Creating a Sacred Space: Compassionate Listening in Serous Illness and End of Life Care
Phylliss M. Chappell, MD, MS, FAAHPM, Houston Methodist Hospital
"Listening creates a holy silence." (Remen, 1996. Page 220) It "creates sanctuary" for the parts of the soul and the heart that "too often go homeless." (Remen, 1996. Page 219)
Through stories, reflections, and art, this presentation will demonstrate the profound impact of listening to patients and families facing serious illness.
Compassion has been defined as awareness of suffering and acting or feeling motivated to help – motivated to prevent or palliate suffering. Suffering can be isolating, and seriously ill patients and their families can feel alone. Compassionately bearing witness to the suffering of another can create a deep connection and reassure them that they are not alone.
Through compassionate listening, a palliative care physician understood that the goals of care for a young man dying of an aggressive glial tumor had more to do with marrying his beloved than with the details of transitioning from tumor-directed to comfort-centered care. Moreover, through the palliative care team's compassionate response, working with others in the hospital and the community, the groom entered a decorated and softly lit hospital chapel in a wheelchair. He was slumped to one side as a result of the tumor ravaging his brain, yet he beamed with joy as he prepared to enter into a sacred union with his "best friend." The ceremony was heartbreakingly beautiful as the bride wept with joy and anticipatory grief while she walked down the aisle. Though we all knew that through death, they would soon part, the groom said with conviction that he felt "like the luckiest man in the world."
An elderly man with advanced chronic obstructive lung disease—dyspneic, frail, and refractory to treatment—insisted against the healthcare team's recommendations on continuing all aggressive therapies to prolong his life. With persistence and compassionate listening, the palliative care nurse learned that the patient and his wife were raising their grandchildren, and he "just wanted to see his baby graduate." With the assistance of the hospital and high school staff, a high school graduation ceremony was held at the patient's bedside for his young granddaughter. With his goal accomplished, he died peacefully the following day.
The trust engendered through compassionate listening may allow the heart's wishes and longings to be heard, unearthing what is deeply valued by patients and their families and revealing what brings quality and meaning to their lives. The act of listening deeply, generously, compassionately is a selfless act that requires setting aside one's own experience to be fully present for another. Compassionate listening facilitates connection, understanding, trust, and shared decision-making. (Meldrum, 2011)
The suffering soul "wants to be witnessed," wrote Quaker elder and educator Parker Palmer, "be seen, heard and companioned exactly as it is. When we make that kind of deep bow to the soul of a suffering person, our respect reinforces the soul's healing resources." (Palmer, 2016)
Dr. Rachel Remen describes listening as "the oldest and perhaps the most powerful tool of healing." (Remen, 1996. Page 219) Silently listening and holding a compassionate space for the suffering of others offers solace and the reassurance that they are not alone. Compassionate listening is essential to the art of palliating the suffering of seriously ill patients and their families.
The "holy silence" created through compassionate listening may allow the soul's wishes and longings to be heard, unearthing what is sacred to patients and their families and revealing what brings meaning to their lives.
References
1. Chappell PM, Woodbury C. Wish of a Young Failing Heart: Compassionate Listening in Palliative Care [published online ahead of print, 2021 Jan 15]. J Pain Symptom Manage. 2021; S0885-3924(21)00006-3. doi:10.1016/j.jpainsymman.2021.01.001
2. Remen RN. Kitchen Table Wisdom Stories That Heal. New York: Riverhead Books The Penguin Group; 1996, 2000
3. Meldrum H. The Listening Practices of Exemplary Physicians. International Journal of Listening. 2011; 25(3): 145-160, DOI: 10.1080/10904018.2011.604603
4. Palmer PJ. The Gift of Presence, The Perils of Advice. On Being. https://onbeing.org/blog/the-gift-of-presence-the-perils-of-advice/. Published April 27, 2016. Accessed November 27, 2020.
Through stories, reflections, and art, this presentation will demonstrate the profound impact of listening to patients and families facing serious illness.
Compassion has been defined as awareness of suffering and acting or feeling motivated to help – motivated to prevent or palliate suffering. Suffering can be isolating, and seriously ill patients and their families can feel alone. Compassionately bearing witness to the suffering of another can create a deep connection and reassure them that they are not alone.
Through compassionate listening, a palliative care physician understood that the goals of care for a young man dying of an aggressive glial tumor had more to do with marrying his beloved than with the details of transitioning from tumor-directed to comfort-centered care. Moreover, through the palliative care team's compassionate response, working with others in the hospital and the community, the groom entered a decorated and softly lit hospital chapel in a wheelchair. He was slumped to one side as a result of the tumor ravaging his brain, yet he beamed with joy as he prepared to enter into a sacred union with his "best friend." The ceremony was heartbreakingly beautiful as the bride wept with joy and anticipatory grief while she walked down the aisle. Though we all knew that through death, they would soon part, the groom said with conviction that he felt "like the luckiest man in the world."
An elderly man with advanced chronic obstructive lung disease—dyspneic, frail, and refractory to treatment—insisted against the healthcare team's recommendations on continuing all aggressive therapies to prolong his life. With persistence and compassionate listening, the palliative care nurse learned that the patient and his wife were raising their grandchildren, and he "just wanted to see his baby graduate." With the assistance of the hospital and high school staff, a high school graduation ceremony was held at the patient's bedside for his young granddaughter. With his goal accomplished, he died peacefully the following day.
The trust engendered through compassionate listening may allow the heart's wishes and longings to be heard, unearthing what is deeply valued by patients and their families and revealing what brings quality and meaning to their lives. The act of listening deeply, generously, compassionately is a selfless act that requires setting aside one's own experience to be fully present for another. Compassionate listening facilitates connection, understanding, trust, and shared decision-making. (Meldrum, 2011)
The suffering soul "wants to be witnessed," wrote Quaker elder and educator Parker Palmer, "be seen, heard and companioned exactly as it is. When we make that kind of deep bow to the soul of a suffering person, our respect reinforces the soul's healing resources." (Palmer, 2016)
Dr. Rachel Remen describes listening as "the oldest and perhaps the most powerful tool of healing." (Remen, 1996. Page 219) Silently listening and holding a compassionate space for the suffering of others offers solace and the reassurance that they are not alone. Compassionate listening is essential to the art of palliating the suffering of seriously ill patients and their families.
The "holy silence" created through compassionate listening may allow the soul's wishes and longings to be heard, unearthing what is sacred to patients and their families and revealing what brings meaning to their lives.
References
1. Chappell PM, Woodbury C. Wish of a Young Failing Heart: Compassionate Listening in Palliative Care [published online ahead of print, 2021 Jan 15]. J Pain Symptom Manage. 2021; S0885-3924(21)00006-3. doi:10.1016/j.jpainsymman.2021.01.001
2. Remen RN. Kitchen Table Wisdom Stories That Heal. New York: Riverhead Books The Penguin Group; 1996, 2000
3. Meldrum H. The Listening Practices of Exemplary Physicians. International Journal of Listening. 2011; 25(3): 145-160, DOI: 10.1080/10904018.2011.604603
4. Palmer PJ. The Gift of Presence, The Perils of Advice. On Being. https://onbeing.org/blog/the-gift-of-presence-the-perils-of-advice/. Published April 27, 2016. Accessed November 27, 2020.