Thursday, February 14, 2008

Analogies

Analogies can be great for creating an image that is within a person’s experience and/or worldview. One of the first analogies I was struck by was in a family conference in the ICU. The patient was a older gentleman with multiple chronic illnesses and history of hospitalizations. He walked into the ED, but now he was in the unit intubated, sedated, monitored: how did he get sicker in the hospital? And the classic hope-filled statement: “he’s a fighter, he’s pulled through before.” The intensivist used the analogy of a building that a bomb goes off inside of: from the outside it looks fine, but inside it’s been badly damaged. Listening, I saw at least some of the family member’s become less angry and defensive, more open to talk and hear what was being shared.

One of my favorite analogies is when people try and get a sense of “how long” someone has. If they are old enough I ask if they have any children. I then use the analogy of pregnancy and birth: that you know it’s coming, and you probably think you have an idea of how it’s going to be, but ultimately it is something that we do not have control over in terms of timing or how it unfolds. It seems to be helpful, maybe just to remind people that they can live with uncertainty, no matter how uncomfortable it is.

This week I came up with a new analogy and I’m rather pleased with it. E and I were explaining about switching him from IV analgesic to a transdermal Fentanyl patch. We talked about the advantages of having a steady state of opiate in his system rather than the up and down with prn dosing, but he was concerned because, if I understand him correctly, he wouldn’t know that it was working if he didn’t feel that immediate effect from IV push (not a rush exactly, but something that lets you know you’ve gotten medication). Finally I said “it’s like a soaker hose” and that seemed to make a connection.

Language is so powerful and so full of layers of meaning, but it can also delight.

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