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Caring for People on the Edge:
Emergency Medicine, Negotiation and the Science of Compassion
James O’Shea
Editors’ Note: The author, a physician specializing in emergency medicine, finds his work replete with negotiations of all kinds, many of them demanding compassion. Finding similarities to police hostage negotiation work, O’Shea reviews the neuroscience involved, and concludes that professionals of any kind who must demonstrate compassion at work can pay a price in their own peace of mind, or at an extreme, even in their ability to continue to do the job at all, when the demands exceed their time and ability to recharge their batteries of compassion. Most insidiously, the author finds hidden curricula in the training of his profession, and of others, which militate against the professional ever adopting a compassionate enough attitude to really suffer stress—or to do the job properly.
Negotiation’s starting point is often one of distrust and opposition, partly because each side associates the other with a history of suffering, caused (which makes one defensive) as well as experienced. Yet the act of negotiation requires that we “process” our own suffering, as well as that of others. Typical training in both my own field—emergency medicine—and negotiation lacks this element. I began to realize that there were other parallels when I had the privilege first of encountering, and later doing a small amount of experimental training with, Jack Cambria, the longtime (2001-2015) chief hostage negotiator of the New York Police Department (and contributor to multiple chapters in this volume, noted below.) This chapter is the result of those discussions’ impact on my longstanding interest in compassion, as a working quality not sufficiently developed or even discussed. An example may help.
Sarah
During my medical school education, I received knowledge and procedural skills, but I did not have one single lecture on how to actually handle my job. As a first-year resident, I encountered a 28-year-old woman who came in with symptoms not unlike a common cold. She was unwell, but did not appear critical based on her vital signs and history; she had a slight fever, and she was tired.
She was accompanied by her largely unconcerned husband. He had other things to think about; he had their three beautiful kids running around the little emergency department examination room. Two hours later that same man pushed me out of the way after his wife was declared dead, so that he could get to the bed to “wake her up”. He turned to me in shock, with a face in the most indescribable agony, and asked me to help to wake her up. My attention was torn between him, the children and the blood on her body from what we had had to do to her to try to save her. She had a rare emergency condition with a high mortality rate, and she deteriorated and died without warning.
Practicing medicine requires one to process a significant amount of suffering, that of others and also our own. A knowledge of how humans are biologically designed to handle exposure to suffering can be a powerful tool, both in negotiating well and in the practice of medicine. In this article I will use medical settings, and their often unrecognized negotiations, to illustrate the value of such knowledge for negotiation more generally. This choice is partly dictated by the settings I know; but also, medical practice and biological research throw some of the issues into a sharp light, and I join at least two other authors in this work in finding these settings useful for illustrative purposes. [See NDR: Morash, Non-Events, and NDR: Jendresen, Creativity]
I believe that medicine involves more negotiation than is commonly recognized, and an emergency department physician in particular—my personal specialty—is in one of the occupations others in this volume have argued as needing some of the skills of a police hostage negotiator. [NDR: Volpe et al., The Unknown]. In the real and tragic case of Sarah outlined above, there was a need to negotiate with other doctors in order to get specialists down to the emergency department quickly, and a need to negotiate with Sarah’s husband to consent to an invasive and painful procedure for his wife in the midst of his own shock and fear. There was also the need to negotiate the reality of the situation as it unfolded, which played out in trying to explain to Sarah’s bereaved husband what had...
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For full contents please purchase The Negotiator’s Desk Reference.
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