Meaning in a Half-opened Eye

When I interviewed for hospice chaplain jobs, a question I got just about every time was, “What do you do when you visit an unresponsive patient?” By that my prospective boss meant patients who would not respond to anything I did, like touch their hands, talk or sing. Usually they could not talk, or if they did, it was to themselves or to the world at large. During such visits I could feel invisible. If that is so, you might wonder why an interviewer would ask such a question. But rather than being a gratuitous curve ball, it strikes down deep at the essence of a chaplain’s role and to what it means to exist as a person.

While some patients truly could not respond because they were in a coma or were asleep, I often found many so-called unresponsive patients did respond if I loosened the definition of communication, or spent a long enough time to give the patient enough chance to respond. I remember one time when I introduced myself to a lanky man as I sat down in a metal chair by his bed. He did not reply, and after several seconds, I figured he had not heard me or did not understand me, so I drifted off into my own thoughts and guessed this would be a very short visit.  Luckily I lingered in my own reverie. I say luckily because after a full 30 seconds at least, he had processed what I had said, and gave an answer that a normal person would give after just a second or two max. I said something else, waited another 30 seconds as if that were the normal way to talk, and again he gave an appropriate answer. I thought to myself, “I bet most visitors casually stopping by would give up before they found out he could converse.  I wonder how long he went without having a chance to talk.”

The key task of a chaplain is to find a way to reach people. This means slowing down enough to see details that the average visitor would miss. Like an eye half opening or a finger moving in response to my voice. Like more rapid or more relaxed breathing when I hold the patient’s hand, or their turning their head towards or away from me when I sing, indicating their yay or nay to hearing it. (Believe me, there were plenty of “nays” to the music option.) It is not I who is invisible with these patients. It is the patients who are invisible to those who too automatically designate them as “unresponsive.” The patients’ essence as persons, I believe, is their ability to reach back in return, to connect with others.

Interviews are not the ideal environment for nuances, so my answer to what I did with unresponsive patients ran along the true but more superficial lines of, “Well if I knew they were religious, I would say a prayer. Otherwise I would touch their hands, sing a calming song, or say something friendly and soothing. Sometimes I would just sit by their side, in case they could sense the presence of another human being who cared enough to notice them.” Perhaps my interviewers liked this answer (at least the ones who hired me did) because they thought that kind of patient gave nothing for the chaplain to do. On the contrary, finding the key that will breach what separates them from me takes the observational skills of a Holmes and the deliberateness of an artwork restorer.

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11 thoughts on “Meaning in a Half-opened Eye

  1. Hi Karen!
    Thank you for this lovely post. Those of us who work with hospice volunteers try to encourage them to use your methods. I think a great many of us feel like we need to “do something” to be useful. It is hard to readjust our thinking so that we slow down, way down and let the patient fill the room with their style of communication. It takes patience, perseverance and a whole lot of opening up to be with someone who is not communicating in the traditional ways. I will share this with our volunteers, thanks again and a blessed new year.

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    • Goes to show the patience pays off. And the winner is: the tortoise! I am delighted that you want to share my writing with your volunteers. By all means you can let them know that I am available as a resource to communicate with them. Also, if any of them have a special anecdote, they can guest blog or I can write it up for them. Sincerely, Karen

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  2. When we are watching a football game or other sporting contest, we routinely learn to appreciate details which can only be fully understood in slow motion. Sometimes other people require extra time to process what is happening in their world, and you expressed this idea beautifully.

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  3. Consuelo says:

    … observational skills of a Holmes, deliberateness of an artwork restorer” maybe the patience of Job, the insights and skills of a top-notch diagnostician and the ability to recognize “hitherto undescribed” phenomena, that is, the ability/humility to discover. Many a potential breakthrough in science and medicine has been witnessed but not appreciated by 10 or more clinicians before the one comes along who’ll say “Did you see that? Did you?” That’s the person that will uncover what was seen in a hampered, ineffective way by others. That’s the person who “discovers”. Thanks for sharing your discovery.

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    • The effects of your praise, beyond swelling my head, is to be reminded of a study I heard about that revealed even more subtle changes in “unresponsive” patients when people spoke to them calmly, played music to them, etc. The study (Sorry, I don’t have the reference.) showed that there were physiological changes that occurred in response to such stimuli. I think this means for example change in pulse and body temperature. I hope of course that these changes meant the patient was pleased rather than irritated. The point is, we can “magnify” reality with more and more precise “microscopes.” Ultimately, when I please a patient, this might mean all those cells in him/her are throwing one heck of a party.

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  4. Very perceptive post, Karen. Spoken like a true (authentic and relevant) Chaplain. The power of patient presence. . .I’ve found this with elderly folks, people on the street and in jails, shelters. . .and it always reminds us that words can be weak ways of communication. Someone should write a book called, The Language of Presence! Thanks for your I-Thou approach.

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    • “Perceptive”–thank you for such high praise.

      What you say reminds us that slowing down and being quieter yields riches not just with chaplains and patients, but many other kinds of interactions as well, including our own friends and families. I’ve heard that paraverbal (i.e. tone of voice) and nonverbal signals can take up the lion’s share of communication over the linguistic content.

      I haven’t written a book with that title, but part of the book I have written, due out this spring, includes anecdotes about “minimally responsive” (i.e. can communicate with the bat of an eyelash for example) as opposed to truly unresponsive patients.

      Chris, may you and I continue to have an “I-Thou approach” as we continue commenting on each others blogs. Other readers of our comments here can see his at http://secularchaplain.wordpress.com/

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      • Thank you, Karen. Yes, I find it quite encouraging when compassionate persons, spiritual as well as secular, can take the I-Thou dyad to heart. Humanity practicing humanity (a Confucian ideal as well) is particularly needed in the venues we work within. I especially appreciate the perspective in your post that I would summarize as: Slow down and Sit with (I might also add, Shut up!). Those of us who were trained to be speakers (I was once a Protestant “Minister of Word. . .and Sacrament”) can have a hard time with the Slow. . .Sit. . .Shut guideline!

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  5. Thanks for your post. I know from the perspective of someone who has lost a loved one, sometimes the presence, not the words, from friends is what eased the pain the most.

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