Can You Hear Me Now?

This is a guest post from David Mossholder, one of our chaplains at Hospice Southwest PeaceHealth in Vancouver, Washington. It was originally published on The Chaplain's Corner in our September hospice newsletter. 

Has anyone challenged you to the ALS “Ice Bucket Challenge” yet? If not, you’ll probably stay dry as the massive campaign featuring bone-chilling water has largely passed by. While the challenge had a few detractors, mostly complaining of wasted water, the movement inspired everyone from former presidents to preschoolers to dump buckets and/or donate bucks. Since July 29th, the social media marketed movement has raised over $53 million to support the ALS Association and fund research of Amyotrophic lateral sclerosis (ALS or “Lou Gehrig’s disease” in tribute to the famous first baseman who died from ALS at age 38). The money raised from the “Ice Bucket Challenge” in just over one month is even more amazing when compared to the $64 million raised by the ALS Association in all of 2013. More importantly the entertaining challenge has helped this dreaded disease become part of our cultural consciousness and everyday conversations.

  • Every single day an average of 15 people are newly diagnosed with ALS.

  • More than 5,600 people are diagnoses with ALS each year.

  • As many as 30,000 Americans may currently be affected by ALS.

  • Average life expectancy of a person with ALS is two to five years, from time of diagnosis.

  • ALS occurs throughout the world with no racial, ethnic, or socioeconomic boundaries.

(ALS Association)

Speaking of conversations, I recently was intrigued to watch the dynamics of communication that occurred between one of our patients, “Martha,” who is struggling herself with advanced ALS, and her significant other, “Joe”. Not only did my visit with them give me a front row seat to their love, it also gave me a refresher course on the essentials of listening. This month, I wanted to share with you the nuggets I took away from my visit with them, as we can all ever improve our listening.

LISTENING STARTS WITH RESPECT

Martha cannot speak. Instead, because of her ALS, all she can do is make noises and nod her head. This means she is obviously greatly limited in what she can say. But because of Joe’s love for her, he places value in her attempts to communicate. He believes what Martha has to say matters, and he shows that through his efforts to understand.

Listening starts by respecting that what the other person has to say is valuable.

phot credit: whisper by timothy brown creative commons

phot credit: whisper by timothy brown creative commons

LISTENING TAKES EFFORT

In order to figure out what Martha is trying to say Joe uses a large plastic board filled with rows of letters. Martha spells out her words by nodding as Joe points to one row and one letter at a time. This can be a painstaking process but it highlights the fact that listening is not easy and is not automatic. True listening requires we fully engage and make a genuine effort to understand.

Listening is not a passive activity. Instead it requires our full participation.

LISTENING REQUIRES PATIENCE

Despite his best attempts, Joe doesn’t always get it right. Often he has to start all over again and try spelling multiple times before he understands what she is trying to say. But instead of growing impatient and giving up, Joe just keeps at it. He shows his concern and commitment to Martha by giving her the time that is needed. When it comes to real listening there are no shortcuts.

Real listening cannot be rushed.

LISTENING DEMANDS FOCUS

To help himself “hear” Martha, Joe silences the television. Turning off distractions helps him focus more fully on what she is trying to say. When we are distracted and our focus is divided, it is far more difficult to tune in to others. Like a spotlight our focus can truly only be on one thing at a time. Eliminating distractions helps narrow our focus and place it squarely where it belongs – on the person we are hoping to understand.

Listening involves tuning out distractions & tuning in to the other person.

photo credit nishanth joice creative commons

photo credit nishanth joice creative commons

LISTENING IS SUPPORTED BY SILENCE

In trying to spell out the words Joe would ask clarifying questions (“Is your letter on this row? Is it thisletter?) but then he would be silent to give her enough space to “speak”. The truth is, we cannot be talking and listening at the same time. Interrupting the other person breaks communication and blocks the flow of information. While we can keep “one ear open” while our mouth is moving, real listening requires something much more golden – silence! Silence is truly golden because it affords us the opportunity to hear the heartbeat of another person.

Listening requires closing our mouths while opening our ears.

LISTENING REVEALS OUR LOVE

photo credit: sweethearts by patrick, creative commons

photo credit: sweethearts by patrick, creative commons

In watching the communication between Joe and Martha it was so easy to see their love. His efforts to understand her were motivated by a heart that loves his lady despite her limitations. Likewise, in the work we do and in our relationships too, our love for others is clearly seen by our efforts (or lack of thereof) to understand and to truly listen. We love more loudly with our ears than with our lips.

Thankfully most of us do not have to go to the lengths required of Joe and Martha to communicate with others, but real listening remains a lifelong challenge. Who needs your ears today?

Will you take the challenge and take the time to truly hear what they have to say?

 

A Funny Thing Happened . . .

This morning I went to the hospital to start discharge planning for an urgent admission to hospice. I entered the patient’s room to talk with the family. The main family member was talking on the phone, and the others were visiting quietly, so I stood aside for a moment while I waited for the family member to finish talking on the phone.

I stepped towards the patient’s bed and placed my hand on their arm. I looked at the patient for a moment, and stopped, thinking to myself, “I don’t think this patient is breathing.” The patient’s arm was warm, but I didn’t feel a radial pulse. I watched for a moment, and did not see them take a breath.

I looked around the room. The family was chatting quietly, and the main family member was still talking on the phone. This isn’t unusual, sometimes people pass quietly and the family members fail to notice right away.

I caught the eye of the main family member, and tried to break the news gently.

“I’m sorry, but I think the patient has passed.”

The family member looked at me and said, “I know – they died early this morning.”

(The family was just hanging out, finishing saying their good-byes.)

They were all amused at my surprise. I just said, “Well, as you can see, I have excellent assessment skills!”

There is your laugh for today. You’re welcome.

Vicarious Trauma – When Your Heart Can’t Hold Any More Stories

broken heartMy most recent posts were about compassion fatigue – the first was on recognizing compassion fatigue, and the second was on what to do (or not do) when you are experiencing compassion fatigue. And then you may have noticed, this blog has been quiet for a little over a month. I think I can safely say that I had been experiencing some compassion fatigue myself. And so as I was dealing with life, I did not take time to write. I probably should have. However, as I was doing some research for the last two posts, I came upon some information that really caused me to stop and think. I came across a term that I had not heard before (although apparently it has been around for a while)- “vicarious trauma”.  This term was used as another descriptor for compassion fatigue. At first I thought “No, that just doesn’t sound right. What in the world does that even mean?” But the more I read, the more it made sense. The concept is that trauma or crisis affects more than just those who are personally traumatized.

Think about this – say you have a friend who is going through a divorce, or a terminal illness, or has lost a loved one, or is experiencing some other type of life trauma. If you are close to that person and are walking with them through that difficult time, it is not unexpected that we take on some of their pain. I believe that as humans, that is how we are built. We were not made to carry pain on our own.

Now consider someone who works with people in crisis regularly – a therapist, a police officer, an EMT, a funeral director, a pastor, an healthcare provider. Caregivers in such circumstances understand that we have a tough job. It is not unexpected. However, some cases are particularly tough. Some may trigger an additional emotional response. For instance, my toughest cases are young patients, patients who are my age with children the same age as my children, or patients with lupus (I have similar autoimmune issues). Having one ‘extra difficult case’ is challenging, but with extra support and the realization that perhaps we are experiencing a more intense emotional response than usual, we struggle through.

Vicarious trauma, or compassion fatigue, is the accumulation of sad story upon sad story, crisis upon crisis, trauma upon trauma, until our heart just can’t take anymore. At least that is how it feels to me. Although we are not directly involved in the trauma, we begin to carry their pain, and vicariously experience some of the effects of the crisis or trauma. It can produce not only emotional distress, but physical symptoms as well, similar to PTSD in severe cases.

Sometimes I have some control over the circumstances – I realize that for whatever reason, a certain patient or situation is going to be particularly difficult. If I can identify that, then I can get help to face the challenges. However, sometimes circumstances are out of my control, and before I know it, my heart says, “NO MORE!”  In the past month, I have experienced this to a degree. I have two friends, VERY dear friends, who are going through treatment for breast cancer. My best friend lost her father. I am dealing with issues within my family of origin that I thought were dealt with years ago in therapy. I was hurt very deeply by someone I thought could no longer hurt me in that manner. The hospital that I work at has been very busy, and there have been more than a few heartbreaking family meetings. And these are just the things that I s choosing to share in this public forum.

So what have I done under these circumstances? With my friends who are going through chemo, I have tried to be more present, and help in more practical ways. With my friend who lost her father, I took time off work to be with her and attend his memorial. With my family issues, at first I just withdrew, but that didn’t feel right. So I’ve tried to set some good boundaries, and create a framework to move on in a positive direction. It is a blurry line being feeling safe and withdrawing, telling the truth and striking out when one has been hurt, and trying to be real and authentic while keeping yourself safe. At work, I have tried to make good use of my time, and still maintain contact with my co-workers.(In my position, I am often a ‘lone wolf’, and have to be really purposeful about teaming with others when possible and maintaining communication with my colleagues.) As for the tough family meetings and patient situations, I have tried to debrief with the others involved when possible, and I have also relied on co-workers who were not directly involved for a listening ear, as well as for advice on how I might improve. Lastly, I think my saving grace has been that I leaving for vacation tomorrow, and I have had that to look forward to!

What might I have done differently? I have been a failure at self care. I have been eating horribly. The other day I had red velvet cake and ice cream for breakfast. Not a very productive way to start the day! I have not been exercising regularly – I have been “too busy” after work getting ready for vacation. I have gained back weight that I had previously lost, and of course that does not help my outlook. I have done too much complaining and whining. I think it would have been better if I could have discussed my frustrations in a more objective manner. I really need to improve my ability to ‘reframe’ the situation. And there were times when I knew I was frustrated or short of compassion, and I just moved ahead rather than taking a break or asking for help.

And there it is. This has really been more of a stream of consciousness and a cathartic exercise rather than a helpful article on vicarious trauma or compassion fatigue. But one thing I have learned in life is that part of the reason I have been placed on this earth is to share my crazy, beautiful, chaotic, genuine, messy story so that others can learn from it, or in the very least, so that you know you’re not alone.

If you want to read some truly informative articles about vicarious trauma, you can find information at

http://www.olgaphoenix.com/statistics-painful-truth-about-vicarious-trauma/

http://secondarytrauma.org/secondarytrauma.htm

And woohoo! Tomorrow, I am off on vacation! You can follow my travels on my other brand new blog, This Beautiful Holy Mess. My husband of almost 30 years and I are taking a road trip from Vancouver, Washington to New Orleans. In July. It should be quite the adventure.