I have often been treated better: more warmly, more kindly, more humorously, more respectfully, more affirmatively - and acknowledged as a real person - by the man or woman who is mopping the floor in the hospital room.
And so have the elderly patients with whom I have shared a hospital room. Many of whom carry on delightful, animated conversations in response to gentle entreaties and lighthearted banter. They are laid back, easy and real ... until the technician, or clinician, or caregiver arrives with their blinders on and their singular focus...
What is the "quality of life" experience there.. in that moment, that is so comforting, relaxed, and reassuring - and often, sadly, is not present in more uptight caregiving or clinical encounters? I think there are two issues. First, there is no pretense - no mask. Folks are acknowledged; taken and offered as they are; Second, there are no aloof walls of assumptions presumptions, minds full of charts and schedules - no hidden agendas.
There are no clear signals of let down your guard discomfort - not among the patients ... who have little guard and urinary privacy left to let down - but among the caregivers and clinicians.
My hunch is, having had wonderful encounters with family members, technicians, nurses, nurse practitioners, and physicians; that it has to do with how comfortable these folks are with themselves. Yet, in conversations, many have said that it was not always that way.
So here is the good news. It's apparently all learned behavior. It's not about manipulating the patient or putting on false fronts. It's about taking the opportunity to learn to be present, real, and deeply in touch with yourself ... who you are... who the patient is (not a nagging mother, or a remote father, or a diagnosis, or a procedure).
And in that existential moment, one chooses to be there, fully present and accounted for - that's where the phrase - attending physician, really comes from.
Maybe it should really be "the paying attention caregiver"; the relaxed, being herself/himself care giver. By doing that, the caregiver also gives permission for the patient to be herself or himself ... to be relaxed, appreciated, acknowledged, to let go and be an intrinsic part of the conversation. In both boxing and Tai Chi, they call it telegraphing your punches.
What you get when you do this, is a present and accounted for dialog like the attendant - not a monologue. Patients can instantly tell the difference. A recent study of animal behavior shows that most animals from mice to fish can detect pheromones of fear, anger, anxiety, and even impending death. Just like the cat at a New England nursing home - whom the staff has learned to trust when calling the family - who only visits patients who are about to die.
Maybe there is a hurried caregiving or clinical equivalent. Perhaps we are sensitive the the pheromones of hastily applied hand sanitizer or makeup, or a quick trip from the office, which fails to mask the anxiety of too many demands, too many patients, and too little time before office hours, as they rush from room to room, or house to office to hospital and home again.
Perhaps they could take a lesson from Barbara, the second wife of Miles Standish, the uptight Puritanical leader of the Plymouth Colony, who said to him, "Don't be so standoffish, Miles!"
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