The Power of Being Present

Working with different surgical services in a hospital setting provides the opportunity to meet a wide variety of patients. When I met Sonja, a 50-year-old Spanish-speaking South American woman, living in New York as an illegal immigrant, we were able to communicate well despite having to use a telephone interpreter. Our conversation flowed and she became comfortable and relaxed during the psychosocial assessment. She showed strength in her past, having beaten cancer more than once. Sonja demonstrated much resilience despite the hardships that life had thrown her way.

A few days later after our first meeting, I was getting updates on my patients when I heard the devastating news. Sonja, who had to come into the hospital days prior for an emergency surgery, was just found to have advanced late-stage and aggressive form of cancer.

When I joined the interdisciplinary team to visit Sonja at bedside to tell her the news (with an in person interpreter this time so it was a bit less impersonal), her reaction was what one might expect; tears and overwhelming shock. Because Sonja was so familiar with her previous cancer diagnoses, she was aware that aggressive and late stage malignancies did not have good outcomes. “I don’t want treatment. Look at me; I just want to go home”. She had been so frail and sick for such a long time that one could not blame her for feeling hopeless.

And so, after offering her our sympathies, and suggesting she possibly contact the little family she has close by, the team allowed Sonja some space to herself.

A few hours later I visited Sonja at her bedside to check in on her. She had not had any visitors, as her son was only able to visit in the evening after work. She had been left on her own to start trying to digest this difficult news. I saw it as my job to provide Sonja emotional support so she would not have to be so alone.

I have become most aware of the importance of recognizing power dynamics in these scenarios. Sonja’s hospital room was not ideally set up for me to pull aside a chair to sit with her, so I crouched at her bedside as we spoke. We were eye to eye, as in no way did I want her to feel anymore ‘powerless’ than she probably did at the time.

There was nothing in this situation that I was going to say that would make this patient cancer prognosis better. Prior to entering her room, I was anxious about what was to come, as I knew nothing I could offer her would change the course of her cancer. Realizing that all I had to offer was an ear to listen, my time to spend with her, empathy, care, and support proved to be more helpful to her and rewarding to me than I ever anticipated.

Sonja felt safe in this space we had created which allowed her to cry as she was able to let out her feelings and emotions. She expressed her exhaustion with all that she had gone through, as I listened and acknowledged these frustrations. I sat in silence with her, not daring to rush, rather encouraging her to move at her own pace. For most professionals in hospital work, providing such time to sit with a patient is not a luxury they have. Luckily, as an intern, my caseload is more flexible and was purposefully reduced this day so I could provide Sonja the time she needed.

Sonja asked me what I would choose to do if I were in her situation regarding whether to get treatment or not. I understand why our patients and clients ask us these questions. They ask these questions looking for validation and reassurance that their decisions were right for them. Ultimately, my role is to support the clients’ decisions, as they are the masters of their own lives. But still not fun to explain why it isn’t appropriate.

Michelle:         “Oh… Sonja, I can’t answer that.”

Sonja:              “I know you’re younger than I am, but what do you think you’d do?”

Michelle:         “Even if I was your age. Even if I was from where are from, lived similar lives…”

Sonja:              “Yes but…”

Michelle:         “There is no way to say what I would do if I was in your situation, because I would never be able to imagine what it would be like to live the life you’ve lived.”

I offered to speak with her about the different options, her thoughts about them. Ultimately, as these options were not yet laid out for her yet, I recommended she speak to those who know her best, her family and friends.

Michelle:         “I don’t know a lot about you Sonja. But from what I do know about you, I have learnt that you are an incredibly strong and resilient person.”

Sonja:              “I have suffered a lot.”

Michelle:         “And even more, you have conquered a lot.”

Sonja:              “I have gone through cancer and have beaten it before, I don’t think I can do it again. I don’t think I can do the treatment another time, I’m so sick…”

Michelle:         “And that is absolutely your decision and it is okay to make that choice too.”

Sonja cried and at this time I was kneeling at her bedside. I offered her a hug, which she accepted gratefully. In this sterile, environment where it feels so disconnected to not have contact with other human beings, a touch on the shoulder or a hug can be incredibly powerful. Sonja had spent the entire day of crisis unable to share this with a family member or friend to talk and hold onto; and I truly felt that this hug was the most meaningful, therapeutic moment that I did throughout this session. It was heart wrenching for me, I could truly feel how frail she was at this time. Sonja clung to me and cried into my shoulder. It was hard for me to personally hold back tears until I left her room.

After a long weekend, I visited Sonja one last time to say goodbye, as her medical plan involve being discharged with continued outpatient clinic visits. I spoke to her, asked her how her weekend was. She told me it was filled with family and friends, and that she was feeling a bit better. Although they are few, I was thankful to hear that she has strong supports.

She told me how thankful she has been to have me at her side through this difficult time. She asked me for my personal phone number (which I told her I could not provide, however gave her my name, hospital e-mail address and wrote this down in Spanish – using Google Translate – so that when she comes to the hospital for follow-ups she could have me paged). I told her it was an absolute pleasure to get to know her, and she repeated it back in her own way… our phone interpreter somehow had gotten disconnected, and before I left her for the last time, Sonja surprised me by actually saying in English, “I love you”.

I can’t make this up. It felt like a scene from a movie.

It was a wonderful and powerful experience. By far, this has been the most meaningful interaction I have had in my entire (admittedly, short) career so far as a Social Work intern.

Typically one goes to the hospital to get something physical repaired. You’re sick? Take this antibiotic. Got a cut? I’ll stitch you up. It’s been tricky at times navigating the role of the Social Worker in such a fast paced, ‘get them patched up and send them home’ environment. I have had numerous interactions with patients who truly did not need emotional support and whose work with me consisted strictly on their discharge plans.

However, when a case such as that with Sonja arises, I feel that my specialty of Social Work and these empathic qualifications shine through. For ultimately, in the end for this patient, she did not want the medical ‘fix’. She did not seek the chemotherapy that the medical professionals offered for her terrible diagnosis. Rather, instead she reached out her hand, and what was of value to her, was having the emotional support, a hug, and simply someone to be present with her in that moment. I learned the value in not having an answer, and the power of simply being present.

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