INTUITION AND THE CARE-GIVER
Over the years, I attended many a lecture on education, on obtaining employment, and yes, even on palliative care or hospice care, where the speaker emphasized that 85% of communication is non-verbal. Even in the realm of verbal communications, people do not always, “Say what they mean,” or “Mean what they say.” So what quality or aptitude can be depended upon to help us truly understand what others are conveying, consciously or unconsciously, verbally or non-verbally. I nominate “Intuition,” as a chief requisite for comprehension of the human condition in all its manifestations. And this quality or aptitude is so needed where care-givers are committed to dealing with persons who are nearing death.
I once heard an eminent nurse, whose specialty was palliative care, say this: “We walk with our patients, eye to eye, ear to ear, shoulder to shoulder, and heart to heart.” Intuition under girds the “heart to heart” communication between care-giver and patient.
Elisabeth Kubler-Ross, in her writings and lectures, and in the workshop I attended which she conducted 22 years ago, stresses the emotional and spiritual aspects of persons facing death. As a care-giver, to deal adequately with these aspects, one must hone a developing capacity for intuition.
The “Body-language” of a patient, even of one confined to a chair or bed, is significant for what it may tell us of the mental stage that patient is in on that particular day. If we enter the room and the patient is reading or crocheting or doing a crossword puzzle, we can ascertain that he or she is still somewhat “engaged” with life and learning. If the patient is staring at the television or listening to music or glancing out a window, chances are the television and music and window view offer a background for the wandering of the mind, for introspection or for contemplation of the fragile situation of impending death. Then there is the patient who says nothing, but turns away when the care-giver or others enter the room. Wordlessly, that gesture says volumes: “I can’t deal with seeing or talking to anyone just now. Leave me alone.” And verbal and non-verbal requests must be respected and acknowledged. The intuitive care-giver never takes this “brush-off” personally.
Doctors, nurses, therapists and care-givers, who pick up on the non-verbal clues of patient behavior and acknowledge them, provide hope in any circumstances. The patient can then say to himself or herself, “Whew! This person understands me and where I am at today.” Six years ago, I had my hip replaced by a wonderful and world-class surgeon. I was making a good recovery, having plenty of rehabilitation in the hospital, but when the surgeon entered my room one morning I was still in bed. He took one look at me, smiled and said, “Oh, lipstick, --that’s a good sign!” That simple six-word acknowledgement that I was “on the mend” just “made my day,” and if I remember, I worked even harder during the afternoon rehabilitation session.
Perhaps the most beautiful and dramatic episode of exercising intuition, in working with a patient, occurred for me about a decade ago. On a regular basis I served as a palliative care volunteer in two hospitals of a small city. I visited with patients once or twice a week. But my husband and I also left our names for emergency or “overnight” situations where a volunteer’s presence was needed. I was called by the Pastoral Care Coordinator of a hospital which did not use palliative care volunteers as such. There was an elderly woman patient in that hospital who screamed every night after evening medications had been given and could not seem to sleep or find peace. She was about eighty-two, frail and terminally ill. The Pastoral Care Coordinator asked me to come and be with her at night.
I came in at eleven each night, when the nurses were changing shifts, and I sat by her bedside and just chatted with her. Over the course of several nights, I learned the life story of the patient. She had been the wife of a man who went overseas to serve in the Canadian armed forces during World War II. He returned from wartime, and unbeknownst to her, brought another wife for whom he established a home in Toronto, almost two hundred miles distant. When my elderly patient had discovered the bigamy in 1947, she did an unusual thing for that era. She divorced her husband, never remarried and took up a career as a legal secretary. In that capacity, she worked successfully until retirement age. In her personal history, sad as it was in some ways, I could find no apparent reason for her terror and anguish as the time for sleeping came each night. The nighttimes I spent at her bedside there had been no screaming.
One night, in the second week of my “overnights” with this dear lady, it was about three a.m. and I was very sleepy, and hoped my patient would nod off for a bit so that I could just catch a little nap in the “Cadillac chair” I occupied at her bedside. Half-asleep, I just brought the words, “Your father,” into the conversation. Immediately she became noticeably agitated and I became wide-awake! Perhaps these two words were a clue to her night-time terror. Ever so gently, listening to my intuition, I probed her distress at the mention of her “father.”
I learned that my patient had grown-up on a farm, one of several sisters. Eventually, I asked point-blank, “Did your father ever ‘bother’ you?” She nodded yes. The next question: “Where did this take place?” “In the barn,” was her reply. Then I queried, “Did you ever tell any one about this? Did it happen to your sisters, do you know?” She answered “no” to both these questions. I was to learn she had been about seven when “It” happened the first time.
We sat there quietly for a little while and her agitation diminished perceptibly. Finally I said to her very slowly and very deliberately, “Well you know, my dear, you were not to blame!” I shall never forget the calmness of her face and voice as she kept repeating over and over, “I was not to blame. I was not to blame.” She was almost radiant with relief.
Soon thereafter she fell asleep peacefully. When I left the hospital at seven a.m., I told the charge nurse, “I am almost certain you will have no more difficulty with this patient at bedtimes.” And it was true. There was no more screaming. The next day she went into a coma state and died shortly thereafter. Her brother-in-law wrote a note of thanks for whomever had helped to provide her “Peace at the last.” (Cardinal Newman) What a privilege for me to have eased an inner pain and turmoil that had haunted this precious human being for seventy-five years! I count this experience as a defining moment in my twenty-four years as a palliative and hospice care volunteer. And I give the credit to the cardinal rule of hospice and palliative care volunteering, “Come with no agenda of any kind, but always with open ears, open eyes and an open heart.” In other words, exercise your intuition!