Hospice social workers walk lines between extremes to serve people in challenging situations. One such line is steady, normalizing empathy. One one side, there’s indulgence in your own emotional response to death-related topics. On the other side, there’s dismissive or uncaring treatment of painful topics, as if they aren’t supposed to be painful.
Both extremes reflect the provider’s unwillingness to be emotionally present.
The emotionally indulgent extreme
When the emotions hit us so hard all we feel is our own pain and we feel as if we need to leave the room, we are not being emotionally present. Nor are we when our discomfort with a patient’s unusual behavior that we need to turn away to hide our smirking or snickering. We can show tears and even cry a few sniffles if that’s how we’re feeling, but not if it distracts us from the reason why we’re there.
The mission to support your patients and clients is like driving; our own emotions are like the weather we may need to drive through. You can still get to where you’re going in inclement weather because you drive carefully, mindful that the weather won’t impede our progress.
The cavalier extreme
We want a matter-of-fact manner of communicating. It normalizes the experience. We want some degree of steadiness, holding the space so that the people we work for can express their emotions. But this doesn’t mean being cold, detached, cavalier or dismissive.
The film 50/50 shows a doctor walking into a room without making any eye contact and informing a patient of his cancer as he speaks into his dictaphone. He’s talking only to his dictaphone as if there isn’t a human around. He’s not at all in touch with how difficult it is for the patient to receive the diagnosis. He acts like informing people they have cancer is so normal for him that the only thing noteworthy about the diagnosis is that it’s rare.
The doctor took normalizing to the extreme, relaying the heart-crushing news as if the patient would take it in a normal way.
I have rarely seen examples of disregard this extreme in hospice, but unfortunately, it happens. What is more frequent is an apparently detached attitude accompanied by what feels like rushed goodbyes. It’s as if there’s a part of them saying “too much pain in here… time to run get a slushy.”
It’s not time to get a slushy, or to do anything to avoid the pain. The pain is there. It’s real. To be honest and authentic in a painful situation requires that we feel the pain.
We feel the pain but continue to do our jobs. We have hearts and spines. We cry, but we don’t fall apart. We feel the fear, but we don’t flinch.
How to normalize with compassion
We communicate that death is a normal part of existence by showing up authentically. By honestly acknowledging the experience, we assist our patients and their family members through the denial. We take the time to witness the expression of emotion. Treat it as important, but not tragic. Maintain our structure, but with tenderness.
Our attitude shows confidence that as hard as this time is for them, they will get through it. There is ok-ness amidst the suffering. As much as our tenderness shows that the experience they are having is special, our demeanor validates their experience as it implies that it is also normal.
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