Frank Gabrin's story: Discovering 'the heart of care'

Editor's Note: Frank Gabrin, DO, passed away last week from complications from COVID-19 at the age of 60. In May 2012, Gabrin authored a heart-felt cover story for Medical Economics. Here it is in it's entirety, including the video interview.

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Almost 15 years ago, when testicular cancer was diagnosed in me for the second time (a new primary tumor with metastasis), I remember telling God, "No! Not yet!" If I had died then, my life would have been a tragedy. I had yet to leave my mark. I was only 38 years old. I wanted more. Thankfully, my physician, surgeon, nurses, hospital, healers, friends, and family were able to deliver a rock-solid cure and give me another chance to make something more of my life.

I was cured, but I must admit that on the last day of chemotherapy, as I walked out of the hospital, I found myself feeling very disappointed and sad. For months, I had crossed off the days, treatments, surgeries, diagnostic tests, and appointments on the huge calendar on my refrigerator door. Now, that calendar was blank, and worse yet, my future was a big blank as well. Completely hairless, with orange skin and blue fingernails, nauseated, and short of breath, I could barely crack a smile.

I felt alone and vulnerable sitting in my favorite recliner in the family room. Was I really better? What was I supposed to do now? The life I had before my diagnosis was great by most people's standards, but I was not satisfied. Facing my own mortality had given me the opportunity to think about what I really wanted from my life. I wanted assurance-now more than ever-that when my life was all said and done, my time on this planet had counted for something.

I wanted to feel that I was making a difference every day and that my work had value, meaning, significance, and purpose. I wanted to know that I mattered and that I was making the world a better place. What greater purpose is there than helping others? Isn't that why I chose to become a physician?

RETURNING TO WORK

Despite my renewed, burning desire to use my skills and training to help others, almost as soon I returned to the emergency department, I was again feeling overworked, overstressed, overburdened, underappreciated, and dissatisfied. I began to dread going to work. I had a severe case of burnout.

Why did I go through all the mutilating surgeries and arduous treatment? To feel victimized by the medical system I'd worked so hard to become a part of? Was this really as good as it gets? There had to be more to life and the practice of medicine than this.

It turns out I was not alone in feeling dissatisfaction and burnout at work. Statistics show that many of you feel the same way. What adds to our stress is the fact that the public and our government are unhappy with what we are doing for them, and to get us to do better, they are now legislating healthcare reform and beginning to link patient satisfaction scores to our reimbursement.

From this place of frustration with the way I was practicing medicine and living my life, I began to reflect on my personal experience on the other side of the stethoscope. Cancer, as well as AIDS, heart disease, and stroke, are the modern plagues of humanity. These, like death itself, are the great equalizers for all of us. Each of us inevitably will need medical care. At some point, every doctor (or should I say medical care provider) will find himself or herself on the other side of the stethoscope. When we do, we will expect the best care. Although I received the same treatments and chemotherapy as others in my shoes, I am considered one of the lucky ones. Some did not survive. What made the difference for me?

ONE EXPERIENCE ESPECIALLY MEMORABLE

Looking back at the cure and the care that I received, one experience stands out. It was a Friday afternoon. I had spent the whole day at the hospital, getting lab work and imaging, meeting with the anesthesiologist, and now I was sitting in my urologist's office, wrapped up in a paper gown on an exam table covered in paper.

He was a world-renowned surgeon in a facility that delivers world-class care. He had an entourage behind him: a surgical fellow, a surgical resident, several interns, and a couple of medical students-all men. Each of them had the opportunity to examine my one remaining diseased testicle and probe my inguinal area and abdomen.

They all stood silently as my surgeon explained the upcoming mutilation procedure: castration; I would become a eunuch, and he told me what to expect. When he was finished, he asked whether I had any questions. I had only one. Once he removed the testicle, could he place an implant? After all, I had one on the other side already. He told me no. Such implants were not available anymore because of the silicone scare with breast implants.

That moment was the straw that finally broke this doctor's back. It was just too much for me to bear. I began to sob uncontrollably. Here I was, vulnerable, exposed, and humiliated, and now crying like a child. I was no longer rational. I had totally lost control.

My extremely professional and detached surgeon, whom I thought was cold, rolled his stool closer to me, pulled my head to the starched lapel of his lab coat, and wrapped his arms around me. He did not say a word. The only sound in the room was that of my desperation, anxiety, and overwhelming sadness. He held me for what seemed like forever until my sobbing subsided, my tears stopped flowing, and his lab coat was covered with my snot. He then pulled back, offered me some tissues, looked me square in the eye, and said, "I get that this is awful, and it seems unbearable, but you are going to be healthy, happy, and whole again. I want you to know that I am willing to do whatever it takes to help you through this. No matter what. I promise. Someday, all of this will just be a great story for you to tell."

Then he did something even more unexpected. After he washed his hands and cleaned up his lab coat a little, he turned to me, shook my hand, and said, "Even though they don't make them anymore, if you can find one, have it sent to my house by FedEx over the weekend. I will bring it with me and place it during your surgery." He had given me a weekend project, something to do instead of moping around worrying about my surgery on Monday.

EMPATHETIC CARE

Care has nothing to do with outcomes and measurable data, Gabrin says. It happens with the interpersonal interactions between patients and caregivers.

It has taken me years to realize that it was this empathetic care from my surgeon in his office that Friday afternoon, without surgery, drugs, or treatments, that was the intangible ingredient that ensured my chemotherapy would be successful. In the nearly 15 years since I have been cancer-free, I have come to the clear understanding that care and cure are two completely different things.

As a society, we have become preoccupied with technology and speed. We live in a world where we have come to expect instant answers, instant solutions, and even instant cures.

Modern medicine delivers amazing cures every day and is responsible for curing me of cancer. But as we focus on the technology, we blur the distinction between care and the delivery of the cure even more. Cure without care involves only the rapid diagnosis and treatment of our patients and completely moves us away from the human experience of delivering care. Rarely does delivering a cure without giving attention to the intangible aspect of care satisfy us or our patients.

THE PATIENT ENCOUNTER

We need to understand that true care does not involve the solution or the cure. As it was with my surgeon, the heart of the genuine care he gave me was not in his power to fix or solve my problems. It was not within our technology, our machines, or in our medicines. My personal satisfaction and consequent healing was within the patient encounter he had with me that late Friday afternoon, within his ability to connect with and feel the pain and angst I was experiencing and then, within his expression of compassion for me.

It is when the expression of cure, the solution to the immediate problem, becomes confused with the care itself that the waters become muddy. This is the real issue that lies at the heart of this country's dissatisfaction with healthcare today. The government can pass all the legislation they want to, they can change the way that healthcare is paid for, but we will never be able to satisfy the patients we care for until we get clear about what care really is.

Care has nothing to do with outcomes and measurable data. Care does not happen in the application of the mechanics of medicine, the x-ray, or the IV. Care happens in the interpersonal interactions between the caregiver and the receiver of care. Care happens at the patient's bedside and nowhere else. For the process of care to occur, you need two individuals, a giver and a receiver: a doctor and a patient. The process of care involves intangibles only.

INTANGIBLE ASPECTS

If we really want to create satisfaction in our business of giving care, we must broaden our focus from the physical details of what we do (the cure) to include the intangible, energetic, unseen aspect of the art of medicine. We need to set our sights directly on care. When we focus on our desire to help others and give the intangible needs of our patients a higher priority than our own by delivering the intangible, then we finally will have the "more from life" we all crave within the context of what we already do.

It seems we are anxious, terrified, and almost unwilling to sit with our patients and feel their struggle/pain. And for good reason-it's uncomfortable and sometimes painful. Real-time magnetic resonance imaging (MRI) shows this assessment to be true. When examining experienced meditators focusing on empathy, all the "feel-bad" centers and neurotransmitters in the pre-frontal cortex are activated. Sitting and feeling another's pain actually hurts.

COMPASSION

Don't worry about the pain you may feel while you are "in" their pain. It will not overwhelm or destroy you. As soon as your patient believes that you get it, that you feel it with them, you will both be able to tell. Shifting your attention to compassion at this point will energize you, empower you, and ignite your passion for caring, thereby changing and making things better for your patient. This feels incredibly good.

Humans are hard-wired to care. The same MRI imaging of experienced meditators who focused on compassion indicated that this is true. The images show that all of the feel-good, dopamine-rich centers in our prefrontal cortex light up when we are engaged in compassion. It really does feel good to care.

You see, feeling their pain is what allows us to really help patients heal. You can't go straight to the compassion without the empathy. The heart of genuine, real, or true care for another human being lies in our ability to lament and grieve with another. The best part of making the effort and taking the time to go to this uncomfortable place and expressing our compassion for our patients by letting them know we want the best for them is that in this intangible process, we find our own satisfaction.

For patients to feel our care, we must be willing to do whatever it takes to satisfy our own need to answer the cry of someone hurting or in need of companionship. We must reconnect with our original, pure, and uncorrupted desire to help others. Real caregiving is not in the fixing, but in acknowledging the depth and reality of the human condition. Our ability to truly give care comes from knowing that, when our time comes, someone will be there to lament and grieve with us. As I learned from my own experience with my surgeon, none of us wants to, or can, go it alone.

FIVE-STEP PROCESS

So what is the bottom line? I have learned that to feel good at work, I have to remember that I came here first and foremost to care for others. The cure is secondary. Yes, I have to provide the best cure available, but I will never be satisfied when all I deliver is the cure.

We are all providers of care. Our expectation from this career was that we would feel good because we are caring. Our patients' expectation is that we will care. Our personal well-being and satisfaction requires that we stop and rise above the physical stuff of cure in each patient encounter and deliver the intangible goods of care. This is what will satisfy our patients. This is what will satisfy our souls.

What I do now, when I am at my patient's bedside, is remember that I want to care and that delivering care is the only thing that will satisfy me. Delivering care is an intangible but simple five-step process that requires me to engage my mind and my heart, to use my thoughts and emotions to help another.

• I cast out thoughts of the past and future to focus on the "now."

• I connect with the patient.

• I put the patient's needs in front of my own. I make him or her more important than whatever challenges I face that day.

• I empathize with the patient. I try to feel the patient's pain as if it were my own. I stay in this empathetic connection with him or her until we both feel something shift.

• I then turn on my compassion for the patient and let him or her know that I will do my very best for him or her.

I use this technique in my practice of emergency medicine, and it has revolutionized the way I feel about who I am and what I do. It does not take very long, and it is time well spent. Twenty-six years into this career, I am more excited, more engaged, and happier to be at work than ever before.

I now know that my care makes a difference and makes things better for others. I know that I am satisfied because of the way I provide care. I finally understand exactly what care is and what it takes to care. I remind myself every shift that to have an extraordinary day, I have to remember why I am here and to include my care in every cure. In my opinion, this is the solution we have all been looking for. This is the way to bring satisfaction back to the medical profession for those of us at the bedside. This is the way to create satisfaction on both sides of the stethoscope.

Today, I can say that I have finally made the best of my last chance and found what I had been looking for my whole life. I finally know that what I do and how I do it matters. I matter. I truly care for others. Clinically, nothing feels as good or is better than that for me.