It’s the Little Things

Room service.  Crossword and Jumble.  A good movie.  Quiet, alone time.  The thoughtfulness of my husband.  Time to think and heal.  Love.  Caring.  Respite.

My husband gave me the opportunity on Friday night to enjoy a relaxing evening in a luxurious hotel room following a challenging week of work.

My job is demanding.  It’s often chaotic, sometimes overwhelming and always (eventually) rewarding.  This week, I experienced a verbal attack from a family member that was unprovoked and unwarranted and, as I was able to realize days later, had nothing to do with me.  I was also able to comfort a different family making a hospice decision.

In grad school, we were encouraged (and required) to reflect on our experiences and write a weekly “process recording” about the experience, our reaction(s) to it, and future learning opportunities.  My initial reaction to the verbal attack was shock.  I could not believe that such a knee-jerk, volatile eruption would occur in my work setting over an unintentional clerical error. Next, I felt completely inadequate and ill-prepared to offer an appropriate response beyond a mea culpa.  I stammered at the sheer audacity of the arrogance from which the words were hurled. And I wanted desperately to say something as stringent in rebuttal; instead, I just stood there and took the “punches”.  Still, I could neither fathom the verbal venom spewed at me nor buffer the environmental disruption to those near my office at the time.

After the eruption, and a handoff to another professional, I composed myself.  I had a different family to visit.  This next family member couldn’t have been more kind and concerned as we discussed hospice care for a long-time spouse.  Life review.  Pain and symptom discussions.  History of past medical professional promises and “useless, invasive procedures”.  “I just want her to be comfortable”.

As difficult as the topic of hospice and the death of a loved one may seem, this conversation was MUCH easier for me to handle than the first.  Emotions were just as prevalent, but they were different.  The focus of attention was different.  It was simply two people talking about the comfort and care of a loved one.  Two people working together to determine the best plan of care.  Something the first episode could have been as well.

What I’ve learned from these two very different situations is that when dealing with the physical decline of someone they love, people will act and react in very different ways.  For some, concern is focused on care and comfort.  For others, responsibility for finances and other decisions take precedence.  Still others may not know where to focus their attention.  Some people are kind and appreciative of information and support.  Others lash out in anger (which may stem from fear of the unknown future of their loved one).  Elizabeth Kübler-Ross wrote extensively about the stages of grief.  These two scenarios I experienced illustrate that grief accompanies all forms of loss:  death, independence, relationships, changing family roles.

I know that it’s important to approach each new resident admission with fresh eyes and renewed concern.  Although I’ve done dozens of admissions in the last few months, it is likely the first nursing home admission for residents and their families.  Each individual will have their own concerns, their own focus of attention, their own emotions, and their own reactions to this process.  My job is to make them all feel heard, comforted and cared for as they embark on this new journey regardless of how they may make me feel.  I’ve also learned that I need to insulate myself from the negative emotions and outbursts of others – grow a thicker skin; that’s a more challenging chore for me.

So I think I’ll encourage everyone to focus on the “little” things like Jim made me do on Friday night.  Love, caring and respite for all involved.  It’s the same approach to be taken in conversations about healthcare choices and decisions.

Caring Choices is aware that difficult conversations are made more perplexing when emotions get out of control.  If we begin talking from the place of love and caring, conversations will flow more easily.  If we start talking before a crisis hits, we’ll be better able to make decisions based on love (and respite) and not something more complex.  It really is the little things in life that make it worthwhile.

(c) 2014 Caring Choices