The case for compassion

holdinghandsI wanted to share with you a blog from the Washington Post, written by the co-founders of an important organization, the New York Zen Center for Contemplative Care. The Center follows in the footsteps of Upaya, where I participated in the “being with dying” program. I was particularly struck by the opening paragraph, describing a heart-breaking situation with a patient who is dying of cancer:

“I am dying. My tears are not because I am sad I am dying. I am just so disheartened that no one wants to talk to me about this and just sit with me. I wish someone would sit with me, like you two, and just be with me at this crucial time.”

It’s such a small request—one that the authors fulfilled without a second thought—but one that can quite literally mean everything to someone who is facing the end of their life.

Ultimately what we’re talking about in these situations is the need for compassion.

We often hear the term referenced in terms of health care, but not everyone realizes how critical compassion really is to any palliative treatment plan. There is a strong scientific basis underscoring the role that compassionate care plays the psychological and, consequently, physical well-being. It takes myriad forms and it’s clearly not quantifiable in scientific terms, but there is little question that small acts of compassion can have a massive impact; holding hands, listening to someone sharing their story, smiling at one another in silence, or even crying together all provide a level of comfort to a dying patient that many of us cannot conceive of.

The response of the patient they referenced leaves no question of that:

“As we were leaving Sarah’s room, she smiled and said, ‘Thank you both for pulling up a chair and sitting down. Thank you for looking at me. I felt you so engaged and that you were curious about me. When we sat in silence, which was kind of awkward at first, it turned out to be just wonderful because you didn’t run out. Maybe this is what I missed my whole life—care, attention and curiosity and silence. Thank you for offering that.’ 

She died quietly the next day, leaving us an invitation to imagine a health-care system that provides not only care and attention but also curiosity, presence and when there is nothing more to say, silence.”

So I’d like to leave you with a simple request of your own. As the holiday season barrels towards us, please take a moment to exercise compassion, however briefly or minutely with a loved one because in the end, those moments are all that matter.

Wishing you all peace for this season and all the year.


Death and dying in many languages…

A few weeks back I talked about meditation and how its beauty lay in the fact that it required no specific spiritual orientation—it’s open to people of all religious or even non-religious backgrounds. As a result, it’s something I think can benefit both patients and practitioners in palliative care.

But I thought it would also be interesting to talk a bit about the flipside a non-denominational approach to care. Because despite the fact that I don’t generally consider myself to be a religious person (spiritual yes, religious no), the reality is that working in the palliative setting I’m going to be encountering people from an incredible variety of backgrounds.

One of the greatest challenges we face in the hospital setting is how best to serve the needs of patients and families who come from cultural and ethnic backgrounds different from our own. Obviously the most obvious challenge is that of communication—people for whom English is not their first language may find it challenging to convey their wishes to us. And we need to take time to ensure that we’re ‘speaking the same language’ both figuratively and literally (different phrases and words may have very different meanings in different languages).

But beyond that, it’s important to try and understand how differing cultural backgrounds can greatly influence how people understand and cope with death and dying. In medicine we refer to it as ‘cultural competency’, and it’s where the art and science of medicine meet. Depending on a person’s background they may approach end-of-life issues in a manner that is dramatically different than our own—and it’s my job to try and not only understand how that shapes their understanding of the situation, but also to communicate in a way that is sensitive to that background.

It’s something that we as practitioners struggle with on a daily basis, and an area of palliative care that can always use more research and discussion. And it’s also one of the reasons I feel so fortunate to have been able to participate in the Upaya program where I was able to deepen my own relationship with death and dying by understanding the approaches of others.



Still learning after all these years…

So we’ve just hit the first official days of autumn, and by now students of all ages are firmly ensconced in their studies, whether that be at elementary or high school, university, or even preschool. The rush for school supplies those first weeks of school, seeing all the college students taking over cafes with their binders and textbooks, all of it reminds me of the real joy that is learning.

I think there’s a tendency to think that when we’re done our ‘official’ education programs—when we flip over our tassels and are handed our diplomas and what-have-yous—that the ‘learning’ part of our life is over. My profession is the perfect example of how far from reality that is.

Doctors, if they want to continue to be effective, are necessarily engaged in a process of life-long learning. Just think about it: new scientific breakthroughs, new approaches to our understanding of mind and body, new treatments are always appearing. And wouldn’t your doctor to be on the cutting edge of all that news and information? Of course you would! And the only way that happens is if they retain an active commitment to learning.

But I’m also referring to more informal learning as well. In palliative care we learn that one of the most important parts of our jobs is listening. There is absolutely no way you can be an effective palliative practitioner without listening to your patient; most of the work we do is dependent on being able to assess what they need from us.

And by listening I learn not only about how best to treat my patients, but I learn more about myself. Sure, by listening to patients you’ll learn about their symptoms and how best to manage their pain, but you’ll also learn more about the human experience by listening to their stories and experiences; I can’t imagine an education more valuable than that.