As I was reading “The Light Within”, our August Book Club selection, I was struck by just a small anecdote. The oncologist, Dr. Lois, had just gotten onto the hospital elevator. She was followed by a nurse, then by an elderly man. The two began an animated, friendly conversation. The nurse asked the man about his wife. He replied “I hope that God takes her today. I just can’t stand to see her suffer anymore.” The anecdote ended there but the scene struck me as very familiar. I have been there too…once.
And when I wrote yesterday’s post, I was also moved by author Deb’s insight that “cancer work” is “extraordinary in its engagement with the human drama.” I do miss nursing. I was at my very best as a human being. One of the thing that I believed was most important about cancer nursing was a thing called authenticity. Having and maintaining the requisite knowledge and skills is, of course, essential. But to be an effective healer in the nursing role, you must be able to be in touch with your authentic self. And you must be able to let that authentic self shine through with patients and families.
If you have been reading “The Light Within”, you will have glimpsed authenticity in the physician/healer that Dr. Lois, the gynecologic oncologist, is slowly becoming. Authenticity, I think, may be described as a merging the professional, knowledgable persona along with the genuinely real and caring component of the person’s personality. This is different than a caring statement or caring questions that may be affected or, at least, rehearsed, something learned in a textbook or lecture.
For most of you, I suspect, you know authenticity when you experience it. And that is when trust really happens. What I am calling authenticity is when you sense that the nurse or doctor really does know you and cares about you as a person, not just the next patient to attend to. All other things being equal, this is what defines a good nurse of physician. It is not the same quality as empathy. Empathetic statements can be learned. Perhaps it is more like transcendent empathy.
I remember one day I precepting a new nurse. We entered the room of a man in his late sixties. When I meet first meet a female patient, I generally ask her about her family. When the patient is a male, I ask about the type of work he does. It’s generally how people define themselves in our culture. This man had been a plumber. As I was starting his IV, I started kidding with him about plumbers and the exorbitant rates they charged. This man was very sick. Soon, in fact, he would be terminal. As we left the room, the young nurse questioned me about why I was making “insulting and rude” comments to the poor guy. I told her that I sensed that the man was probably tired of people tip-toing around him, treating him like the pitiable, emaciated shell that he appeared. Giving him a hard time about the work he did was appealing directly to how he thought about himself before cancer. Treating him like one of the guys, not like a victim of cancer.
I remember another patient, an elderly woman. Her daughter was there at the hospital every day. But each summer on a certain weekend, she would take her two children on an excursion to the theme park, King’s Island. The kids were expecting to go. Their mom felt conflicted, not wanting to leave her own mother alone. I told her I was working the weekend. Her face brightened a bit. “Then I feel okay about going. You’ll be here to watch over her.” It was one of the best compliments I ever received. It meant she trusted me. And I think the basis of that trust was that she saw me not just as a responsible member of the staff, but someone who would treat her mother as if she were my own.
The tricky part for us caregivers, we doctors and nurses, is to let a little of ourselves out and let a little of the people we are caring for in. But doing so means letting hurt in. So it becomes a gentle balance, letting hurt in without toppling. We have to return to our cancer work the next day and the day after that and on and on. So we learn to carry the hurt like medal. We keep the pricks from being stabs.
You all have known many doctors, nurses, even housekeepers. How did you learn to trust? What drew you to your favorite doctors and nurses? How did they help make your ordeal more endurable? I would be very, very interested in hearing your insights, observations and stories.
Take care, Dennis