To do palliative care and hospice well your heart does need to be in it. People can easily tell if you are not really there. It doesn’t have to be as obvious as someone who won’t sit down, or who constantly checks the time on their watch. Do you have somewhere more important to be at the moment, than in my room? Something more important that needs to be done than listening to me?
If someone’s heart isn’t really in it people can tell right away. The lack of attention that is paid to simple things. So we do want people to be engaged to actually care for people. It does need to be done professionally, with kindness and respect. People need to have firm boundaries that they do not cross. It’s about protecting yourself and also the person that you are working with. You can be friendly but cannot be their friend. You can be caring but it must be in a professional manner. We are guests in their lives, and we do not want to disrupt pre-existing relationships.
We are involved possibly in the final chapter of someone’s book of life. It is not about us, but about them. They are the stars of their own show, of their own movie, of their own stories. We are only extras, or play a tiny bit part. We may have only a few lines to say, and we will try to say them well. The direction of the story needs to be guided by the person going through it all. We would not be in the same room as them if they were not sick, if they did not need the care that we can provide. We must never forget that, that they are not here because of us, but that we are all here because of them. The patient needs to be at the centre of everything that we do, not their family members or friends but the actual person themselves.
A good heart is an essential for palliative care provision, we need people to actually professionally care for other people. To have basic empathy towards a fellow human being, to try to feel what it would be like to be in their shoes. To witness another person’s suffering and want to do something about it is what compassion is about. That a person in pain of whatever sort be it physical, emotional, social or spiritual, cannot be ignored. That we have to try to do something about it. There are no guarantees with the treatments that we will try out, but there needs to be a promise. I will keep on trying, I will not give up on you, I will not quit this relationship. No matter how hard it gets.
A heart is needed, but we also need your mind, your best professional mind. Drawing upon all the training that you have received over the course of your whole career. Using the experiences both professional and personal that you have had to bring it into the patient encounter. To really practise at the top of your scope of practice. To be willing to search for new ways of doing things, to never settle for, oh well, that’s all she wrote. To keep on trying to make things more comfortable. If only we could make them better, if only we could fix and cure, but we are at the limit of what humans can change. We have fought Nature as much as we can but we have hit the wall. We will not give up on caring for someone but they need us to be at our professional best. To bring the brain fully online, fully present. Actively listening, actively seeking to lessen the suffering. Sometimes we have to be creative, trying things in combination that have never been done before. It might not work, as I said there are no guarantees, but I have made a promise to you, that I will get you through this, you and your loved ones will be guided through this. Many times we are inventing things on the fly, I don’t know what will happen tomorrow, let alone today. I am not in the business of predicting and fortune-telling. I will monitor your situation and adjust according to your ever-changing needs. I will try to get ahead of the game, to try to outrun your pain. I will be looking for possible game changers in order to change the outcome of your story. I will not let you suffer, and will try my very best, with heart and mind in synchrony.
If needed I will hold your hand, but please know that is not the only thing that I have to offer. Whole person care is a two-way street, I will bring my whole person into the care space in order to look after you as a whole person. Existential distress is a natural response to a threat that threatens your very existence itself, when your life is at stake. Time is literally running out, and I will try to make the most of that time. I will try to make you comfortable with all the skills and knowledge that I possess, and if I need to up-skill or refer on, I will do so. I will bring my best professional self into each care encounter, heart, mind, soul. I have to no guarantees that any of my therapeutic experiments will work, all I can offer is a promise.
A promise that I will care for you as well as I professionally can, always looking out for your best interests, and that of your loved ones. Priority one is your personal comfort. I will listen to you, and will get to know you as well as I can. I will try to look into your heart for what is most important to you. I need to get to know your mind in order to find out what is concerning you the most. Your physical body I will try to help the best that I can. Your spiritual and social selves I will try and get a decent poker read of, if I can help I will, but if not my team members will be asked to come and help out.
No man is an island and we are more interested in continents. How can our team help you in a greater fashion. How can we surround you with professional care in order to decrease the stress in all aspects of your whole person? What can we do to make your situation more comfortable. Not just physically but emotionally, spiritually, and socially?