I know it's a difficult time and I'm feeling it too." So, it's really acknowledging the feeling and empathizing with it but also being able to share and you're not alone.

Adrienne Boissy:
Well, that was much better than what I've come up in my house. So, I have many MS patients who often come back from waiting in the waiting room, come back to see me and then they burst into tears immediately. And oftentimes they say, "I don't know why I'm crying. I'm not as bad off as the patient in the gurney in the waiting room." And so, in my own mind, I've called that a sufferer-o-meter, that we humans have this fascinating approach that somehow we should be comparing our suffering to others and assigning it value. And it's not a helpful thing for any of us to be doing quite honestly. So, I love in your approach that you're not saying... What I'm going to call out that you're not saying is, "I understand." That you're assigning value to that distress in another person and that you're validating that it can occur in you as well, even as a parent, right. Someone who is supposed to have it all together and is incredibly cool.

Amy Freadling, PhD:
Sure. No, absolutely. I think that it's also just recognizing that as hard as we try to have it all together, we're human and imperfect and it's just a recognition of saying, "Okay, I'm having a really hard time. Maybe I'm not handling this situation as well as I would have hoped." And rather than criticizing oneself, the next step is, "Hey, now that I have this awareness that I'm not doing as well as I would like, how do I start moving and getting back on track again?"

Adrienne Boissy:
So, let's make this specific to healthcare though because one of my worries is that, we in healthcare may come to it with a narrative or a mantra that we're here to help others, right? The patient comes first and you always hear these anecdotes of, "Put your mask on before you..." Right. And yet, I personally don't always think it's helpful. And I know that many of our caregivers don't seek out the help that they may actually need. They do discount it in service of the next patient coming or the work to be done. Can you reflect on whether or not that something you see that's unique to healthcare?

Amy Freadling, PhD:
I would say over the course of my career, I've seen that a lot in healthcare. I've seen that though in a number of other populations and really across the world in general. That help seeking is seen as weak. Maybe it's seen as indicative of a larger problem with a person. I typically find people who seek help are very strong because it's recognizing that there is a need for additional resources. It's being very proactive and trying to solve problems in a way that makes the most sense.

Adrienne Boissy:
Well, there could be a another line of narrative there that if I'm all together, if I'm a doctor and I'm a mom and I'm a nurse out there, I should be able to figure it all out by myself. And yet you're right. It runs counterintuitive to everything we know about why teams are strong and why there's so much resilience potentially, to be found in teams as you're not relying on any single person. I see that concept of team shine through here over and over and over again. That when you ask some of our caregivers, "What's kept you going?" They say, "My team. The people I work with." Is that something you're also seeing and hearing and is there a way we might continue to leverage or amplify our teams to support each other?

Amy Freadling, PhD:
Oh yeah, absolutely. It's always nice to know when you have team members who have your back. You can count on to chip in and help out with the work and also can chip in and help out if you're having a bad day. And so, I think really moving forward, it's continuing to bolster teamwork but also that human connection and being able to reach out to one another and say, "Hey, I'm concerned. It seems like you're maybe off your game today or having a hard time," or even if you're not concerned, a simple, "How are you," can go a long way in normalizing that many of us are here 40, 50, 60 hours a week with one another. In many ways we become not only a team but almost like a family.

Adrienne Boissy:
I'm going to plus one your idea of, "How are you?" Sometimes we do forget to ask how each other are doing. I didn't even ask you. It was a good example. And the other part of that question is, "How are you today?" Which I think gives people grace around today, wasn't yesterday and may not be the next day, right? Every day is so dynamic and different. So, I would add that piece to your check-in with people.

Amy Freadling, PhD:
I love that. And I also love the idea that there is building a culture of actually really wanting to know how someone is doing today. I think when people say, "How are you many," times it's just this idle passing greeting and the standard response is, "Okay." It would be great to get to a place where people feel more comfortable saying, "Today's not a good day."

Adrienne Boissy:
I agree. Sometimes it's with intention and sometimes it's simply a greeting or hoping to move beyond. You spend a lot of time with both clinicians. I'm curious in our clinician population, as we think about our caregivers, those that are out there with our patients, nurses in particular, as well as our physician colleagues, PAs, et cetera. Do you see different distress or different stressors for them as opposed to other populations or are we really all united in this human suffering?

Amy Freadling, PhD:
I think that we're very much united in many ways. There are probably some differences with folks who have direct patient care. So, our clinical workforce who are dealing with the sickest of patients and certainly dealing with ventilators and deaths and then certainly the chatter outside of the workplace about whether people should mask or whether this pandemic is really all that serious. I think that certainly can be traumatic and frustrating for a number of folks but many people are dealing with the same things as we discussed already. The losses, the grief, the extra pressures of maybe school's in session, maybe people are homeschooling, remote working, non-work remote working. Everyone's experience, I think has some similar challenges.

Adrienne Boissy:
So, you're reminding me as you're talking though, when we're asking that, "How are you," and being authentic about hearing the answer, part of it is making sure we're truly curious and not making assumptions about, "Oh no, that person has their mom living here. And it's a two physician home. Everything must be going great." Sometimes I think we tell those stories about our colleagues and our friends and our peers when actually that person needs to check in just as much as someone else.

Amy Freadling, PhD:
Yes, absolutely. We're all human at some level.

Adrienne Boissy:
Well, don't tell anybody that.

We touched on the concept of meaning and you were talking about different ways that people are finding meaning. Of the caregivers that you're caring for, can you talk about what lessons we might take or how is meaning being found in a time that does have some scales tip toward loss and grief?

Amy Freadling, PhD:
Well, I think for a lot of the people that I work with, it's recognizing what's important in life. It's putting things into a new perspective. It's also a recognition of what we have that's still within our control. So, the flexibility that taking on complex patient cases. I think people have a sense of pride of the work that they've been able to do. And at times maybe have even surprised themselves about how much they've been able to balance and take on. And with that, I think comes awareness moving forward as we progress through the pandemic. Things may never be quite the same as they were. We're adaptable. We can be flexible and we can bounce back from these challenging times.

Adrienne Boissy:
I wonder too, whether this ability... There's probably a better term, I'm just a neurologist. So, you'll have to correct me but there's got to be some way that the brain focuses attention on the things that matter most, right? So, we are awash in healthcare with these myriad of things we must do. Such as guidelines to follow, protocols, patients that need us and meetings to go to, et cetera, et cetera. And yet I have some sense that even in my own life, that this caused me to narrow the list of things that I must do on a daily basis that actually matter the most. And have you seen that as people are talking? Are there examples where people have really honed in on that in a way that has been helpful and provided that meaning? You could say it's just me but it would be much more helpful if you could validate my spirit.

Amy Freadling, PhD:
I do think that many people are coming to that place but it does require that space and intentionality. I think early on in the pandemic, we were all experiencing more of a crisis mode where we were moving in different directions very quickly and probably didn't allow ourselves to have that space to say, "Okay, what is it that I can realistically accomplish and how do I narrow down my focus?"

Adrienne Boissy:
Do you think we're experiencing trauma? Will people look back at this or are how many people experiencing trauma as a result of this past year? Do we need to be talking and thinking about trauma informed healing and where does that come into play?

Amy Freadling, PhD:
Yeah. Absolutely, the trauma informed approaches make sense and we need to be mindful that trauma may be present in a number of individuals in ways that we hadn't anticipated. And so, certainly this is a time that we would expect some trauma responses to emerge. We see that quite frequently with incidents of prolonged exposure to stressful or distressful events without those opportunities to pause and rest and repair. So, in sound respect, going back to the question of, should we put on our oxygen mask periodically in order to help others? It's not just to help others. It's really to help ourselves and to make sure we get to the other side of this situation with a minimal risk of trauma or other emotional health-related concerns.

Adrienne Boissy:
Why do you think that's so hard for people to do?

Amy Freadling, PhD:
My experience has been that it's very uncomfortable to admit that we can't do all things. We can't be all things to all people at all times. That we make mistakes. We have flaws and weaknesses. I think we need to get to a place where we can slow down and be okay with who we are regardless of the limitations we may possess.

Adrienne Boissy:
How have you tried to do that? Your office has been fielding innumerable projects, work streams, interventions, showing up with meals, fueling stations and the whole nine yards. How do we as an organization talk about doing that as a system more consistently and what can we learn from others? Or what can we share with others about how they might think about it? Talk to me about what you've learned and how we can spread that.

Amy Freadling, PhD:
I think what we've learned and certainly, our team has been tasked with a lot of responsibilities and then our partners with officer caregiver experience, you've referenced some of the meal delivery and other things that they've done, wonderful work. And what I think is a big takeaway is that it's been a team effort, a spirit of real collaboration and partnership across our enterprise to ensure that people are well supported but also to jump in when the people providing that support may need a break as well. So, let's get back to that community and that sense of teamwork that we discussed. And again, being able to openly express to one another, "I've got too much on my plate. Can you help me out with this?"

Adrienne Boissy:
So, how are you today? How as someone who's charged with the Caring for Caregiver program... Across the enterprise, how are you recharging and how are you amplifying that in your own team?

Amy Freadling, PhD:
I love the word today and Adrienne, I will use that more often moving forward. Today is a good day. Right. But there have been days that have been terribly challenging and stressful. The multiple demands coming forward with pretty rapid fire-ness. I think each and every day, what I really try to do for myself personally, is to stop and reflect on, how did my day go? What are some things that may have been difficult and challenging and how do I let them go? And then what are some things that I did well?

And then I try to close that chapter of my day and really shift my focus to life outside of work, as best as possible. Obviously, there are some things that get in the way but in a similar fashion and really trying to encourage our own team to recognize the great work that they're doing, the meaning behind that work but to ask for help and offer help along the way. So, if you're having rough day, let me know. Let me see how I can help. If you're thriving and doing great, how can you jump in and offer help to your teammates as well?

Adrienne Boissy:
That sounds great. I think often it's people like you who will teach us how to do it better and better by modeling it, in part, but by coming up with concrete things that every team could do. I heard one is simply asking and now I'm just thinking about buddies, right? If you're having a good day, then pairing with someone who we know that could use a little bit of a lift or a five minute debrief might be a helpful strategy.

So, as we think about employee assistance programs that you've led, I also want to spend some time there because the pandemic has amplified a lot of societal issues, systemic racism, disparities and needs that matter both in life and in health, right? We're seeing more domestic abuse and more mental health concerns. So, talk to me about how you've leveraged some of your programs. Maybe employee assistance is one of them. But talk to me about how we show up for those different populations and are you seeing different needs emerge that maybe all of us need to be more attentive to?

Amy Freadling, PhD:
Yeah. Early on in the pandemic, we worked with our colleagues in the Department of Psychiatry and Psychology to launch an emotional support hotline. And I think that was really well-received for that immediate response. One other thing that we've really done is expanded our virtual counseling offering. So, not only are we able at this time with some of our typical restrictions being lifted to do telephone counseling, but we also can meet people where they're at with even FaceTime. So really, accessibility is so important for our caregivers. And I think that we've been able to respond to people in ways that we haven't been able to before with the technology that's become available. When folks come, they come prepared and they're excited to talk with us with. They're eager and ready. Our cancellation and no-show rate has dropped significantly from the previous year.

People want services, they want support and they recognize the need. And like you said, issues of relationships, family issues becoming more pronounced. Anxiety, grief. Those are some of the trends that we have seen. Additionally, though, we have to be mindful of drug and alcohol use on the rise across our population. Not just within our caregiver population but beyond. Certainly with isolation sometimes comes gravitation towards bad coping strategies. So, that is an issue that we're seeing. And certainly, also an increase in suicidal thoughts. So, we need to be mindful of the risk involved in all of our population.

Adrienne Boissy:
So, let's play that out a little bit. So, I'm a well-intentioned caregiver walking up to one of my colleagues saying, "How are you today?" And if they say, "I'm great," maybe I say, "Tell me what's great." And we have a great dialogue. And then we move on. Then I walk up to another colleague and I say, "How are you today?" And they are either clearly impaired or I have significant concern about them. Do you have suggestions for the normal person about how to in invite in or be curious so that you can learn enough to be helpful or make the right referral? Those conversations are not comfortable depending on what your relationship is with that person. But how do we avoid stepping into the deep end but also knowing we're in the deep end and then helping be productive and doing something about it? Is there a standard language or something that you've seen work?

Amy Freadling, PhD:
I'd love to use the standard, “it depends on” response.

Adrienne Boissy:
I'm not going to let you get away with that. But you could try.

Amy Freadling, PhD:
I had that feeling. I think it's always important to use oneself in the conversation and to be able to say, "I am concerned about you. I am concerned. This is what I'm noticing. Is there anything more you can share with me?" Trying to open that up a little bit. Within our employee population, we do have a 24/7 on-call response through my team. So, if there is a concern regarding impairment or risk of suicide or self-harm, myself or a member of my team are available to jump in and offer some support and assistance and ensure that the situation is fully addressed and evaluated.

We also understand that these things may come up in a family situation. And if it's not within our scope, certainly one of the things I encourage is having the resources available, whether it's the National Suicide Lifeline or contacting a person's family member or friend, if you know. Or it might be even a police intervention as well. What I hate is for people to not ask the questions because the questions feel uncomfortable. I'd rather have people ask the questions then not and have an adverse outcome as a result.

Adrienne Boissy:
Still ask the question, I'm hearing and pick up the phone if you're concerned or if you are the person and willing. But even if you're the caregiver who heard something that maybe you're concerned about. It's okay to call. Is that fair?

Amy Freadling, PhD:
Absolutely. Call and call early on. We do have caregivers who will call us several days a week after the event or situation. Maybe because they're concerned that they're going to cause undue stress or hardship for their colleagues in some way. The goal of reaching out for help is not to be punitive. It's really truly to help.

Adrienne Boissy:
Are there other programs, Amy, that you want to make our audience aware of that they might use or you've been really proud of in terms of their impact and success?

Amy Freadling, PhD:
Again, I think the other thing that I've been very proud of, not only with our team, but our partnership with healing services, spiritual care and bioethics is that we have a really good and robust offering of support for our teams. So, teams who are dealing with distress or critical incidents, we offer both onsite and virtual support. Both to individuals and to groups and that ability to collaborate and ensure that our caregivers are supported in a real time has just been amazing.

Adrienne Boissy:
I remember a story from one of our chaplains. I'm going to get all the details wrong. So, bear with me but he was the pastor of a congregation where there was trauma. So, this is not a COVID topic but one of the members of the congregation had murdered his family. And I think either himself had committed suicide and the pastor had the onerous responsibility of, "How do I heal this congregation?" And from that moment on, chaplains are my heroes for life because they sit in those spaces and it's not just chaplains, of course, I know that you sit in those spaces. Sometimes I'm in those spaces but they're comfortable sitting in those spaces with no agenda needing to get out of it other than sitting in it with the congregation or the person in front of you. And I'm forever awed by that.

Talk to me more about that relationship because I think each of those perspectives brings a different, wonderful way of thinking about how we show up for people.

Amy Freadling, PhD:
Yeah and I think what you have described is this unifying force with our colleagues and spiritual care and bioethics and our employee assistance programs. It's really being present with another person. Being able to listen and to seek understanding without trying to run in and quickly fix something that maybe can't really be fixed. And so, its meaningful work to hold space for a person, to feel whatever they're feeling. It gets back to that earlier conversation of, I think many of us were very inclined. Let's fix it. Let's move on to the next thing. And it's great healing to allow a person to feel what they're feeling and say, "It's okay to feel that way."

Adrienne Boissy:
There is a beautiful article that somebody just sent me as we come to a close around... It was a clinician who had felt her own ability to connect with her patients erode over time, I'll try to share with our listeners, who had felt her empathy erode. Her ability to connect with her patients erode over time. And there was a singular moment where she connected with the patient. She sat and she held their hand. She had a conversation about the fears the patient had about getting a necessary surgery done. And then she felt it flood back. She felt that, "My ability to simply be present in this moment may be all I need to unleash my empathic self." And I know for so many people in healthcare, my biggest worry is that they're giving empathy, as much as I hope they're getting it filled back up. But it's certainly a risk for our caregivers. And I think some of what you're talking about is how do we continue to model that? Any reflections on that story?

Amy Freadling, PhD:
Yeah. I think the risk of burnout is very real when we continue to be actively engaged in helping others. We give so much of ourselves at times that we don't allow ourselves the opportunity to rest and repair and recharge. And so really, I think, again, modeling that moving forward is, how do I give a hundred percent, not only to my patients, my fellow caregivers but how do I give a hundred percent to myself and really checking in with that along the way. And one of the things I do with my own team is we do mindful moments during our team huddles and we share some practices that we can use, not only with our clients, but also for ourselves. And we also check in as humans and really just see how we're doing and what's working well and where the challenges are. So, again, it's that human component of resting, repairing and reconnecting.

Adrienne Boissy:
I'm going to sprinkle on your idea. One tip from Brené Brown that I heard recently was that families often come home and if I'm the one who has been home all day with my kids, I'm exhausted for different reasons. And if my husband comes home from work, he's exhausted for other reasons. And that family sometimes needs perhaps to compare their buckets. Have you heard of this? So, instead of just saying, "Hi, I'm tired," or "Hi, I'm feeling exhausted." You put a number on it. "My bucket is 20% full. Your bucket is 30% full. Boy, we're going to have a hard time managing remote video gaming tonight." So, it's a more tangible discussion of how are we going to come together as a team? How are we going to come together as a couple to make our family functional or our life functional or the care of the patient functional.

Amy Freadling, PhD:
Yeah. I love that. And in my household, one of the things we say is, "Use your words." And we say that to our kids but we have to say that as a parental unit to one another. And it's hard to know how your spouse or your kids or your family members are doing if you don't invite that conversation. So, I love that conversation of, "How full is your bucket? How do we divide and conquer? And are there certain things that we thought were priorities that perhaps we need to let go of for the time being?"

Adrienne Boissy:
That's right. How Full is Your Bucket, is a fantastic book if any of you have not read it yet. And certainly something you could share with your families.

Amy, if you could dream for our audience about what they could be doing to keep themselves going in this pandemic, not yet over pandemic year, what would they be?

Amy Freadling, PhD:
First is self-care. And I know it sounds so basic but it's really things that we all know but lose sight of along the way. So, am I exercising? Am I sleeping? Am I eating mindfully?

Adrienne Boissy:
Oh, you're adding mindful into that. I love that.

Amy Freadling, PhD:
Well, certainly I think it's important. I think we've all had some mindless opportunities along the way.

Am I connecting? Am I engaging in hobbies? I think that is my wish for everyone. And then the second is really to have a mindset that recognizes what we can and can't control and being okay with the difference. Recognizing that we're all human and we're going to have good days and bad days. And that's okay. But it's also a mindset that recognizes that the situation albeit long is still somewhat temporary. And we need to get to a place of recognizing what's most important and having some gratitude and taking away some of the meaning that is a part of all of this.

Adrienne Boissy:
Well, my gratitude to you specifically for reminding me of the basic and I love how you framed the invitation of a culture that asks how each other is doing. And if I could plus one that idea for our community, it would be to make sure, "How are you," includes yourself. Perhaps on the way to work, perhaps on the way to school, perhaps in those few moments after you wake up. How are you today?

So, thank you so much for joining us. It was an absolute pleasure.

Amy Freadling, PhD:
Thank you.

Adrienne Boissy:
This concludes Studies in Empathy podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcasts. Subscribe to Studies in Empathy podcast on iTunes, Google Play, SoundCloud, Stitcher or wherever you get your podcasts. Thank you for listening. Please join us again soon.