Our Life Stories: Dr. Deirdre Heersink

Lisa Belisle: Hello, I'm Dr. Lisa Belisle and you are listening to or watching Radio Maine. Today I have with me in the studio a fellow family doctor and leader at MaineGeneral Health in the Augusta and Waterville area. Dr. Deirdre Heersink, thanks for joining me today.

Deirdre Heersink: Well, thanks so much for having me. It's a very nice opportunity.

Lisa Belisle: Yes, you and I have known each other for a bit in actually multiple kind of layered roles and side by side experiences, and I love this project that you just spent quite a bit of time on.

Deirdre Heersink: It was definitely a learning curve. You can think something is going to be kind of easy, because you have an idea, but then when you get to the doing, it reveals some complexity. So certainly this was a really great project and I can tell you a bit about it.

Lisa Belisle: Yeah, so this was Life Stories.

Deirdre Heersink: Yeah. So just for context, my position for MaineGeneral, currently I'm the medical director for their rehab and long-term care at Gray Birch, and we also work at Maine Veterans Home. But prior we had a different facility we also covered. It's a unique care setting. I trained in family medicine and did family medicine for a period of time and also some hospital medicine. But moving into this position about five years ago, I've learned a lot about this sort of special place of providing care for people with rehab and long-term care, because it is this environment that is this space sort of in between the hospital and home. And for some people it's a transitional space where they're just getting rehab and returning home. And for another fairly sizable, really the majority of folks, they may end up needing long-term care because their care needs exceed what they can get either from their family or relatives or other supports in the community.

And when you're providing care for people who, it's 24/7, generally lifelong care, the relationships that are formed between the staff and the residents are just so layered and rich. Something I didn't realize before taking this job was the number of people who never get a single visitor that live in long-term care across the country. The rate is about 60% of people in long-term care never receive a single visitor. And I think that is a situation that people obviously don't plan for. They aren't assuming they're going to be in a situation where they're going to have a health vulnerability or a care need that makes it so that they're not able to live independently and maybe are very separated from their previous loved ones, through losses or whatever, different reasons. So the relationship with the care team, I think, those people become their family.

And certainly in COVID that family was leaned on even harder, because we had no visitors that were allowed for a prolonged period of time, and a lot of restrictions. The residents were not allowed to leave. So you kind of had this lockdown like we all experienced in our homes, but not in your home, and with people that are caring for you that you have different levels of relationship with. And through that experience we did definitely lose some staff, lose some residents. And on the other side we ended up in this situation of having quite a lot more sort of agency and traveler staff, which is a challenge because it ends up leaving the people that are getting the care being cared for with people that may know a lot less about them. And so certainly within the pandemic, one of the things we witnessed was the knowledge people had about the residents they cared for for a long time helped them care more with a level of detail than they could if they didn't have those relationships.

They really knew people very well, what their favorite drinks were, and would bring them in. We had one guy who really loved blue Gatorade, and people were like, maybe that will be the secret sauce that helps him revive through this illness. So those little details that people that really know about you really do make a difference, both to your quality of life but actually to your literal survival, because I think these small things are kind of these touchstones that can reawaken people a little bit sometimes when they are brought back to the sense of being cared for and known. So in our post pandemic phase, we were challenged with tons of staff turnover, because when we have our traveler staff, they're generally only coming for like a 90 day time.

And then if you're rotating all of your staff every 90 days, it gives you not a lot of time for your staff to really get to know your residents. So we kind of saw this moment of feeling we were losing that connection between our staff and our residents. And I ended up seeing a video for an online award ceremony through Not Impossible Labs. If anybody hasn't seen that, I would check out their website and you can view their award winners. They have some very interesting projects that they've done. But this was just good timing. It was like February of 2021 that I happened to see their online awards, and they had this company called MemoryWell that was talking about their process of trying to help capture life stories so that care teams could know the residents they were caring for with more detail. So when I heard about their process, I was interested, but the challenge between that sounds like a good idea and actually doing it, I didn't think it would be super complicated. I was like, oh, well, we should just make that happen. And the making it happen was a good experience, but it just revealed a lot of details that you had to work through.

Lisa Belisle: You actually ended up writing a grant to support this work, and you ended up doing almost a bigger project than maybe you had originally anticipated.

Deirdre Heersink: Yeah, I kind of thought it would be pretty straightforward and just, oh, we could just engage with this and everything would just, how easy, right. But I definitely have to give major kudos. The philanthropy department at MaineGeneral was very supportive, and Ashley, one of the folks in that department, really helped with the process of figuring out who to apply to the grant for. And the Maine Health Access Foundation was our supporter for this. So we did get a grant and did a pilot, with the goal of offering this. The process that they do oftentimes for MemoryWell is they have their own writers call and phone interview residents, and then they will write up the story. For our residents, the challenges of some cognitive impairment or hearing impairment, what we opted to do is engage with some volunteers through our HELP program, which is our elder life volunteer program through the hospital for delirium prevention, which is a wonderful program, and MaineGeneral is really invested in it and has long roots in it.

And it's a wonderful program. Started out of, I think, Harvard with Dr. Sharon Inouye, if people don't know her also, she's fabulous, and presented actually at the Maine geriatrics conference this past May up in Bar Harbor, and she's just incredible. But so that worked out really nicely because we were able to find a way to engage volunteers with our residents. And I think the engagement for that was more positive for both our residents but also for the volunteers. And it has forged some relationships which have been ongoing, and these people have been returning and visiting with people that they've previously interviewed. So it sort of has this ripple effect of relationship building that lasts beyond just the capturing, so to speak, of the stories. But their original process would be that they would phone interview somebody and they would write this story and then send the story to them. So we made some modifications with that process, and I think it was nice because it really enriched the patient experience in a way that I hadn't anticipated fully.

Lisa Belisle: I'm just interested in understanding how you ended up getting to a place of watching something as a program and saying, oh, that seems like a good idea, to actually fully implementing what ended up being a pretty good size program that you subsequently recently presented on Grand Rounds about, you believe will be on the BBC in an upcoming episode, and you brought in a Colby undergraduate to work with you on this. So overall, I mean what you've done with this work while you are still a practicing physician and medical director and also the vice president of our medical staff now, I think we can't really understate how much effort you put into this.

Deirdre Heersink: Definitely more time than I was originally expecting. I think the very first kernel was really just people being open and supportive to the concept. And the very first thing, I just self-funded a couple of trial stories to see how would this work. And I think the very first story I did was with a gentleman who has since passed. But the experience of, first off, just spending the time with him to hear his story, recognizing the really very tough life experiences he had had, his complete willingness to be utterly frank about some really personal details. And really, when I left the interview, I felt a little worried, honestly, that the writers would not be able to take that discussion that was 40 minutes or so and make it into something that you could put on someone's wall so that the staff could have a little bit of a deeper sense of who this person was.

And when I got the story, I was like, wow, I can't believe you were able to take the truth that was in this experience that was shared between these two people and capture that, but with a character that sort of shades some of the moments that really need a little more subtlety and need a little privacy around them. They were able to maintain this privacy but still shine a light on the heart of the core of that person in a really artful way, that was like, oh, this isn't just a resume, this isn't like a list of what did you do in your life or something. This is kind of a human connection that then you're hoping you draw out some little gems that really ring true about that person. That was incredible, honestly.

And that I think has been something I've seen in all of the stories. And one of the things that was actually very interesting when the BBC came to do this podcast, they filmed one of our volunteers interviewing one of our residents, and at the end of the time that they filmed this interview, I met back up with them. They had fallen in love with this person. They said, oh my goodness, Dot is just so amazing, her story. Because the same thing, when you spend 40 minutes asking somebody about childhood memories and the questions that we've worked through and developed over time, some of them had to be changed or added. I think we've evolved the questions that we ask, and volunteers don't always ask all of the questions.

It's really a guided conversation, but it really gets people talking about things that they haven't thought about or talked about in a long time. And I think particularly at this phase of people's lives, that ability to go back into your memory about all these other chapters of your life. There was something one of the residents said when she was interviewed later as part of our pilot, to reflect on what the experience was. She said, well, when you come to a place like this, it's easy to forget who you are. But when I saw my story, it reminded me of who I am. And I think that is the thing that's, for all of us, seems scary about the idea of living in an environment that we don't have a lot of control over, because really no one wants to give up autonomy. But it is also this sense that you'll lose yourself in this kind of, you've got to be very careful that you don't turn long-term care into an extension of a hospital experience where it's a chest pain in room five.

It should never really be that way. But there are certain environments where we need to be succinct, we need to be problem focused. Your favorite kind of Gatorade is maybe not going to make the list. But when you get to, this is where you're going to live out the rest of your days, we have to find some way to take in a fuller picture of all of these individuals. And our staff that have been there for a long time each get different relationships with different residents, but the ability to transfer that between people is challenging, because our way of handing information to each other is sometimes very siloed.

Lisa Belisle: One of my favorite elements of this is the work that you did in the month that you spent with the Colby College undergraduate student who came in. And I don't know that he will end up going into geriatrics or family medicine, but he was so drawn in by the stories of the people that he spent time with. And you told me that he learned that one of the residents liked Sudoku, and then he ended up going and actually separately bringing back some Sudoku puzzles for this person to do. And really this sense of the richness that is medicine that isn't always brought to the surface in this current day and age.

Deirdre Heersink: Well, it reminds me, I know that in medical school, I went to UNE, and we're very focused in our early training about trying to think about the whole person, and there was like a humanities and medicine course that we did at some point. But I think one of the ways that you can actualize that is through connection and listening, and that is the challenge of having a little bit of time. It doesn't take as much time as we think it would take. I think this student's experience was interesting because his previous experience with medicine was being a tech in the ED, and this is very different from that, because the kind of time you're spending with people is a different length of time. And I think that was really interesting for him just to widen his view of what are different paths that you can take.

And I think one of the skills that is really helpful from this experience for him, because he did interviews with a number of our residents, was this process of, all relationships are a bit of a dance and you have to meet your partner with what they are doing. And even though this is someone who, English is not their first language, I actually wasn't sure if this project would really resonate with them, with their previous experience it seemed really outside their previous experience. But they did such a great job of being able to change their approach depending on who they interact with. And the person they actually bought Sudoku for was a very remarkable case in my opinion, because it was a person who was in the hospital, had been in the hospital for a very long stay, because they have some complicating factors that's making it very difficult for them to have any appropriate place outside of the hospital for them to reside.

It's not an easy place to be for a long period of time. And the staff, when I mentioned to them this is what we were going to be doing, they said, well, good luck. I mean, she's thrown everyone out of the room, and no one can understand a single thing she says. And he goes in there, and I think he didn't hear them say that. They just said that to me after I came out and told them that he was in there doing this interview. And he was in there for 40 minutes and said as they began to make some rapport and take time, that she was able to express herself. Originally she was too wound up and distracted and kind of moving around the room and not able to articulate herself. But as they spent time together she sort of settled in, and that I think spoke a lot to his ability to change his approach based on who he was interacting with, which is actually a really important skill no matter what you do.

It doesn't have to be in medicine, just in life, being able to react to somebody else's comfort and change your pace based on what they can handle. So actually I think for students it would be a really good experience for them to all do some of these, because it feels a little uncomfortable to do, because you're asking people, and some of the things people are telling you. We had another one that really struck me, where we had a new HELP volunteer who was going to be coming, and his very first interview, they have a little training process that they can go through with MemoryWell, they have the questions. In the hospital, the HELP volunteers are oftentimes interacting with people as part of their work that are at risk of delirium. So he's not a person who has not experienced talking with different folks who kind of have some cognitive impairment or risks, confusion, those kinds of things.

But he came to our facility and he went to do this interview, and the resident that he was interviewing, they were trying to get their rapport going, and the resident said, well, I had a really difficult time growing up, I wasn't always doing good things, something like that. And the interviewer was trying to make him feel at home, and he said, well, at least you didn't shoot anybody. And he said, well, actually I did, and I served time for it. And then somehow they actually were able to really get past that, forge a really great connection, and he continued to come back and visit that gentleman every week until he passed away. And I don't know that you would've, I guess anytime you create a relationship with somebody, you don't know how long it will last or how much connection you may actually feel with that person. But it is the thing I've liked about doing this as a pilot. This program normally is something that people can pay out of pocket to do, and there's maybe some places where it's included through certain opportunities, certain places, but for the most part it is something that people, families, or themselves can choose to purchase privately.

In our pilot we were able to offer this to anyone that was interested, and there was not any barriers of, if you have these resources or you don't. So in some ways, that same gentleman that told that story, that he had served some time, said at the end of his interview something like, nobody's ever spent the time to hear my whole story before, this is such an important thing you're doing. So I think that's been my amazement, is there is no one that you'll meet that won't have things that they tell you that can stick with you and surprise you and humble you and just give you a lot of perspective. There's a lot of grace in the people we're working with, because they're all every day living in an environment that terrifies almost everyone to think about living in.

Lisa Belisle: What you are describing hearkens back to something that I felt really significantly when I was first in medicine, and this is the sitting with people and understanding that their willingness to share their lives and their putting their trust into that relationship was such a deep, such an overwhelming blessing. And for me I felt almost entirely undeserving. Like, who am I to receive this person's story, and who am I to be worthy of this trust and carry this relationship along? And I think it's interesting to me that you chose to do this project that speaks to that as something that you and I, a program that you and I went through, the Hanley Leadership Institute. So this is a leadership program for physicians and other practitioners. And you said this idea of narrative medicine, as they're calling it, is so important to medicine as it currently stands and has always been so important. I'm going to put this in this leadership track, which is fascinating, because I think a lot of people these days think of medicine as, how do we get all the patients through, and how do we make sure that they're cared for in a quality way? And you are saying yes and yes, and I would like to have us remember that all of us are human beings, and how do we continue to touch into that as people in the medical and health professions.

Deirdre Heersink: Yeah, and I think it is this thing that we certainly recognize that it's important, and then there's this challenge of, how do we maybe create a little space for it? Because I think there are lots of people connecting with our residents or patients and getting some pieces of this, but then it is just the nature of our record that it basically takes things and then stows them away. I always think we're sort of like squirrels hiding nuts from each other. But there is an opportunity, I think, to make our record be again something that, it sounds like there are opportunities to do this in some places maybe ahead of others, but have some of those things be part of people's snapshots. You could have a little bit more, for example, like with age-friendly health systems, there is this goal to have the four Ms, and the lead of the four Ms is what matters most to you.

That's just a really hard question to add into your review of systems after, you know, do you have a fever, or, you know what I mean? It's just hard to figure out, like, are you a smoker, what matters most to you? I struggle a little bit with how to make the space to really collect that. Because if somebody asks me that, I don't think I'm ready to just give you a one liner, it's really hard. So I think this project partially was also noticing that for our staff their burnout rates were higher than ever, and maybe higher than people other places. Partially I think because, number one, the work is hard. The reimbursement I don't think is enough. And I think the losses when you have these long-standing relationships are more intense for those folks, because they might have known these people for months or years.

And so when you're losing residents, for the staff that have been there for a long time, that is really a lot of emotional connections that they have with these folks. So this was partially also thinking about, I'd been on Ombudsman call listening to direct care workers about what is their why, and I think across the board their why is about these relationships and about caring for these individual people. And if you have so much turnover, that can be hard to pass forward, invest in, maintain. But I think that little kernel of love is like a very important little fire for us to tend, because this isn't really work in the normal sense of work. It's a little bit of a vocation. So trying to tend that a little bit, but it's tricky to find ways that our system will think that that's important.

Because they need to have a way that they can say, ah, it's important because of something that we can see or take note of. So that is the little bit of the trick. But I would say I did bring some of our pilot results down to AMDA, which is the American Medical Directors Association, in March, and there was a lot of interest from different health insurance companies. And through the Moving Forward coalition, I think there is interest in figuring out how to do something like this on a scale. And I think there's probably some opportunities. Maybe someone out there knows things about how we could use technology to help us do this too. So you could have these conversations and have some of the work be started for you, so you have something that you can fine tune. Because I think that seems like something I would wonder about. Everyone's excited about ChatGPT. I don't know if that's just an opportunity to put it to work for the growth of compassion, but I don't know, that sounds like something I don't know enough about. And it ultimately sounds like, if you don't know enough about something, you should make sure someone who knows something about it is more thinking about the pros and cons of that actual reality.

Lisa Belisle: One of the other things that came up, so you happened to do a Grand Rounds on this, and I think it was literally the next week Dr. Dan Vick and I did a Grand Rounds on something called diagnostic overshadowing. And this is something that we did as a result of the Joint Commission and some standards that are being brought forward, which are essentially saying that people who have various vulnerabilities, as you've termed it, might get either a delayed diagnosis, the wrong diagnosis. It's been people who have maybe cognitive issues, maybe they can't think the way that the rest of us think that we think, or they don't communicate the same way. And so as a result there are actually delays in care, there's cost to the patient, there's cost to the system.

So what you brought forward was, you said, is there a connection, can we actually help create a connection between the story and not going down the path of diagnostic overshadowing? Is there a way that somehow we can prime both sides, the people who are doing the story sharing and the people who are hearing the story, that can actually help from a health standpoint? Because I think that you've identified something that's very important. If you go in and you have, I don't know how much time you have with a patient, I think many practitioners in family medicine on the outpatient side, you're talking 10, 15 minutes maybe. And how do you get the really important stuff that could really actually help people's health, and do it also while you're finding out, do they smoke, have they gotten their preventive screenings done, and you're dealing with people who have pretty significant long-term chronic needs. You probably don't have that much time with them either. So how do you prime both sides to give and receive the information so that it is meaningful?

Deirdre Heersink: Yeah, I mean I think, ideally when we have an ability to have a relationship with somebody over time, we can grow that, right? And if it can be somewhat consistent. But there are certainly challenges that we face of just ultimately the amount of people that are doing the work versus the amount of people that need the care. We have a big mismatch, and that was in the making, was certainly accelerated by COVID for both sides of that equation as well. So it is going to be this tricky thing. And I think everyone that has had children probably has had that experience of, and this is going to sound a little like an odd way to think about this, but if you're trying to get your two year old to put their shoes on quickly, it will take twice as long.

So if you just allow the time that it will actually take for them, whatever their time is, to feel like, I had a transition, I now don't feel rushed and I can do this, it actually is faster. And I think this is a problem of the way we provide medical care a little bit too, is that really we have probably so many people all under such time pressure that the experience is, I don't think anyone's listening to me. Because each person is, but if we actually added up all of the hours, all of the conversations, you're repeating the same half-told story to seven people, instead of getting a little bit more time to give the whole story to one person. I think that that is challenging. And I think some of it is, if people did know, here's what I already know about your story, that might also help a little bit. Because again, the way our records are, we have little bits and pieces all over the place, and so then you do sort of feel like, you are not sure as the receiver of healthcare if people have the whole story. And if we don't know people's baseline, we can't orient in any way to, how is today. And we can see a person today and think we know what their baseline is, because we sometimes can't imagine that it's that far from where they are today.

And I think that's the thing of experience, when you've worked for kind of a long time, when you've seen people in different contexts, you're like, that's partially why when somebody brings in a picture from home from a week before, you can be like, oh, okay, I was losing track of our baseline because I didn't realize, like, last week, that was your last week. I don't know, there's probably a limit to how quickly we can communicate, and I think we're just going to have to keep figuring out what that is. And for some people their story is complicated and their way of telling it is complicated. I don't remember the number, you might know, what's the average amount of time that a doctor listens to a patient before they interrupt? I think it's like seven seconds or something. It's crazy.

Lisa Belisle: It's abysmally short, is one way to put it.

Deirdre Heersink: Short. Yes. And so I think that's certainly probably too short. But I guess this is this challenge, if we're trying to also make sure that we aren't missing things. So we do need to help shape and navigate the conversation to make sure that we're getting all of the things that are important, so we do have the whole story. Because sometimes people, what they're telling you, there is a piece of the story that they might not have noted, and you have to say, oh, anything like this, to bring it into the conversation. But that's going to be a trick for us to tinker with. Maybe there are people that already have spent a lot of time looking at, what is the optimal amount of time to have exchange, or is there some way to even set context to help bring us through more on the same page. Because I think that's what everybody's looking for, is feeling like they're connecting and they're being understood.

Lisa Belisle: Yeah, and as you've said, it might start with time, and also are there ways of communicating that make it more or less possible? We're taught motivational interviewing, for example. That's just one of very many different ways that we could be communicating with people that we're collaborating with on their care. And I think understanding just how important that is, it's not just about what we're gathering from people for our information, but it's about how we're gathering it, and there's a whole skillset around that. And I think about where you and I are. There's a lot of people who are later in their careers who have now retired as a result of COVID. There's a lot of people who felt kind of right behind us who felt squeezed by childcare and they're kind of stepping out for a moment. So what I'm seeing now is a lot of very new, very eager, very professionally young people entering the field. And so I feel like there's kind of you and I and our group, and then there's these very eager people that we're going to be tasked with helping to understand, how do we move forward in a way that enables us to care for patients successfully, care with patients successfully. Because it's not really us caring for them, it's all of everyone helping someone care for themselves.

Deirdre Heersink: Yeah, and I think one thing that I think about a little is, I went back this fall because Dr. McPhedran, who is the founder of the Maine-Dartmouth residency, passed away, and I went to his service and was just struck by how many people from how many walks of life and how many ages were there to remember and celebrate his life. So I reread John McPhee, The Heirs of General Practice, and when I read it there was like a quote in there somewhere about somebody who had had an appointment with him at the FMI, and that in this appointment it was a neurology appointment, I think it was a 45 minute consult, that the patient spent 45 minutes with him but felt like they'd been with him all day. And I think there are some people that are just really good at communicating and connecting, and we probably need to make sure we're getting some time shadowing those people in our training, because you can learn so much just from interacting with them as an individual.

I would just say, even coming to tell him about a case that I had, it was like he had the ability to slow time down, because his presence was so there. And we live more and more in a time where there is stuff distracting us, there's cell phones, emails, pages, whatever, overhead pages. We have a very distracting environment, and I think that is this challenge, because the more distracted we are, the less satisfying that exchange of connection is. It is very energy intensive to be present for another person. And I think that's its own thing of, how do we make sure that we set up people's work schedule and life in a way that they can come with the energy that they need to give, because it is a very energy giving work and it brings energy as well. But if you mismatch that for the long term, that I think is where people get burned out, from my two cents anyway.

Lisa Belisle: It's good. I'm glad I'm in this with you. You and I can keep this conversation going for the foreseeable future, no doubt, and try to figure this out somewhat. Because I think you're absolutely right, and somehow we need to keep connecting to our own wisdom, and we need to keep finding ways to recharge ourselves and to find passion around what is a challenging profession.

Deirdre Heersink: You know, I think, I don't know what other people think, but yeah, that sense of, it's just variable. You have to be your own dance partner too, and know, when do I need to take a slow dance, or just sit in the corner and have a cup of water because I'm just a little tuckered out, and then you can get back up and find a new song you're liking.

Lisa Belisle: So just, you know, pace. Absolutely. Well, I'm hoping that in introducing this idea to the group of listeners, those of you who have been listening or watching who might have an interest in this sort of wonderful project, Life Stories, and particularly life stories in long-term care, I'm hoping that you'll reach back out to us here at Radio Maine, maybe try to search out Dr. Deirdre Heersink, because she really is truly a forceful, passionate, wonderful advocate for patients and a wonderful leader. And I know this is such a small period of time that you had free, and I'm really so happy that you were willing to share it with me today.

Deirdre Heersink: Thank you for inviting me. I was a little nervous, but you are a wonderful host, so you put me at ease.

Lisa Belisle: Well, thank you very much for coming. I'm Dr. Lisa Belisle. You have been listening to or watching Radio Maine, and as I said, I do encourage you, if you have an interest in this topic, then please do try to connect, because I think it is a project that has a lot of potential for the future. And Dr. Deirdre Heersink is an individual who I can personally attest to has exactly the type of tenacious and excellent and thoughtful personality who could actually partner with you on this. So thank you for coming in today.

Deirdre Heersink: Oh, thank you.