The Retrievals S02E04: "The Solutions" – Detailed Summary

Introduction: A New Season of Change

In Season 2, Episode 4 of "The Retrievals," titled "The Solutions," host Susan Burton delves deep into the evolving landscape of pain management during cesarean sections (C-sections) at the University of Illinois Chicago (UIC) Hospital. This episode explores the cultural shifts within the Labor and Delivery (L&D) unit, driven by dedicated healthcare professionals striving to enhance patient care and communication.

Introducing Corey: The Heart of the Unit

The episode opens with the introduction of Dr. Corey de Burgrave, a charismatic anesthesiologist beloved by the L&D team. Corey’s arrival each morning is met with enthusiasm from the staff, highlighting his integral role within the unit.

• Sue (Susan Burton): “I was wondering how many people actually say that spinals and epidurals actually fail” [01:08].

• Corey: “I walk through that door, it's always kind of like a. Okay, like I'm doing something right, because these people are relieved and happy to see me” [02:09].

Mindy, a nurse on the unit, affectionately describes Corey as the "unit baby," emphasizing his rapport with both patients and colleagues.

• Mindy: “Corey is our baby. He is the unit baby. He was a resident with us. He just vibed with us” [02:35].

Clara’s Transformation and the Push for Change

Clara Steele, a patient who underwent a C-section, returns with a transformed demeanor and appearance, symbolizing confidence and resilience. Her experience becomes a catalyst for questioning longstanding practices surrounding pain management during C-sections.

• Clara: “Stop. Like, I didn't understand that. I could simply say, you need to stop. She's not okay” [03:52].

Clara highlights a pivotal shift in the unit's culture, where patients feel empowered to voice their pain and discomfort without fear of dismissal.

Heather’s Initiative: Redefining Pain Management

Dr. Heather, an OB anesthesiologist, spearheads significant changes aimed at improving pain management during C-sections. She emphasizes the importance of both verbal and systemic approaches to address patient pain effectively.

• Heather: “I want to highlight here that even though I've been doing this for 15 years, I'm still learning. I'm still uncovering things that I think I maybe missed the boat on, that I thought I was being empathetic” [07:25].

Heather introduces a systematic approach to pain assessment, integrating regular pain score reminders and detailed documentation within the electronic medical records (EMR). This system not only prompts healthcare providers to address pain proactively but also gathers valuable data for future research.

• Heather: “OK, we're gonna go to sleep, no problem. She said, I don't wanna go to sleep” [10:00].

Teaching the Next Generation: Empowering Residents

Heather conducts a class with anesthesia residents, challenging them to reconsider their perceptions of "difficult" patients. Through interactive discussions, she reveals that patients labeled as difficult are often those who advocate strongly for their own comfort and well-being.

• Heather: “Patients don't feel listened to, they don't feel respected. They don't feel like they have a voice” [09:44].

Residents share their experiences and confront their biases, fostering a more empathetic and patient-centered approach to care.

Corey’s Compassionate Approach: A Case Study

Corey narrates an intense experience with a C-section patient who initially resisted anesthesia. Faced with an emergency, he breaks professional norms by addressing her with informal language and empathy, ultimately persuading her to accept pain management.

• Corey: “She was resistant, but she knew that she was putting herself and her baby in danger” [11:48].

This anecdote underscores the effectiveness of genuine human connection in overcoming barriers to patient care.

Implementing Heather’s System: Measuring What Matters

Heather's innovative system mandates regular pain assessments every 15 minutes, triggering alerts for scores above three and requiring follow-up questions about the nature and location of the pain. This approach ensures that patient pain is consistently monitored and addressed.

• Heather: “If you're not having pain, you're not reminding them of anything” [22:45].

Despite initial pushback, the system has been lauded for fostering better patient outcomes and providing a wealth of data previously absent from medical literature.

Legal Implications and Racial Disparities in Pain Management

The episode delves into the legal challenges surrounding pain management during C-sections. A notable case, Delfina Mota versus United States of America, illustrates the courtroom skepticism faced by patients asserting they experienced unmanaged pain.

• Judge’s Ruling: “The plaintiff's version of the events is not credible” [31:08].

Furthermore, the episode highlights racial disparities, citing a Texas study where Black patients reported C-section pain five times more often than White patients. Clara reflects on the lack of discourse around race and pain, emphasizing the need for broader conversations and systemic changes.

• Clara: “And it should never happen to one of your own” [41:54].

Changing the Culture: Empowerment and Advocacy

Clara, Mindy, and Heather exemplify the new culture at UIC, where speaking up and advocating for patients is normalized and encouraged. Mindy questions fundamental practices, pondering alternatives to awake C-sections and advocating for patient preferences.

• Mindy: “Maybe some women truly prefer not to be awake, and we push them towards being awake during C section” [34:00].

This collective effort not only enhances patient care but also serves as a model for other institutions aiming to prioritize patient experiences and outcomes.

Conclusion: Stories as Catalysts for Change

Susan Burton concludes the episode by emphasizing the power of storytelling in driving medical and cultural transformations. Clara’s story, intertwined with the narratives of Corey, Heather, and Mindy, illustrates how personal experiences can challenge and ultimately change entrenched medical practices.

• Sue (Susan Burton): “Stories are also a kind of evidence. They too can change the way doctors practice medicine” [42:19].

The episode underscores that while systemic changes are essential, the human stories behind these changes are equally vital in fostering empathy, understanding, and continuous improvement in healthcare.

Final Thoughts

"The Retrievals" Season 2, Episode 4: "The Solutions" offers a compelling exploration of pain management during C-sections, highlighting the importance of communication, empathy, and systemic interventions in improving patient care. Through insightful discussions and real-life examples, the episode advocates for a more compassionate and patient-centered approach in the medical field.