Make a good stack

Stacking square bales of alfalfa, grass, or straw on the rack isn’t for the faint of heart. It’s invariably the hottest day of the summer, or so it seems (and not a bit of wind, either). Dust, sweat, and noise all converge into discomfort as the bales keep coming from the chute. Back and forth, picking up a bale, stacking it on the rack, picking up, stacking, picking up, stacking, and hoping the machinery doesn’t break down. 

My brother and I had just finished baling a small field this past summer and needed to move a bit down the road to do it all again. I’d been on the rack for the past few loads; I was tired, dirty, and thought I was glad to have a short break driving the open-cab tractor for a few minutes. I pulled onto the gravel road and started on my way. Suddenly, a large semi-trailer appeared on the road. There was plenty of space for both of us, but no escape from the large cloud of dust that followed, and the driver had to know I’d be quite literally eating his dust. I met his eyes, and saw one of my patients, grinning ear to ear. A connection, if ever so brief. I know he got a bit of enjoyment out of my temporary misfortune.   

Sometime before that on a more typical day in the office, I was assessing a patient for admission to the nursing home. She had some progressive difficulties with memory, and it was getting to a point where her loving family was concerned. “But I do pretty well at home, I’ll be fine,” she told me, obviously concerned about losing some degree of personal freedom.  

As part of her assessment, I asked her to remember the names of five common objects. After completing another task, we turned back to these to examine her recall ability. “Can you tell me the five words I asked you to remember?” I asked. 

“I want to go home!” she exclaimed, a smile on her face and putting up one finger with each word emphatically said. “See, that’s five words!” We laughed about it together as we made a connection, if ever so brief. I know she got a bit of enjoyment out of her witty response.     

We have the privilege in medicine of serving others. Sometimes it’s hard to keep this fact top of mind. There are so many distractions like documentation, quality metrics, and computer alerts, that add to the sense of work without a sense of caring for people.  

Keeping a human connection in medicine can be a bit like stacking a good rack of bales. It takes intentionality, attention to detail, and consistency. Consider the following to make a good stack and find the connections with patients as people” 

1. Be intentional.

When stacking bales, there’s a certain order and procedure to follow. First bale in the middle, next to the sides, and then next row get the middle right again. When making connections with patients, be intentional from the start. Look for a common interest or conversation point, but of course let the patient guide. It may take a visit or two to learn about what makes a patient unique, but there is almost always something there to build upon during the next visit. 

2. Be consistent.

When stacking bales, this is probably the hardest. Keeping good placement with each bale while being tired, sweaty, and dirty isn’t easy but is of paramount importance for success. Diligently looking for opportunities to connect with patients can be equally difficult with the mental fatigue and distractions we may encounter at work. I think the best thing to do here is to remember that we truly serve people in medicine, and re-focusing on this fact can be renewing.   

3. Keep track of successes.

I’ll be the first to admit I’m not the best at stacking bales. I’ve had my share of times the tractor has had to stop so we could pick up a bunch off the ground and basically start over. But I’m sure proud when we get a field done and the hay in the barn; there’s a satisfaction in that completed work that’s hard to describe. Similarly, when you have a good connection with a patient, there’s a sense of fulfillment. One positive connection can make the day’s work seem important, distinctive, and rewarding. Look for these moments and make note of them.    

Make a good stack and look for connections with the people you meet. This will infuse more joy into caring for others.   

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.