Wednesday, December 7, 2011

Holding Someone's Hand: Being Present

When a friend's mother died, I sent a note of sympathy and shared a memory that stays with me to this day of her mother's smile beaming at my children as they spoke Japanese like natives. In the midst of death and loss, it helps to remember some of the joys too. In an email today, she told me my note was a great comfort to her. We don't always have the right words to open into difficult places with each other, but sometimes in our silent presence or by our actions, we can assist someone through a difficult place with or without our awareness.

When another out of work nurse and I chatted about taking care of patients, I told her I was the, "You are going to walk today" nurse. I worked with surgery and trauma patients who thought it was a good idea to stay in bed and wait for the pain to go away, but not on my shift. I gave them the pep talk, the pain medication, and then I helped them do it. Believing you can do something goes a long way toward doing it, and having a reassuring presence coach you through an unknown process is beneficial. I walked them all, and, eventually, they all told me they felt better for it, albeit, sometimes a day or so later.

Today, my husband got to ride his bike for the first time in six weeks-  the reinroduction of time to himself gave rise to this reflection, "While I was riding my bike, I was thinking that if I gave a retirement speech what I would say." I asked, "What?"

"There is no dollar value to being present with someone in pain. There is no award for holding someone's hand. All of these metrics that define medicine and patient care forget that." 
My Husband said this 

He was asked to write himself up for an award. Navy medicine rewards "command impact" particularly on things that result in real or virtual dollar savings; "positional leadership" holding titles that hold meaning on the food chain; and participation in administrative tasks and committees. Awards are most often written by the recipient. He said, "No thanks." It irritates him to no end that doctors get accolades for programs they create, meetings that they attend, but not the patient care they give. That is seen as "just your job" which you do less and less of as you move into the administration of care. Presence is not valued by Navy Medicine in any definable metric, however,  a program that does naught for thousands but generates an award for one appears to help your career.

I may be more familiar than is normal with grief because of my years working as a nurse. My friend wrote about the sympathy note I had sent, "I think that your considerate words and the look in your eyes encouraged many patients and their family." I thought it was interesting that she knew I would look them in the eye. If you don't look someone in the eye, you don't see their suffering. When you are churning a thousand people through a paper mill of "support" or hustling a hundred through the glad handing of dignitaries, you are not present. This post is about being present, about holding someone's hand, about looking a grieving person in the eye and seeing them where they are, pain and all.

Opportunities to express grief are infrequent and sometimes it catches you by surprise. Once, while cleaning my children's handprints from the glass sliding door, a Cat Steven's song overwhelmed me- from a pain in my chest, a great sadness released into tears. At the base of that pain, was the wish that my grandmother could have known my daughter. She would have so enjoyed her. The pain of desperately wanting to share something with someone who is gone can lurk for years before bubbling forth. A gentle presence that can hold you, your hand, and your soul tenderly, can facilitate a place for grief to emerge but so can a song, a book, or a movie. Sometimes storylines say things we can't say outloud in our lives.
...it's hard to stay mad when there's so much beauty in the world. Sometimes I feel like I'm seeing it all at once, and it's too much. My heart fills up like a balloon that's about to burst. And then I remember to relax, and stop trying to hold on to it. And then it flows through me like rain. And I can't feel anything but gratitude for every single moment of my stupid little life. You have no idea what I'm talking about, I'm sure. But don't worry, you will someday.   
Lester Burnham in American Beauty written by Alan Ball