I was recently assigned to a hospice patient that had been seeing another social worker, but hadn’t been having much of a connection. When the team decided that he might open up more to another man, I was the obvious choice. While his stepson was very much involved and visited the long term care facility every day, it is often difficult for a patient to confide in someone so close and emotionally invested. I agreed that it was a good idea and put the man on my schedule.
Shortly after, I made my first visit and was warmly greeted by both patient and family. The man had led a fascinating life and spoke about his past experiences with a cheer slightly incongruent with his current physical condition and prognosis. I found his attitude to be a breath of fresh air in a field where encounters gravitate toward the negative more often than not. At some point during our discussion I asked a seemingly innocent question about how his day had been going so far. To my surprise, he responded that he had slept late, but wished that he hadn’t woken up at all. He delivered this tidbit in a rather matter-of-fact, decidedly drama-free manner. Throughout the rest of our time together he reiterated in several different ways that he was essentially waiting impatiently for the end and that it could not come soon enough. I was baffled.
At our next team meeting his nurse, aide, chaplain, and previous social worker all reported that they had had the exact same experience with this patient and that they had simply not known how to respond. The man’s behavior and statements were a definite source of discomfort for all parties involved. I met with him three more times with the exact same results. I racked my brain for ways to bypass his defensiveness in order to find out what was going on beneath the surface, refusing to accept his bravado. Only today did I receive a glimpse of the explanation for which I had been seeking.
As I sat down across from him at the dining room table, he began our conversation with a point-blank question: “When this all starts to happen, how aware of the process will I be?” This admittedly took me off guard as I am very conscious of the fact that anything I say could easily be misconstrued as medical advice. It is for this reason that I always preface my responses in such situations with a reminder that I am a social worker and that such inquiries are better directed toward the nurse or doctor. Being exceedingly pragmatic, the man explained that, while he understood this, he would like any information that I could provide him. He went on to explain that almost every medical professional by whom he had been treated had danced around the question and had failed to allay his fears. I sensed an opportunity.
I began by addressing the reason the answer to his question was important to him. It seems that one of his doctors had explained in detail how he would eventually bleed to death, but that there was no telling when this might happen. This left the patient literally sitting on a time bomb (his tumor) that would one day detonate with no warning. At that moment I saw this man, whom I and so many of my colleagues had insisted was unfazed by his impending death, drop his tough exterior and reveal his fear and anxiety regarding the inevitable deterioration of his condition. It made perfect sense that he would have many questions for which he feared there would be no answers. Would the process be painful? Would he know he was dying? Would he lose consciousness, or could it just happen in his sleep? I then understood that there were larger forces at work that were contributing to his suffering rather than alleviating it.
His doctors had been noncommittal in their answers because they were uncomfortable that they could not, with much accuracy, provide him with a sufficient explanation. The one doctor that did take time to explain what would physically occur skirted the topic of how this would affect the patient on a psychological and emotional level. The man had given up on receiving any satisfactory or comforting information and had decided to embrace his anxiety as the undesirable but unavoidable response to a medical community that had neglected his emotional comfort as a result of preserving its own.
Too often we avoid our own discomfort at the expense of our clients/patients. It is the ability to live in that uncomfortable space while maintaining a clear desire to address a patient’s needs that will determine our effectiveness and competence as practitioners. In this case it only took four visits to get to a place where the cathartic process began to appear in the distance, if only as a faint light at the end of the tunnel. He and I both received a bit of hope born from the fact that we had dropped some level of pretense and were having a dialogue that he had thus far been denied. What comes in the future remains to be seen, but the significance of these circumstances was not lost on me. My eyes have been opened to the grave consequences that can result from well-meaning professionals avoiding difficult discussions. I am confident that this will inform my practice and benefit many future patients. Until next time.