Why Interdisciplinary Teams Ten Years Later?

Iwas recently moving my office when I came across this reflection piece written some time ago. As I reread it, I became acutely aware that what I discovered on that first day almost 11 years ago is still as salient today as it was then.

As a psychologist, about three years ago, I was invited to join a very well established palliative medicine team consisting of three palliative doctors and three nurses to help with the psychosocial issues that they did not have the time nor the expertise to handle. I was not sure what palliative medicine really encompassed at that early time in my career but was confident that with my training and experience in trauma, I would not be all that unfamiliar with human suffering at the end of life. The first day with the team I was quickly immersed in a sad situation in which a grieving father of two small children was having great difficulty saying goodbye to his young dying wife. After a lengthy session I exited the room to find a cadre of professionals standing outside the door ready to whisk me off to my second referred patient. I was puzzled by the exasperated and frightened looks on their faces and thought, “Wow, this is going to be a very busy job.” One of the palliative nurses grabbed me by the arm and led me down the hall. As we walked she told me about an extremely distraught adult daughter who had just lost her father. The daughter was crying uncontrollably in the room. I was not at all surprised by the scenario of this case, but suddenly realized that if the daughter was still in her father's room, the dead body was probably there also. I stopped and asked the nurse if the patient was still alive. She quickly moved us along, indicating the patient had been dead for over an hour.

I have no idea how I could have thought that working as a psychologist in palliative medicine would protect me from seeing a deceased patient. I started to panic. The equally panicked nurse began to explain that the daughter was diagnosed with paranoid schizophrenia and had been “wailing for some time.” Of course this fact had no effect on me, as psychiatric diagnosis and therapeutic intervention are easily within my scope of practice. I was totally focused on seeing my first newly deceased patient. When we arrived at the room the nurse and I looked at each other, took several deep breaths and entered. I immediately sat in the chair closest to the door focusing on the crying daughter draped over her deceased father's bed. The nurse scurried past the daughter to the chair between the window and the bed. She was inches from the deceased man and continued to look terrified. I thought, “Great, she is as scared as I am.” I began to interview the daughter, careful to maintain eye contact so as not to allow my eyes to stray to the bed.

The daughter was very cooperative and I quickly learned that although she had not been taking her psychiatric medications, she was feeling comfortable, aware, and in control of her limited symptoms even in the face of this difficult situation. She stopped crying and wailing and we began a conversation about what she thought and felt about her father's death. She was very clear about her role as a daughter and lovingly described the importance of wailing at her father's bedside. “This is how grieving is supposed to be done,” she adamantly explained. “This shows respect for my father.” I paused and asked if she needed to “wail” more. She said, “No, I will wail again over the casket at his funeral for the last time.” We talked about her father and how he had lovingly supported her all her life. She talked about who would help her with the arrangements and she described in great detail the extensive support system she and her father had built. We problem solved as to how she would leave her father's body and return home.

Crisis over! I just wanted to get out of the room and away from the dead body. I had no doubt our nurse was closely watching and wondering what kind of a psychologist they had hired who practically sat outside the door of a patient's room. Surprisingly, the nurse seemed much calmer, so I “played it cool” and asked where they needed me next.

As I drove home after that first night on service I suddenly experienced one of those amazingly clear moments that we all experience sometimes—if we pay close enough attention. I laughed to myself and became excited for my second day on the job. The next morning after rounds I asked the nurse for a few moments alone and inquired about the previous day's encounter. She rapidly fired her reactions to my behaviors, commenting on how scary it was to be trapped on the other side of the distraught daughter so far away from the door. She expressed irritation at my rapid seizure of the chair next to the door, perceiving it as “our new psychologist's escape route.” I laughed to her dismay and shared that I had not been afraid of the daughter but of the dead body. Her mouth dropped open and she too began to laugh. She had no idea this was my first encounter with a deceased patient. We talked about totally misinterpreting each other's reactions but soon recognized the individual strengths that we each brought to the table. It became very clear this new relationship was not only going to offer very humorous encounters at times but would also enrich and expand our own awareness and professional lives.

Our team now often takes the time to reflect on the beauty of interdisciplinary practice. We laugh at each other's weird ideas and perspectives at times. We even get discouraged and angry when others do not “see it our way.” But in the end we never diminish the true value of what various disciplines bring to the team and to patient care. We each have our own individual beliefs and perceptions. We assuredly get into trouble when we try to do it all ourselves and fail to utilize our different trainings and perspectives. Effective interdisciplinary teams complement, expand, and enrich not only patient care but the experience of providing that care as well.