On the Perils of Someone Treating You Who “Woulda-Coulda-Shoulda” Known More About You
By Rick Rader, MD, FAAIDD, FAADM
The Giving Tree, the moving story about the love of a tree for a boy, was written by Shel Silverstein, one of America’s most treasured poets. Among his most memorable poems was “Woulda-Coulda-Shoulda.”
All the Woulda-Coulda-Shouldas,
Layin’ in the sun,
Talkin’ bout the things
They woulda coulda shoulda done…
But those Woulda-Coulda-Shouldas
All ran away and hid
From one little Did.
I can’t help but think, from a clinical perspective, that the “little Did” is an appropriate reference to those clinicians who have had the skills, experience and confidence to treat patients with complex disabilities. The ones who sat across the table from them and knew where they lived, who they lived, with and what they were going to do when they left the clinic.
The ones who “Did” bother to ask themselves, “Is there anything we can do here to make them more comfortable, relaxed and less anxious?”
“Regret is a sign you’re paying attention.”
The ones who “Did” reflect on how their own feelings about disabilities translated into their behavior and clinical thinking.
The ones who “Did” remember to speak to them, and not about them.
In an article by Leon Seltzer, “Woulda Coulda Shoulda: The Kaleidoscope of Regret” offers, “This well-known word grouping, when it’s delivered not by another but (wistfully) emanating from yourself, is intimately tied to the emotion of regret. And who hasn’t experienced regret over things they’ve said or done in the past – or, for that matter, didn’t do?
In order to have regret, one must appreciate and realize that something else could have occurred, something different could have transpired and perhaps, some other action would have resulted in a better outcome.
It is being oblivious to not appreciating that knowing about your patient is an important starting point. Regrets cannot be experienced if the actor did not recognize that their effort, delivery and energy could have and should have taken a different path. When does taking a different path make sense and allows, and even encourages “regret”? Can regret ever be considered a badge of courage?
Regret rationally relates to things that didn’t turn out as hoped. The turning point is being able to courageously say, “if only…”
“If only” I knew that his right arm was the best site to draw blood.
“If only” I knew that she preferred a skin patch to an injection.
“If only” I knew to ask him if I could press on his belly.
“If only” I knew that she never had a pelvic exam before today.
“If only” I knew that his crying meant he was relaxed.
Regret is only valuable if it can be resolved – if it’s a point of departure versus an endpoint.
Seltzer brings home the nature of a “departure” and how it relates to clinicians understanding the need to “know,” really “know” the person; the patient with a disability and the value that this knowledge provides. “To get a good return on your regrets, turn them into hard-won insights and wisdom-about who you were back then, who you are now, and who you can yet be in the future. Hopefully, what you’ll discover is a greater willingness to take (carefully calculated) risks and make the most of whatever opportunities now present themselves to you.”
Unfortunately, we can’t rely on medical, dental and nursing students to know what they don’t know, at least not at the beginning of their training. It is therefore up to clinical educators, mentors, preceptors, families and advocates to insist that “knowing that you need to know about the patient and the person” is paramount to avoiding regret and the need to ever say, “I shoulda, coulda, woulda.”
HELEN Journal wishes you well on your road to becoming the “little Did.”
“The order of words in this delicious morsel of dialect varies with the user. . .. In this rhyming compound, a triple elision does the hat trick: although each elision expresses something different, when taken together, the trio conveys a unified meaning. Shoulda, short for should have (and not should of, which lexies call a variant but I call a mistake), carries a sense of correctness or obligation; coulda implies a possibility, and woulda denotes conditional certainty, an oxymoron: the stated intent to have taken an action if only something had not intervened. . . . Taken together, the term means ‘Spare me the useless excuses.’”
