World’s Most Politically Laden Hospice Visit

Almost always when I visit a hospice patient and possibly his or her family members, they and I are meeting for the very first time. That is one of the beauties as well as one of the challenges of hospice work: there is no existing prior relationship that will constrain what we want to say to each other; no built-in script of expectations. We offer each other the freedom that comes with speaking to strangers. Of course that has its own limitations; I do what I can to build trust within minutes or even seconds, because of the shortage of time at our disposal.

Once in a great while, the patient and family and I do have a prior connection. One time I had to minister to the spouse of one of the members of the committee that voted on chaplain salaries! But even touchier than that, I had to visit with my supervisor’s supervisor’s top echelon so-and-so [As you can imagine, I am purposely being vague.]  Ms. So and So was the patient’s daughter; the patient was her father. What was I going to say to them? Why did they want to see me? What if I said something either of them thought was insensitive or at least mediocre?  How was I going to put this in the medical records, which the daughter had easy access to? This was not my idea of a job evaluation.  But just think how much worse it must have been for the nurse: what if they saw her washing her hands a few seconds shy of the required amount? What if she fumbled with administering the medication and spilled some?

I made my way through this best I could by trying to be with them as I would with any others in our species suffering this universal crisis: I sat with them; I became acquainted with her father as I would with anyone new; I talked about this and that neutral subject with Ms. So and So. I took an interest in everything they said. The major difference between that visit and all my routine visits is that I did not attempt to give them permission to reveal their vulnerabilities or to pursue deep questions such as what mattered the most to them now. I had to obey the constraints of our existing business relationship.

Years later, as I recall this mother of awkward visits, I wonder from their point of view what their underlying agenda was, assuming no sadism toward low-level staff was at play. (Yes, nurses, and even more so social workers and chaplains are low-level; we are always on the bottom of those hierarchy charts that hospice agencies hand out at new employee orientations.) I have the feeling that Ms. Top Brass and her dad felt some comfort by not choosing the care of an outside hospice. They felt more at home with “their own” hospice. Rather than consciously or even subconsciously trying to avoid death or issues surrounding it on the one hand, or trying to make employees squirm as a sort of retaliation for death’s reach of even the most powerful on the other, they wanted the familiar, the outwardly tame.

To my relief, there were no further visits, as her father died soon thereafter. The daughter returned to work; I was dutifully vague in my medical notes about the visit, estimating the amount of time spent with them and that I my goal was to offer attentive listening. The outcome I listed was that calm pervaded the household. Perhaps she read the note, pausing over it just long enough to register the distance she had sometimes kept between herself and her own capacity for outwardly demonstrated compassion.

2 thoughts on “World’s Most Politically Laden Hospice Visit

  1. Consuelo M Beck-Sague, MD says:

    How differently we all see ourselves versus how we are “really” seen! And is there ANY reality? Who knew that the PhD. chaplain is considered among the “low-level” staff! Anyway, very often, when I am writing a note in a record, I have wished I could put in my “SOAP” (subjective, objective, assessment, plan) for my plan:”Attentive listening”. But if I did so, I wonder if the insurance would bounce it back? I hate to have to put some lame thing in my note like “reassurance” or “anticipatory guidance,” when in fact, all the healing the mom and kid needed was ATTENTIVE LISTENING! They don’t need to be reassured, for heavens sake, they need to be heard.:)


  2. I think reality is embedded in structure and context. As a doctor, you know that a cell will have a different function or “identity'”depending on who its neighboring cells are.

    Re: low-level staff: One of my many adjustments from going from leading a pulpit to serving as a chaplain was to give up status and power. I went from spiritual leader to “spiritual coordinator.” The mystique of being a member of the clergy counted little if I was “out of compliance” with any of the regs!

    Your observation about attentive listening shows that you are in touch with your “inner chaplain,” as we all should strive to be. -Karen


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