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When They Learn You Work For Hospice

Posted by Carla Cheatham on Tuesday, March 19th, 2019 in Hospice Whispers: Stories of Life, Spiritual Care Integrity and Excellence, The Power of Presence

WHEN THEY LEARN YOU WORK FOR HOSPICE (a 5 1/2 minute read)

“I often joke that if you want to suck all the air out of the room at a dinner party, tell folks you work for hospice…”

I was asked to write more about how to “recover” when we as hospice staff, or any type of caring professionals,
experience various reactions from others when they learn what we do for a living. Whether we’re out socially or
even at the grocery store, we often face *gasps* and looks of sympathy or repulsion or admiration followed by,
“Awww, you work for hospice…?!”.

Below are just a few examples of how others respond to the news and how I work to balance being caring while also caring for myself. Like anything, my strategies are a work in progress, so I look forward to hearing what YOU experience and do, as well.

Taking Time Off…
One self-care ritual I teach to healthcare staff revolves around their name badge. The goal is to avoid thinking
about work until they put their badge on for the day. Then, at the end of their shift, I encourage them to debrief
whatever they need to from their day and then, once their badge comes off, to put their workload and concerns
from their shift down and leave them there.
I have a special place I keep my badge and I leave my work concerns there with it. I do my best to not pick
them back up until I put it on the next time. It seems to help many of us because it’s a tangible boundary we
set for ourselves and a commitment we make to our loved ones to not bring our work, or the energy of it, home
with us.
We need moments when we’re not “on” as a hospice worker, with all the expectations and assumptions that
knowledge can bring up in others. There are times when I literally do tell the friends I go out with, “Tonight, I do
NOT work for hospice. I screw toothpaste caps on toothpaste tubes in the toothpaste factory for a living!”
I honestly do LOVE it when people tell me their stories…most of the time. But there are days I need a break, to
just be Carla and not any of my titles or roles; to not figuratively wear my badge that indicates I’m a helper and
open for business. If I don’t take time off, I become a crispy critter not fit for human consumption. Practicing
what I teach about good self-care is the BEST gift I can give to others, even when they don’t like me having a
boundary, at least not with them.

I do care. I do want to listen. And I also need space to listen to myself, first, so I can hear others from a grounded, centered place from which I can bring my best self, (not a hot-fried mess).

Most often if I or someone else spills the beans about what I do for a living and I see and/or feel people start to
react to the news, I’ll quickly respond as gently as I can, “It’s actually the best gig I’ve ever had, and even the
most fun. But I’m off duty today, so who’s seen the newest Star Wars movie…?” The goal is to politely decline
to go there, to respectfully set a boundary that I’m not up for having that talk today.

Protecting Myself From Being a Pariah…
Holding my boundaries when I’m off duty can also be about refusing to pick up the Grim Reaper scythe,
because the news can be quite a downer for the party’s energy, and it never feels good to be the “buzz kill.”
People sometimes edge away from me and visually scan for the nearest exit or excuse to go talk to someone
else, if they’re uncomfortable with death.
Other times if I face the social obligation of responding to, “What do you do?”, I’ll give the honest answer,
quickly followed by the toothpaste factory line. They usually laugh in relief, as it lets them off the hook from
talking about a squeamish topic and gets me out of having to deal with what I know isn’t rejection of me, but
cumulatively can be wearing.

Putting Down the Halo…
It’s quite an honor to receive persons’ gratitude for this work we do, and to be told so often what “angels” and
“special people” hospice workers are. I never want to verbally or emotionally shove gratitude back at someone
and shut them down. That doesn’t feel good either.
But let’s face it, that freaking halo can get reeaaallly heavy!! Just like we need time to not wear our badges, I
think we also need time to just be human, have a drink, smoke a social cigar, tell an off-color joke, make out on
a date, whatever it is that we would never do in front of patients and families.
The point is to not have to be an “angel” or “special person” all the time. We have to be able to be real and
down to earth and shop for groceries and have a bad day and even have meltdowns and a touch of road rage
without feeling like we’re diving head first off of others’ pedestals.
Besides, we’ve all seen what happens when public figures begin to believe their own press. We don’t want to
fall into the trap of thinking of ourselves as constant heroes or somehow above the rest of humanity and
become pompous arses on one extreme or burned out shells of humans on the other.
So in the face of such admiration, I’ll thank them and then say, “But you know, I missed the first three days of
fractions in 3rd grade and never caught up, so I think it also takes special people to be accountants…” and I
smile. It may take them a moment, but then they get it: We can all do our work in a special way if we just show
up well for others, regardless of what our job title may be.
It levels the playing field and I’ve found it to be an easy and yet connective way to politely decline the invitation
to the top of the medal stand. It helps keep me humble (hopefully), and protects my own neck and back, as
well as my social life, from the weight that comes with special status.

How to Not Listen Without Being an Ogre…
Again, I do love collecting and hearing others’ stories. People fascinate and inspire me. Besides, as an author
I love a good tale. But sometimes people still need a place to process their grief, and when others find out we
regularly play in that sandbox they come running to show us their toys.
Please hear me, I don’t mean to be crass or belittling to those who are in a place of grief and deserve to have
their stories heard again and again as long as they need to tell it. What I do mean to say is that we can softly
decline to be at work when our badge is off.

Cabbies turn off their lights when they aren’t on duty so folks won’t feel abandoned on the side of the street when the yellow car passes them by. We can, too. Just because someone around us has a need, doesn’t mean it is our responsibility to fill it.

We get to have limits. We get to have time off. We get to cry “uncle!” when we’ve had enough. We are not to
be used. We are not here to be taken advantage of, though I am certain that is never the intention of someone
who needs to tell their hospice story.
If I have it to give easily, I will listen to their story and offer words of support. If I don’t have it to give, however, I
owe it to everyone to take care of myself by not trying to give others a drink from my empty well.
So when I do not have it to give, I typically listen for a moment, then place a kind hand on their arm and quietly
say, “I appreciate and want to hear your story, but…(I’m distracted by the gathering, promised my family I
wouldn’t work tonite, am pretty exhausted from my week, etc.). I’d be glad to (have coffee, chat by phone, talk
afterward, find another time) later when I have my full attention to give you.”
That’s just an example of some options. Find what feels genuine and right for you and your personality and
voice. But find something. Make a game plan with a friend before you go out who will agree to come and play
“extract the bereavement counselor/chaplain/CNA/nurse/physician/social worker/staff member/volunteer” and
help you find a way to gracefully exit.
Allowing persons the dignity of finding their own sources of support from loved ones or professionals and not
rescuing them in the moment when they happen to stumble upon a hospice worker does not make you, or me,
a bad guy. We are not abandoning them.
Our title is not an open invitation that means we must listen to anyone, anytime, anywhere anymore than it is
fair or appropriate for me to drag a mechanic out of a cocktail party to change my oil on the spot because I’m
overdue for an oil change.
Again, I don’t mean to be crass about emotional pain, but if I’m cavalier about my own needs, I’ll burn out my
engine and be no good for anyone.

How to Not Take One For the Team…
Other times, a person’s experience with hospice has not been positive. We aren’t perfect. We do make
mistakes and have service failures. Personalities collide, miscommunications happen, values conflict,
expectations go amuck, and grief can get taken out on hospice professionals and agencies. I was verbally attacked by a former friend who had a very negative perception of her experience with hospice surrounding the use of artificial nutrition with her loved one. I don’t know the story. I wasn’t there. But I became a target when I posted an article about end of life choices that hit a tender spot for her, and it was on.
She called my ethics into question and the frustration she felt about her situation came out at me in a flurry. At
first, I listened and tried to be a space of healing for her obviously complicated grief. There came a point,
however, when I had to put down the rope and refuse to play. I simply didn’t have it…and, it wasn’t my job to
fix her experience of pain. I felt for her, but long ago a wise therapist colleague said, “We help no one when we
allow them to be their worst selves, so do not volunteer to be their punching bag.”
Certainly, there are therapeutic exceptions when clinical judgment says we refrain from taking transference
personally and offer others safe space to work through their stuff, but I wasn’t her counselor, nor was I her
chaplain. I wasn’t getting paid and we had negotiated no treatment or care arrangement of any sort. I was not
obligated to hold space for her struggle, because holding such space takes energy that I get to reserve for my
work while using my down time to do just that, let down.
Sometimes, just like listening to others’ grief stories, I’ll listen if I have it easily to give. But if I don’t, I put my own oxygen mask on first before I try to help others breathe.

I don’t know how these will land with you. I’m curious about other scenarios and responses you have found
that work well. I hope you’ll share them, because this work is challenging enough and it helps to know that we
aren’t alone in navigating sometimes choppy waters.

Peace to you…

Rev. Carla Cheatham, MA, MDiv, PhD, TRT has served hospices as a chaplain and bereavement coordinator. She’s the Section Leader for the Spiritual Caregivers Section of the National Hospice and Palliative Care Organization, Chair of NHPCO’s Ethics Advisory Council, and an adjunct professor at the Seminary of the Southwest and an Affiliate Associate Professor at the University of Maryland. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2019.

Retaining Emotional Health in Professional Caregiving—Part IV: More About Symptoms and Risks

Posted by Carla Cheatham on Wednesday, April 26th, 2017 in Spiritual Care Integrity and Excellence, The Power of Presence

Retaining Emotional Health in Professional Caregiving

Part IV: More About Symptoms and Risks

This is an on-going series from my presentations on the use of ethical boundaries and resilience to maintain both healthy professionals and teams as well as prevent compassion fatigue and burnout.

Most of us, if we are honest, have experienced many of these over the course of our lives:

Feeling helpless

Feeling more / less sensitive to patients’ and families’ stories or emotions.

Being or feeling less accomplished and effective

Lowered self-esteem

Harsh or on-going blame and criticism of oneself or others

Attempts to control others or situations

Working more / less

Holding overly ambitious expectations of oneself or others

Persistent feelings of depression of hopelessness

Feeling out of balance

Misplaced anger, irritability, and/or frustration with oneself or others

Depression

Inability or decreased desire to engage in normally enjoyable activities

Chronic lateness

Sleeping more / less

Feeling exhausted even when getting adequate sleep

Gastrointestinal issues

Having an off day or week, getting overwhelmed when life gets all too life-y for a brief period of time, struggling during a full moon or when Mercury is retrograde are all natural responses to life. They are signals to pay attention, increase our self-care, maybe take a day off to re-charge and re-gain our perspective.

When those symptoms intrude on our ability to conduct our lives and/or persist over the course of weeks and months, it is also a natural part of being human, yet one that requires even more focused attention and care. Bad days pass in time. Burnout, compassion fatigue, depression, etc. will too, but usually need and deserve extra support in order to do so.

If this list feels too familiar or describes someone with whom you work or for whom you care, know that all is not lost. There are steps to take that can support us in preventing and even treating compassion fatigue when it does arise, as I’ll begin discussing in the next post. For now, let’s look a bit more at the risk factors involved.

In one study of hospice nurses by Abendroth & Flannery (2006) stress, trauma, anxiety, life demands, and excessive empathy were the key determinants of compassion fatigue (their composite multiple regression model was 91% predictive, P < .001).

A 2008 review by Sabo found similar results, as well as risks for vicarious trauma to include:

*individual characteristics—previous personal trauma, coping strategies, unrealistic self-expectations

*social and community context

*physical, organizational, structural and contextual work environment and

*work-related attitudes—i.e. the “need to fulfill all the needs of the clients”.

Regarding the risk factor of having experienced personal trauma, one young nursing student approached me, after a guest-lecture on the topic, in tears. She told me the 30-second version of her past and then, with a trembling lower lip asked a question stemming from her deepest fears, “Am I doomed to never be able to be a good nurse for patients and families because of all I’ve been through?!”

Her wise instructor smiled in understanding and placed a supportive arm around her shoulders and nodded in affirmation as I responded,

“Oh, honey, no! That’s not it. The fact that you’re asking yourself the question is a good indicator you’re aware enough to be mindful of it when your own stuff gets in the way. Besides, it’s like someone having a predisposition to diabetes—it doesn’t necessarily mean they’ll become diabetic; it just means they have to be a little more careful than the average bear.”

The most important thing for all of us is to be honest with ourselves and each other, to practice being self-aware, and to frequently check in and ask ourselves the right questions. None of us got into this field to be dangerous, so we must be on guard to protect ourselves and those whom we are called to serve in a way that sets none of us up to fail.

Being in intimate space with patients and families may also provide a greater risk for compassion fatigue, along with being a first responder or a sustained responder, experiencing compounded grief, working extended hours, working in intimate space and/or providing intimate care, as well as internalizing patients’ suffering according to a review by Boyle (2011).

As many of these variables are not controllable, but are the very nature of the work we may do, it is important to focus on those areas we are able to change, which will be the focus of most of this series. To place our energy anywhere else is to set ourselves up for losing battle.

As I wrote in the last post issues of work overload, values conflict, lack of reward, lack of fairness, lack of community, and lack of control have been demonstrated as being of particular importance in the development of burnout (Maslach, Schaufeli, & Leiter, 2001), with control being of particular importance.

Maintaining a focus on the variables we can control and caring well for ourselves in the face of the ones we cannot is the greatest piece of advice I could give in this series. When we bang ourselves up pushing against the tide, we serve no one well. When we waste our time blaming and complaining we become part of the problem and avoid spending the energy, instead, finding solutions.

We certainly need space to vent and grieve, and there is nothing wrong with naming what we believe to be unacceptable. We simply must keep such times in check so that we do not continually live there. Again, I’ll say much more about this dynamic in the posts to come.

For now, here is a great website from the Compassion Fatigue Awareness Project with tools for considering one’s own current state. With self-assessments you can take on-line or print, you can score yourself on 3 different measures—the Professional Quality of Life (ProQol) Self-Test, Compassion Fatigue Self-Test: An Assessment, and the Life Stress Self-Test.

As you consider your results, also consider finding safe and supportive colleagues with whom you can discuss your findings. Being vulnerable enough to admit when and where we are struggling is perhaps our greatest tool, since no healing can ever occur if we do not join the rest of the mere mortals on the planet in accepting that we are not, in fact, super human.

For what it’s worth.

Peace,

Carla

REFERENCES:

Abendroth, M. & Flannery, J. (2006). Predicting the Risk of Compassion Fatigue: A Study of Hospice Nurses. Journal of Hospice and Palliative Nursing, 8(6) pp. 346-356.

Boyle, DA (2011). “Countering Compassion Fatigue: A Requisite Nursing Agenda” The Online Journal of Issues in Nursing, Vol 16 (1).

Maslach, C.; Schaufeli, W. B.; Leiter, M. P. (2001). “Job burnout”. In S. T. Fiske, D. L.

Sabo, BM (2008). “Adverse psychosocial consequences: Compassion fatigue, burnout and vicarious traumatization: Are nurses who provide palliative and hematological cancer care vulnerable?” Indian Journal of Palliative Care, Vol 14:1 pp. 23-29.

Rev. Carla Cheatham, MA, MDiv, PhD, TRT has served hospices as a chaplain and bereavement coordinator. She’s the Section Leader for the Spiritual Caregivers Section of the National Hospice and Palliative Care Organization and an adjunct professor at the Seminary of the Southwest and an Affiliate Associate Professor at the University of Maryland. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2017.

Retaining Emotional Health in Professional Caregiving Part I: Introduction

Posted by Carla Cheatham on Tuesday, March 14th, 2017 in Spiritual Care Integrity and Excellence, The Power of Presence

Every week I receive an email or phone call from a colleague in the professional caregiving field from folks who are worn out, burnt to a crisp, feel helpless and overwhelmed and don’t know what to do about it. I speak to HR Directors and Clinical Managers who are desperate to know how to help their teams.

I’m asked more and more to speak about healthy boundaries, self-care, resilience, compassion fatigue (though don’t put those last two words on most continuing education proposals or they’ll get kicked out for being too froo froo, according to my friends in the know!), and other similar topics.

Certainly, in-person trainings are the best way to approach and care for these needs in organizations and amongst professionals, but I’m going to share a series of posts designed to give more of my content to all of you around these issues. My hope is that it will be of some help to you and your colleagues, save a few bald spots and ulcers (and even suicides), and support managers in keeping good staff.

It stinks to see good clinicians leave a team and walk away from professional caregiving because they’ve been overworked, underappreciated, under-supported, outright mis-used, and/or not trained well in how to take care of themselves and practice resilience while doing some of the toughest of jobs.

At the rate we’re going, I’m surprised more aren’t leaving the field and deciding working for the bomb squad is less dangerous to their health than caregiving. We stay because we love what we do, we’re good at it, we make a difference, and we feel absolutely built for it. Sometimes, though, the problem is that we love it too much, and need someone to pull us back from the edge of unreason by the nape of the neck and nudge us gently but firmly toward greater emotional health.

For the next several weeks, this will be my goal.

I’ll cover the history of burnout and compassion fatigue, signs and symptoms and what the research tells us about its causes and cures. As a sneak preview of the answers to those latter two, I’ll cover boundaries—bad ones lead to us be crispy critters—and resilience—more than just a buzzword, it’s a well-documented source of health, well-being, and longevity.

Part of this conversation involves the stories we tell ourselves and the ways in which we find our own sense of meaning in suffering, not to spoon-feed it to others, but to help us remain grounded and centered in a place of peace and empathy rather than getting caught up into the drama and drug under with them.

I’ll talk about what all of that really looks like in practice, how we off-load grief and manage our counter-transference that naturally arises because we’re human, and how we know when we’ve gone too far. Then we must consider how supervisors and colleagues can handle it when members of a team, the whole team, and/or managers go off the rails and we’re surrounded by dysfunction without contributing to the tangled mess, ourselves.

There’s more, but I hope this is enough of an overview and tease to have you be watching for the rest of the series. Business leaders know this—it costs more to find, recruit, hire, and on-board new staff than it does to take good care of and properly train the ones we already have.

Thankfully, they’re paying more attention to hiring the right fit and supporting them well in their positions so they won’t go anywhere. I give huge kudos to leadership that sees these problems and are seeking to remedy it, willing to go beyond lip-service and put real resources behind these efforts.

One durable medical equipment (DME) company that works with hospices nation-wide has done exactly that—hired me to develop hiring criteria so they hire technicians (drivers who deliver and set up needed items in homes and facilities like hospital beds, O2 concentrators, wheelchairs, etc.) who have the attitude of service to be able to walk into rooms or homes where a loved one has an illness that is terminal. Once they’re hired, they want me to train their technicians to be able to walk into any situation without fear or fumbling. I could have reached through the phone and hugged them when they called with their recognition of need and resulting request!

So, let’s do this! If there’s a particular topic you most want and need, let me know, and I’ll try to make sure to work it in. I’ll look forward to hearing your thoughts as the series goes along.

For what it’s worth.

Peace,
Carla

Nine Weeks of Must-Read Books: Week 6–Spiritual & Multi-faith Care

Posted by Carla Cheatham on Saturday, February 18th, 2017 in The Power of Presence

Nine Weeks of Must-Read Books for Professional Care Providers

Week 6—Spirituality and Multi-faith Care

With the cold weather, it’s more tempting to curl up and read, so I’m posting the books and videos I most recommend to caring professionals and to which I refer in my trainings. It’s not an exhaustive list and does not necessarily contain the latest titles, but they’re what I know works to support us while we prepare ourselves to support others. I hope you find these helpful.

Spirituality and Multi-faith Care

Making Healthcare Whole, Christina Puchalski & Betty Ferrell

I tell others that if Oprah calls and my business takes off or if I win the lottery, I’d buy a copy of this book for every single person in healthcare. Two gurus of palliative care, Puchalski and Ferrell know how important spirituality is for persons going through a life crisis.

Their book lays out an impressive argument, with supporting research, for the respectful inclusion of spirituality into healthcare. They provide a model and tools that make it more accessible for patients and families by making it more comfortable for professionals to include it in their daily practice of care. Definitely a worthy read!

Paging God: Religion in the Halls of Medicine, Wendy Cadge

A professor of sociology, Cadge brings these skills to this fascinating look behind the veil, exploring the visible and invisible ways professional care providers in hospitals include religion in their practice of medicine. Through interviews and observation, she gains keen insights and provides an interesting viewpoint of the ways healthcare integrates patients’ and professionals’ spiritual lives into the daily ups and downs in the sterile, yet human, environment of healthcare. An intriguing book I highly recommend.

How to Be a Perfect Stranger: The Essential Religious Etiquette Handbook, Stuart Matlins & Arthur Magida, Eds.

I keep this book available for my colleagues in whatever healthcare setting I find myself, and recommend others do, too. Think of it as “quick flips” for many of the major religions and denominations or sects of those religions one may find in the U.S. It’s written to help persons know how to dress and act in order to be respectful when visiting houses of worship different than your own.

However, it had brief explanations about beliefs and rituals, including around the end of life, that can help all disciplines in healthcare feel a bit more prepared to engage with persons from other cultures and faiths in a way that is respectful and comfortable for all. Keep this text handy!

The Little Book of Atheist Spirituality, Andre Comte-Sponville

A philosopher and former religious believer, Comte-Sponville moves past the angry rhetoric and debate over religion that often exists, and provide a gentler voice to discuss the often contentious question of God. As I teach respectful care for the existential needs of non-theists (atheists, agnostics, and humanists) to healthcare staff, including chaplains, I urge them to consider this delightfully compassionate book.

My goal is not to convince others to alter their beliefs, and neither is Comte-Sponville’s. The goal is to increase understanding and improve the ability to have respectful, even compassionate, dialogue around what can be a very charged topic for many. The more we understand, the less we fear; the less we fear, the more likely we will be to show up well for patients and families who do not share a theistic belief system. Give this one a try. You’ll be all the better for it.

Stages of Faith, James Fowler

After conducting hundreds of interviews with persons about their faith journey Fowler, a developmental psychologist, developed a stage theory, based on Piaget’s stages, of how our faith matures. While some have criticized Fowler’s work as being too Christo-centric, others point out that it can be applied to persons of any faith or ideology. The more we understand faith as a multi-faceted, often evolving part of an individual’s life the better we can truly meet them where they are at any given time.

I find this text appropriate for spiritual care providers, social workers, and other counselors, but nurses and physicians could also benefit from a deeper understanding of how our faith develops, ebbs, and flows over the course of our life experiences. You’ll learn about yourself and gain greater insight into others with this text.

Relating to People of Other Religions: What Every Christian Needs to Know,Thomas M. Thangaraj

In a very sweet and engaging way, Thangaraj reveals his own struggles and thoughts when getting to know someone of another faith and how the journey strengthened his own. For those being asked to care respectfully for persons of another faith or belief system, this can be challenging at first.

Many whom I’ve taught have resonated with the reflections and struggles the author openly admits in the book and benefit from his ways of reconciling his love for his neighbors and his previous views. This book will help you clarify your own faith while opening up to have more respect for others’.

If Grace is True: Why God Will Save Every Person, Philip Gulley & James Mulholland

Another text I recommend to trainees is this one written by two Quaker ministers on their view of universal salvation. In their view, if grace is grace, then grace must really be full on grace, no exceptions. Sharing their own struggles with scripture, tradition, reason, and experience, Gulley and Mulholland make their case for a grace that is bigger than we can even comprehend and they do so in a gentle way that makes it easier for the readers to follow and consider.

Again, I do not ask folks to read this to change their beliefs, but to help them wrestle with their views to hopefully widen them enough to make room for others’ faith, so that they may provide professional and respectful care for persons of all backgrounds and ways of believing.

Once again, I hope something here has been helpful or inspiring. Be watching for next week’s post on books related to Grief and Meaning. Until then, please share your own most-recommended reads with me, so I can share them with others.

Peace,

Carla

Rev. Carla Cheatham, MA, MDiv, PhD, TRT has served hospices as a chaplain and bereavement coordinator. She’s the Section Leader for the Spiritual Caregivers Section of the National Hospice and Palliative Care Organization and an adjunct professor at the Seminary of the Southwest. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2017.

Nine Weeks of Must-Read Books for Professional Care Providers: Week 5–End of Life Care

Posted by Carla Cheatham on Friday, February 10th, 2017 in Uncategorized

Nine Weeks of Must-Read Books for Professional Care Providers

Week 5—End of Life Care

End of Life Care

Videos

1.) Dying Wish (DVD), Karen Van Vuuern, Wise Word Productions

A physician with cancer makes the choice to Voluntarily Stop Eating and Drinking (VSED) and allows his journey to be documented to share with others. A simple, powerful introduction to the concept, currently considered legal in all 50 states. It will make you think, wrestle with your own views, and find greater clarity.

Learn more at http://www.dyingwishmedia.com/

2.) A Family Undertaking (DVD), Elizabeth Westrate, Five Spot Films

The home funeral movement has grown in recent years, with many wanting to reclaim a natural connection with death. This documentary follows the stories of those who’ve made the choice for a home funeral and burial in a touching and personal look behind the veil that seems such a mystery to so many.

Available for purchase through PBS http://www.pbs.org/pov/afamilyundertaking/

3.) New Rules for End of Life Care (DVD), Barbara Karnes

From the author of the “little blue hospice book” called Gone From My Sight, this DVD goes even deeper into providing information that can be helpful to both clinicians and lay persons. Covering what to expect, medications, hydration, nutrition, and much more, this video will help everyone feel more comfortable with and prepared for caring for someone at the end of life.

Available at https://bkbooks.com/shop/new-rules-end-life-care-dvd-kit-guide-stages-death

Books

4.) Being Mortal, Atul Gawande

This surgeon certainly took the country by storm with his brilliant critique of both society and medicine’s approach to death, the practice of medicine, and end of life care. With a clear style and articulate arguments, he explores our current state and lays out a path for us all to follow to make the changes necessary for a better outcome for us all.

5.) It’s OK to Die, Monica Williams-Murphy & Kristian Murphy

An ER physician who grew tired of running full codes on 97-year old grandmothers, cracking every rib in their body with the first chest compression, because of our fear of letting go, Dr. Monica Williams-Murphy decided to do something about it! I first heard Monica speak a few years ago at a national hospice conference and fell in love with her spirit, immediately. Feisty and passionate, with brilliance and charm, she writes a book that is easy for anyone to grasp but that also provides great insight to professionals about having those dreaded end of life conversations with patients and families. It will make you think and make you cheer.

Learn more at: http://www.oktodie.com/

6.) Notes from Theme Park Earth: A Hospice Nurse’s Personal Journey of Life, Loss and Everlasting Love, Nancy Butler.

What does it look like when a hospice nurse experiences hospice from the other side of the bed? My friend and former colleague opened her still-grieving heart to share stories and insights with all of us about the journey with her husband through diagnosis, decline, and a lot of life and music and love.

As a seasoned hospice nurse, Nancy was in a unique position to see themes and lessons that many may have missed. She weaves them together for us by sharing many glimpses behind the veil of grief and her own professional service. Touching on many levels, it is far from a depressing read and is, in fact, truly inspirational. As Nancy says, “Dying is sad, but it doesn’t have to be grim.”

Learn more at: https://www.chandlerdesignslimited.com/store/index.php?main_page=product_info&cPath=96_97&products_id=237

7.) Hospice Whispers: Stories of Life, Carla Cheatham.

Okay, I won’t practice false modesty; I’m truly proud of this book. Based on examples shared in a training curriculum for hospice and palliative care professionals, this collection of 38 stories was published to help persons increase their comfort with hospice and decrease their fear of death.

The unintended by-product has been that it has helped persons fear their own death less, learned more about how to show up better for patients and families (including their own), and has helped persons process their grief around their own story of life in the face of death. As one reader recently stated, “While reading this book, I laughed, I cried, and I heaved a huge sigh of relief!”

Learn more at: http://hospicewhispers.com

Once again, I hope something here has been helpful or inspiring. Be watching for next week’s post on books related to Spirituality and Multi-faith Care. Until then, please share your own most-recommended reads with me, so I can share them with others.

Peace,

Carla

Rev. Carla Cheatham, MA, MDiv, PhD, TRT has served hospices as a chaplain and bereavement coordinator. She’s the Section Leader for the Spiritual Caregivers Section of the National Hospice and Palliative Care Organization and an adjunct professor at the Seminary of the Southwest. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2017.

Nine Weeks of Must-Read Books for Professional Care Providers: Week 4–Healthcare Ethics

Posted by Carla Cheatham on Friday, January 27th, 2017 in Spiritual Care Integrity and Excellence, Uncategorized

Nine Weeks of Must-Read Books for Professional Care Providers

Week 4—Healthcare Ethics

In honor of the highest-selling month for books, and the cold weather during which it’s more tempting to curl up and read, I’m posting those books and videos I most recommend to caring professionals in practice and to which I refer in my trainings.

Healthcare Ethics

Mama Might Be Better Off Dead, Laurie Kaye Abraham

I probably would not have read this book had I not been made to by one of my favorite professors in my doctoral program. A reporter from the Chicago Sun Times followed 4 generations of an economically poor African American family as one of its members, Jackie Banes, tries to hold it all together.

With several major medical issues in the family, this was easier said than done. Navigating insurance, healthcare, and all the other systems designed to care for persons involves creativity to keep from falling into the massive cracks in their design. It was my first glimpse of the fact that many persons are not opportunistic or crooked or lazy, as some assert, but are simply working to survive a system more akin to a jungle than a safety net.

This straightforward text will make you think, make you re-think, and likely soften your edges and open your eyes.

The Immortal Life of Henrietta Lacks, Rebecca Skloot.

I love this book! This best seller describes the history behind the HeLa cells used in research and the development of life-saving medications and bought and sold for enormous sums of money. The catch is they were taken from a poor, black, tobacco farmer in 1951 without her knowledge or permission.

With persons in medicine making money off of this woman’s cells, her family saw none of it. Secrecy, medical ethics, race, class, and many other factors bob and weave around the personal grief of a family who felt betrayed and the conflicts that can arise when some seek the greater good at the expense of what it right.

It will jar you, challenge you, shock you, and open a world about which you probably have never even heard. Don’t miss wrestling with this story.

Healing at the Speed of Sound: How What We Hear Transforms Our Brains and Our Lives, Don Campbell & Alex Doman.

Drawing on over 10 years of brain research provides information, practical tips, and even exercises to help us understand and make positive use of the sounds that constantly surround us, and can impact our world for better or worse.

Insightful, useful for individuals and professionals seeking to support others, and even fun. You’ll love this book and how it informs your ability to make use of sound even in your work.

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures, Anne Fadiman.

I’m itching to get my hands on this book and looking for a window of time to get it off of my nightstand and into my hands! Having not yet read it, I will defer a description to that provided on Amazon:

“The Spirit Catches You and You Fall Down explores the clash between a small county hospital in California and a refugee family from Laos over the care of Lia Lee, a Hmong child diagnosed with severe epilepsy. Lia’s parents and her doctors both wanted what was best for Lia, but the lack of understanding between them led to tragedy.

Winner of the National Book Critics Circle Award for Nonfiction, the Los Angeles Times Book Prize for Current Interest, and the Salon Book Award, Anne Fadiman’s compassionate account of this cultural impasse is literary journalism at its finest.

The current edition, published for the book’s fifteenth anniversary, includes a new afterword by the author that provides updates on the major characters along with reflections on how they have changed Fadiman’s life and attitudes.”

Once again, I hope something here has been helpful or inspiring. Be watching for next week’s post on books related to End of Life Healthcare. Until then, please share your own most-recommended reads with me, so I can share them with others.

Peace,

Carla

Rev. Carla Cheatham, MA, MDiv, PhD, TRT has served hospices as a chaplain and bereavement coordinator. She’s the Section Leader for the Spiritual Caregivers Section of the National Hospice and Palliative Care Organization and an adjunct professor at the Seminary of the Southwest. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2017.

Nine Weeks of Must-Read Books for Professional Care Providers: Week 3–Boundaries, Family Dynamics, and Team Health

Posted by Carla Cheatham on Friday, January 20th, 2017 in The Power of Presence

Nine Weeks of Must-Read Books for Professional Care Providers

Week 3—Boundaries, Family Dynamics, and Team Health

Boundaries, Family Dynamics, and Team Health

We professional care providers deal with persons and families who are often in crisis, which is when all of their best and worst defense mechanisms and even most dysfunctional patterns can arise, tapping into our own!

The more we understand these dynamics, the better we can notice and heal them in ourselves, keep our own stuff from entering unhealthily into the situation before us, and even be healthier members of our teams and own families.

If we are hesitant to explore and consider these things, we must ask ourselves from where is our resistance coming? Why would we want to avoid the healing journeys we encourage those persons with whom we work to engage in?

These books will empower you to be better and healthier in every arena of your life, so the discomfort of what you might find if you start looking is definitely worth the price of admission!

Generation to Generation: Family Process in Church and Synagogue, Edwin Friedman. This helpful classic helps not just faith leaders but clinicians and leaders of any group to recognize family systems dynamics that can arise when we humans gather with all of our imperfections. The more we are aware of these dynamics, the more likely we will be to recognize them and avoid getting in the nasty middle of them.

With its simple, straightforward language, it helps even non-counselor types gain important knowledge, insight, and skills. Just read this. Trust me!

The Five Dysfunctions of a Team: A Leadership Fable, Patrick Lencioni. Written in an engaging story-telling style, this latest work from Lencioni portrays hurdles teams commonly face that hold them back from being cohesive and effective, as well as action plans for overcoming them. Any member of a team can benefit from having their eyes opened to the dynamics that can tear teams apart and the ideas that may help them pull together to success. A helpful read!

The Gentle Art of Verbal Self-Defense, Elgin Suzzette Haden. This is still a classic. Over 25 years ago, I was 19 and in college, dealing with a very challenging loved one with mental illness who knew no boundaries. A wise therapist recommended this book to me and it helped change my life. Subtle and not-so-subtle put downs come at us on a daily basis, and we likely make them ourselves. This practical, easy to grasp book is full of tools you can use from tone of voice, assertive scripts, body language, and more to help you recognize and navigate challenging conversations. A must read for caring professionals.

Please Understand Me: Character and Temperament Types, David Keirsey & Marilyn Bates. This easily accessible explanation of 16 different personality types includes a self-test to learn your 4-letter type (ENTJ, for example) and includes a great explanation of each types strengths, challenges, and ways of showing up in relationships. When we understand that the way our colleagues, clients, and even friends and loved ones act as they do as part of who they are, it can be easier to speak their language and be more patient with their unique way of being in the world. This is an important piece that will help you professionally and personally in more ways than you can begin to understand until you read it and the lightbulbs begin to go off!

How Al-Anon Works for Families & Friends of Alcoholics, Al-Anon Family Groups. Professionals in all capacities would benefit from even a basic understanding of the impact the family disease of alcoholism can have on all of its members. Issues of trust, esteem, boundaries, control, and so much more can arise for persons who have been impacted by addiction and being aware of them can help professionals notice and navigate these dynamics in their work. Besides, who amongst professional caregivers wouldn’t benefit from a reminder to maintain healthy boundaries and loving detachment in their work?! Prepare to have your eyes opened in ways you never expected.

Facing Codependence: What It Is, Where It Comes From, and How It Sabotages Our Lives, Pia Melody. Many people roll their eyes at the very word, which became incredibly over-used in the 1980s. Nonetheless, it does exist and makes life harder than it needs to be for many, even if they only have small traits of this way of engaging in relationships, as most of us do! Using a simple framework, Melody helps persons identify such patterns, including 5 symptoms and early roots of the behavior and helpful information for healing those patterns. This book will surprise many with its insights and gentleness.

Once again, I hope something here has been helpful or inspiring. Be watching for next week’s post on books related to General Healthcare. Until then, please share your own most-recommended reads with me, so I can share them with others.

Peace,

Carla

Rev. Carla Cheatham, MA, MDiv, PhD, TRT has served hospices as a chaplain and bereavement coordinator. She’s the Section Leader for the Spiritual Caregivers Section of the National Hospice and Palliative Care Organization and an adjunct professor at the Seminary of the Southwest. Through her Carla Cheatham Consulting Group, Carla provides training and consulting for professional caregivers nationwide. She is the author of Hospice Whispers: Stories of Life and its companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook. Her next book, On Showing Up with Suffering: Others’ and Our Own, is set to publish in 2017.

How “Thank you for all you do!” Can Backfire

Posted by Carla Cheatham on Thursday, October 27th, 2016 in The Power of Presence

How “Thank You For All You Do” Can Backfire

by Carla Cheatham

A couple of years ago, I led a presentation for a room full of hospice and palliative care managers and administrators. The topic was compassion fatigue, but it wasn’t your typical “Put up appreciation boards” or “Send out cartoon clips each day” kind of talk.

Instead, I approach compassion fatigue from the stance of boundaries, resilience, noticing the stories we are telling ourselves, and focusing on our own behavior rather than blaming everyone else (even though that’s a LOT more fun!)

It’s definitely the grad school version of get real, get honest, and make real changes, but it’s always cool to see participants REALLY go there and open up to a different way of working. By the time they leave, their shoulders are pulled down away from their ear lobes and they say they feel empowered to go back and immediately implement a new way of leading.

At one point, when I was speaking about what they could do to promote healthier teams, my slide read, “Appreciation beyond rote statements…” I described noticing a trend at an organization where I once worked in which managers all started to write, “And thank you for all that you do” at the end of their emails and texts.

“At first”, I said, “we thought, ‘Aaawwww, how nice!’ Then it happened a second time, and we thought, ‘Oh, ok. They must be serious about wanting to acknowledge and thank us’. But by the 5^th or 6^th or 12^th times, it felt trite and rehearsed and made us want to throw up in our mouths a little bit!”

As I spoke, I saw that classic, “Woops, we’ve been doing that!” look. So I said, “It’s like all of you went to the same leadership seminar where they told all of you at the same time to end everything with, ‘And thank you for all you do!’”

At this, the room absolutely erupted in acknowledging laughter. They admitted that they actually HAD been taught to do exactly that.

“Well, STOP it!” I laughingly said, to more laughter from them. And then, more seriously, I said, “When it becomes rote, we stop believing you and feel like it’s just a campaign slogan. It feels kinda like we’re being played or duped into feeling appreciated, especially if nothing else in the organization actually changes other than your signature line to us. It just doesn’t feel good when it begins to seem automatic rather than something you’ve actually thought about, which I completely trust is NOT your goal, at all.”

They nodded with feeling, affirming that this wasn’t at all what they wanted.

I encouraged them, instead of global or generic phrases, to take an extra 15-30 seconds to think of something specific the person or team had said or done in the previous week or two, or even something that you admire and respect about who they are, and use that, instead:

“By the way, Sarah, I couldn’t help but notice how gentle and calm you were with Mr. Smith last week, even when he was really angry and taking it out on you. Thanks for being so compassionate and understanding with the patients with whom we work. It inspires me to want to be even more like that, myself, in work and in life. Thank you for that reminder.”

“Hey gang, I know it’s been extra stressful lately as we’ve been short-staffed. We’re working on it, I promise. But please know that, while we do, I really see how hard each of you are working to pull together, have each other’s backs, get the job done, while also taking good care of yourselves during a tough time. It truly means a lot to me and I could not be more proud of you guys. I wanna be y’all when I grow up!”

“Brian, before I close this note, I want to make sure to tell you, I heard what you said the other day about wanting to stay above board and not cut corners on our contracts. Thanks for keeping us true to our mission, and reminding me to not lose sight of the kind of person I want to be. I appreciate your presence on our team and in my life.”

“Trish, you were spot on with your comments in the meeting yesterday. Your wisdom and insight never ceases to amaze me. Thanks for letting us benefit from that brilliant brain of yours.”

If any of this makes you roll your eyes because it’s too fuzzy woo-woo, that’s fine. Find what feels right in your environment in your voice given your personality and your team’s. But find something!

Gratitude is one of the greatest hallmarks of resilience, for individuals AND teams, while experiencing a lack of reward, community, and fairness are some of the well-documented precursors of burnout. When we feel truly seen for real, sincerely felt, tangible reasons, it makes all the difference in the world. It increases compassion satisfaction and can make enduring challenging seasons in the workplace a lot easier.

Besides, leaders set the tone for a team, for good or for ill, and that kind of intentional, genuine noticing and naming of the good we see in others can be contagious. You can’t afford to NOT take the few extra moments to build them up.

Thank you for being willing to stretch, spend a little extra time, and find new ways each day to make sure your team knows exactly the what and why behind your words of appreciation. You make more of a difference in their daily lives and how they feel about their work than you’ll ever really know.

Peace,

Carla

Rev. Dr. Carla Cheatham began her career in social services with an MA in Psychology and certification in crisis counseling. After earning her PhD in Health and Kinesiology and an MDiv, she served faith communities and led an interfaith non-profit supporting working justice. Carla then went on to work for 10 years in hospice as a chaplain and bereavement coordinator. Now she is a national keynote speaker teaching professional caregivers about presence, healthy teams, boundaries, compassion fatigue, ethical care, spiritual and existential support for all, and much more. She is the author of Hospice Whispers: Stories of Life and also Sharing Our Stories: A Hospice Whispers Grief Support Workbook available through Amazon. Learn more at CarlaCheatham.com

How Physicians Maintain Their Humanity

Posted by Carla Cheatham on Wednesday, August 31st, 2016 in Spiritual Care Integrity and Excellence

While attending college in my undergraduate years, I had a significant and painful medical issue that required multiple specialists over the course of a year.

Young, scared snotless, with very little support on the journey, I got a crash course in navigating the medical system, medical advocacy, and interacting with physicians and other medical personnel. Many were absolutely amazing! Others, well, not so much.

As afraid and overwhelmed as I was, physically as well as mentally, my emotions were already on the ragged edge. I was also in a small, rural area where respect for women, especially young and outspoken and educated ones, was not at it’s peak in the late 80’s.

To be blunt, misogyny was a daily experience, especially with some of the physicians. Finding my voice was necessary to make certain I got the care and answers I needed. It was awful. And I’m eternally grateful.

I learned a lot about what did and did not work well for me when any medical staff person walked into the exam or treatment room.

I quickly noticed the mannerisms and ways of engaging that made me relax, feel safe and seen and heard; which ones felt condescending, dismissive, shaming, and made me want to finally burst into the tears that were always brimming in my shell-shocked 19 year-old eyes; and which ones felt respectful, reassuring, and filled me with hope and confidence in myself and my provider.

My major was psychology, so I did what I knew to do as a fledgling research geek–I dove into the literature. I found myself studying Norman Cousins’ book, Anatomy of an Illness, the works of Selye, Ader, Cohen, and Felten. I started learning more about the mind-body connection and the burgeoning field of psycho-neuro-immunology. I was hooked. The data was proving what we already instinctively knew. Among other things…

The way a clinician interacts with a patient can be just as healing, or detrimental, as the treatment provided.

For those medical staff who saw me, heard me, and treated me with dignity blended with tenderness and patience, “Thank you” is not a big enough word! As I look back now on that barely-a-young-adult me who could now be my own child, I am filled with gratitude for those who showed up well for me during such a trying time.

One of my greatest lifelines became the pharmacist at the local grocery store. She took time to answer all my questions, helped translate physician instructions that had gone over my deer-in-the-headlights psyche, and was always so gentle and caring. She understood when her kindness finally broke the dam on my hold-it-all-together shell and released my tears.

Over 26 years later, I just teared up while writing this in appreciation for how much of a difference she made in my experience. She probably has no idea how much she meant to me. (Her bosses did. I wrote a letter to corporate thanking them for having someone so compassionate working for them!)

No matter what your role in the medical field, never underestimate how healing your presence can be to someone overwhelmed, in fear, and in pain.

A few years ago, a dear friend invited me to dinner and asked me to consider applying as the chair of the Department of Humanities at the medical school where she worked. I asked her for the 20-second job description. She answered:

“Teaching doctors to be human”

I had never heard a better way of explaining what I feel called to do. Thankfully, it’s what I get to do as I travel to train and equip healthcare staff to show up well when someone is suffering.

The soft skills of caregiving can be taught, and we MUST teach them for the sake of healing, whether a cure is possible or not.

The word “humanism” has gotten a bad rep in some circles as being about an over-focus on humanity to the exclusion of divinity. But those in academia understand a far different definition–the very one my friend gave about the humanities chair position.

It’s simply about being human.

Two years ago, I came across a research article that I hope will get even more airtime called “Attitudes and Habits of Highly Humanistic Physicians” by Carol M. Chou, MD and colleagues (Journal of the Association of American Medical Colleges, Sept 2014). A summary can be accessed here

In short, the study authors interviewed internal medicine residents to find out which physicians they felt best exemplified humanistic patient care. They then interviewed those professionals to identify the habits that contributed to their patient-focused attitudes and their practice of high quality care.

They found that self-reflection, being in a teaching role, and practicing mindfulness were common habits of these exemplary physicians. Even more significant contributors to these clinicians’ effectiveness were maintaining a healthy work-life balance and actively working to develop a meaningful connection with the patient.

The authors also found that not only did the connected relationship help the patient, it helped reduce burnout for the clinician!

Clinicians can be taught, and can improve their ability, to show up well for patients, creating a relationship that is truly healing for all involved. Now, let’s give them the training, and the time, to do just that!

About Rev. Dr. Carla Cheatham:

After a career in social services and advanced degrees in Psychology, Health Education, and Divinity, Carla began working in hospice as a chaplain and bereavement coordinator. She now trains healthcare staff on a multitude of topics through her own Carla Cheatham Consulting Group, LLC and is the author of Hospice Whispers: Stories of Life, available in paperback and as an e-book through Amazon and also as an audiobook through Audible. A companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook based on those stories is set to publish Fall 2016. Follow Carla’s writings through her website blog, her guest blog on hospicetimes.com and also on Facebook or on Twitter @CarlaCheatham.

When They’re Holding Out for a Miracle: Healing Conversations

Posted by Carla Cheatham on Tuesday, July 26th, 2016 in Spiritual Care Integrity and Excellence

In the May 2014 issue of Journal of Oncology Practice I was excited to read an article authored by an interdisciplinary team from John Hopkins titled, “AMEN in Challenging Conversations: Bridging the Gaps Between Faith, Hope, and Medicine”. (Cooper, Ferguson, Bodurtha, & Smith, 2014). It’s brief at just under 3 1/2 pages, so I hope you’ll take a moment to read it. I shared it with my hospice team and they loved it!

What do you do when the patient’s prognosis is medically grim but the patient and family are “holding out for a miracle”? The authors discuss a respectful and easy model for all disciplines to use in handling such conversations using the mnemonic “AMEN” (see below).

I’m especially excited to see the chaplain, Rhonda Cooper, as the lead author! We spiritual care counselors often complain about not feeling respected as a valued member of the Interdisciplinary Team.

But respect is to be found as we empower and equip ourselves to support the team in performing their jobs by sharing our unique skill set.

We must BE the chaplain whom they see as clinically relevant and to whom they want to refer.

AMEN stands for Affirm, Meet, Educate, No matter what and is a conversational tool meant to give the provider an outline to remember to affirm the feelings, meet the patient/family where they are, educate about the medical issues, and assure them of the team’s presence and commitment to them.

It is a “Yes, AND” approach rather than “Yes, BUT” and can meet the needs of the patient and family by honoring their feelings, respecting their beliefs, and guaranteeing the provider will be with them every step of the way. We can do this while also upholding the ethical responsibility to deliver the medical facts of the moment and discuss the next steps in the plan of care.

The hospice team with which I work and I had the opportunity to utilize this approach with a beautiful, talented, precious young teenage woman whose family became increasingly desperate for a miracle as the glioblastoma taking over her brain and body was clearly on its way to ending her life. Asking anyone to face their grief and face medical reality is challenging enough when the patient is older, but when it’s a child…UGH!!

We did not want to deny them the faith that was holding them together and meant so much to them. We did not want to disrespect them by pushing and we did not want to disrespect her by not advocating for her comfort and final wishes. It was a dance no one wanted to do and, frankly, it scared the snot out of all of us.

But we did it, even though her mother was completely furious with us for even hinting at the things about which we were ethically required to educate the family. Several of us were “kicked out” one by one until finally it was only the RNCM and CNA who were allowed to cross their threshold.

The whole team communicated and coordinated care and shared ideas and support behind the scenes as these two women walked into a minefield each day. Thankfully, we had an incredibly mature team who was able to not take things personally and was able to avoid pathologizing their emotional and spiritual pain, labeling them as “resistant” or “crazy”, no matter how hard things became (you can follow the link to another post about handling grief that appears as conflict and anger).

We affirmed their feelings and beliefs. We met them wherever they were each visit. We educated gently but clearly and firmly (that was the hardest part). And we reassured them that they would not have to do this alone because we would be with them every step of the way. And we were, as much as they would allow us.

Almost 2 years after this sweet child died, I ran into her mother in the frozen foods section grocery store shopping for what was needed to make Christmas dinner. I realized I was holding my breath as she tried to place me (in running cap and and clothes, I look a little different!), wondering how she would respond. She asked how she knew me. I finally, softly, reminded her. Her arms flew around my neck as she grasped me and gushed her heartfelt thanks for our patience and unfailing love throughout a sticky, to say the least, situation.

Listening to her share her heart and what it was like to be her on the receiving end, hearing her describe that it was important we kept slowly and gently saying the things that needed to be said, no matter how angry she became, while also affirming her faith and feelings, was a miraculously healing moment for us both.

She had the opportunity to extend thanks she could not at that time. I had the opportunity to lay to rest the one case that had hung over my head for 2 years, wondering if we had done the right thing. It was my favorite present that year.

I often speak about the “sweet spot” between pushing too far and doing too little, neglecting our duties with patients and families in healthcare, especially related to spiritual care. (That series can be found under Guest Articles at HospiceTimes.com). I’m grateful to increasingly hear the “soft skills” of healthcare promoted to (and by) all team members, assisting us in utilizing the research-proven approach of patient-centered communication.

When persons feel heard, validated, understood, and accepted then disagreement about perspectives are much easier to bear.

Connect with my heart and I can more easily accept you disagreeing with my brain.

It can be easy to forget this, and easy to overlook simple techniques that we can all use to connect with patients and families in this way. In a field designed around diagnosis, it can be way too easy to pathologize that which makes us uncomfortable, we do not understand, or for which we feel we do not have time. We may write off patients “praying for a miracle” as delusional or in denial, and it is natural to feel uncomfortable when someone is grieving but acting it out via angry confrontations with staff.

We, the ones with the badges, titles, and uniforms, often forget that we are also human and our own discomfort or “baggage” can get in the way of our truly SEEING the persons with whom we work. Our perception can get cloudy as we label persons in grief as “crazy”, “resistant”, “defiant”, “combative”, etc.

If we can instead see them as well-intentioned humans processing challenging and painful information the best way they can as quickly as they can, and as fellow human beings who deserve our patience, respect, affirmation, and honest connection that still tells the truth, it is the single most ethical, compassionate, and healing thing we could ever do as professionals.

It is a delicate line, but it is possible, and chaplains are well-suited to help lead the way for our colleagues in maintaining that balance.

And so may it be…AMEN.

About Rev. Dr. Carla Cheatham:

After a career in social services and advanced degrees in Psychology, Health Education, and Divinity, Carla began working in hospice. She trains healthcare staff on a multitude of topics through her own Carla Cheatham Consulting Group, LLC and is the author of Hospice Whispers: Stories of Life, available in paperback and as an e-book through Amazon and also as an audiobook through Audible. A companion volume, Sharing Our Stories: A Hospice Whispers Grief Support Workbook based on those stories is set to publish August 2016. Follow Carla’s writings through her website blog and also on Facebook or on Twitter @CarlaCheatham.