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On Care for the Caregiver Professionals in Palliative Care Nursing (I of II)

Posted by: Corry Roach on 4/30/2009

 Many years ago, I was asked to deliver two sequential workshops to health care professionals who wanted to become involved in patient care for a palliative unit that was being created. I was asked to instruct them in how, as caregivers, to assist the mourning process for the dying patient and their families.

 

 I requested no more than 15 participants, as I wanted to have a meaningful, personal encounter with each potential caregiver within the instructional setting. Although I heard their request regarding workshop content, my strategy of approach was perhaps a bit devious. However, I knew with certainty that I would have a clear commitment of dedication from the caregivers who would see my strategy through.

 

My approach is usually not to teach about grief work, but rather get into the thick of it and actually assist people to do their own personal grief work. We must heal from the inside out, and understand our own grief experiences before we can assist others in that process. The exercises I proposed would bring personal insight for each caregiver. Then, as wounded healers, their ability to be present with their terminally ill patients would be authentic and without fear. I wanted to assure the comfort of the caregivers as well as the patients with the topic of end of life care.

 

To that end, each caregiver must clearly understand their motivation, intention and commitment to palliative care, and they must be acquainted and established with their own grief journey. After all, talking about someone else’s grief experience is so much easier than having to look inside our own unfinished business! From experience, my suspicion was that work needed to be done, both on professional and personal levels with these participants.

 

My first surprise was the 47 eager faces who awaited me that first morning, with notebooks at the ready and pens poised.Having long since learned to deal with unexpected situations; I changed my strategy on the fly. What an honour to see such an interest in this field! I still had the intention of teaching through the experiential process, however; I just had to allow for its ‘blooming’ in a more informal, yet totally safe environment.

 

After introductions all around, my first question of them was, “How many of you know you are grieving?”

 

Only one lady raised a tentative hand, and shared that her son was killed in a motorcycle accident 3 months earlier. Forty six others did not acknowledge their grief awareness in any way. They also no longer made eye contact, instead looking at the floor. I watched how they responded to my dialogue with the grieving mother, and I noted this was going to be an interesting day for all of us!

 

I then moved into everyone telling us what their interest was in palliative care, their perceived strengths and weaknesses, and why they thought they wanted to be part of this experience for so many dear patients who were terminally ill and their families.

 

“What are you bringing to the table?” I wanted to know. “Why should you be working here? What qualifies you over someone else?”

 

After heavy silence in the room, I noted someone hugging the bereaved mother as they offered her a tissue. I commented on the strategically placed boxes of tissues in the room, and that I had more in my vehicle if we ran out. The laughter broke the ice as we got down to work.

 

Without fail, each person shared a story or memory of personal loss that affected them deeply. They were saddened, or frightened or disgusted or angered or betrayed by what they had experienced and seen, yet not one of them realized that their personal unfinished business around death had brought them here on this day for a workshop in palliative care.

 

 I shared with them a saying Dr Elisabeth Kubler Ross once told me: “My dear, you must bless those who remind you of your unfinished business; it is an opportunity to grow.” I commented on how annoyed I felt at times when she’d say this to me, because she was right.

 

I also noted I was feeling very blessed in this moment with them, and the laughter moved us on again. I love the emotion of laughter through tears, and see so much of it in this work. A well oiled sense of humor is so necessary in these situations.

 

We then learned about healthy vs unhealthy grieving, and how their differences can be identified. We learned about all the different ways we hide our pain of grief, from denial to addictions to violence to avoidance to depression to bitterness to… well, you get the idea.

 

We then created the opportunity of experiential sharing of issues that led them to this day with us. It was a holy place of healing that day, and we went through many boxes of tissues. I facilitated their grief work, keeping them and the others in the room safe, especially when some tried to leave in their attempts to avoid dealing with their deep emotional pain. What courage they had!

 

By mid afternoon, my participants were exhausted and mellow, with a serene glow in their tired faces that I’ve seen many times, yet it remains difficult to describe.  Perhaps we could call it inner peace of surrender and forgiveness? In this serene space, we were gently able to discuss the importance of care for the caregiver, and how they could clearly now appreciate why the issue of burnout is so prevalent and unnecessary in caregivers.

 

In closing, I asked them what they had learned, and their responses were amazing and humbling. Some felt alive for the first time in many, many years. Some could find no words, but simply held up their hands in a gesture of mute gratitude for what they were experiencing in the room in that moment. Some of them realized that they were feeling completely different about their role in caring for the dying. They didn’t want to fix anyone anymore, because no one was broken!

 

 Death was no longer viewed as a failure of intervention by a health care team. They now felt honest about what they could offer as support to patients and families of the dying.

 

There were some participants who espoused fundamental religious practises, and they were most remarkable in their change in attitude. Where they had initially been fervent and judgmental in their desire to change patients who were non believers or of another faith, they now became humble and gentle in their desire to serve their fellow man without judgment, regardless of their belief system. They expressed a view that death was a sacred thing, not to be feared, but embraced with quiet peace and grace. Some openly wept in gratitude for their spiritual experience of transformation, insight and meaning in their work.

 

“Now, how many of you know you are grieving?”  I asked again, at the close of that day’s workshop.

There was a shout of laughter followed by everyone bursting into applause. Then they all raised their hands!

 

 

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4 Comments

    • May 20 2009, 9:44 PM Mary Jane Hurley Brant
    • Thank you, Corry, for sharing about this healing talk. It sounds as though everyone left more whole, held and comforted. I was sent your site's link from one of my best friends. She said you and I had something in common. Yes, the loss of a beloved child. I am sorry for the loss of your little angel.Yes, this place of mourning. This place that stretches out to gather up other broken hearts. John O'Donohue, the wild Irish philosopher, himself taken from this world prematurely - wrote in his beautiful book, Anam Cara, that something breaks within us that will never come together again. Personally, that is true for me and for most people I know who have suffered a deep loss; a child being the hardest blow to stand up from. My belief is that death focuses one's eyes more on heaven, less on earth. Not a bad thing overall.Our Katie died in the summer of 1999. She had brain tumors for ten years. Some years very bad and some good. She never stopped living nor laughing. For me it was 10 minutes ago and ten lifetimes ago because the psyche does not keep track of time the way we humans often do. I live in a time gap now. It's one of the ways I can help other people because I do not focus on my time apart from Katie. I recommend that practical tool for surviving loss more than any other. That and surrounding oneself with loving people, only those whose hearts have been pierced enough to let the love, as blood, flow in and out. Blessings on your beautiful work. I'll be back if you'll have me. With compassion,Mary Jane Hurley Brant, M.S., CGP, author of When Every Day Matters:A Mother's Memoir on Love, Loss and Life
      Simple Abundance Press, Oct. 1, 2008 http://www.WhenEveryDayMatters.com

    • May 06 2009, 7:53 PM Corry
    • Hello, Katie's mom! Thank you for your kind comments...Time moves so freely in mourning, doesn't it? I think that which breaks, and never comes together again, is the need for superficiality in life. I also recall Hemingway's comment as a bereaved father: Life breaks us, and we are left stronger in the broken places. In a poem I wrote about my sister, who died last year in May of cancer,(blog Sept 08, called In the Quiet) I talk about the footprints they leave on our hearts that make them live forever. I can only hope this work I do creates a legacy worthy of their bright spirits when they were here with us. When they are in our bones and our soul, I agree we don't focus on our time away from them, and yet, it takes hard work to come to that place of peace.I most surely appreciate your beautiful and meaningful thoughts and feelings; please come again! Blessings,Corry

    • May 20 2009, 9:41 PM Mary Jane Hurley Brant
    • Well, Corry,We have another loss in common and similarly timed: your sister a year ago this May and my sister a year ago in January. Yes, Hemingway, there was a family with great suffering but the richness of their writing life will last forever.I'm just delighted to stop by today and throw my arms around Lindsay's mom. I'll send your link around to the mother's in my Mother's Finding Meaning Again group, too. We meet next Thursday.Mary Jane

    • May 23 2009, 8:29 PM Corry
    • Thanks so much for all you do in care of others, MJ! So appreciate your support as well...See you again! Corry

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