Is Presence in the Past?
After 17 years as an oncology nurse in a variety of professional roles, I completed my master’s degree in nursing and worked in collaborative practice in medical oncology. Throughout my clinical years, I witnessed countless patients and their loved ones grapple with the “CANCER” diagnosis, the multidimensional treatment strategies, adverse events therein, changes in appearance and role, quality of life struggles, recurrence, progression, and threatened mortality.
Regardless of race, ethnicity, age, creed, sexual orientation, economic, educational, or social status, this diagnosis could transport the most stable and grounded person to a new dimension.
I am completely fascinated by the range of human responses expressed in fear, anger, and sadness juxtaposed to courage, calm, strength and hope.
My childhood religious faith was troubled by questions and confusion as I tried to relate it to real-world experiences. I found myself seeking spirituality in my life and its role in caring for patients as well as my role as a provider.
I began attending a yearly conference focusing on spirituality in healthcare, established through the efforts of Dr. Christina Puchalski, founder and director of the George Washington Institute for Spirituality & Health (GWish). I learned the value of “compassionate presence.” It meant serving their agenda not mine.
How would I sit compassionately with the patient in front of me setting aside, at least for a moment, a review of the medication list, rating lab results, ticking off the review of symptoms or refilling prescriptions or an unexpected patient arriving in crisis?
It can be done. Not always as perfectly, or as long as desired, but it can be done even if it takes me out of my comfort zone.
I work in a per diem capacity in medical oncology, covering other APs during vacation, maternity leave, FMLA or where there are vacancies. I often meet patients only once. On one occasion, I entered the exam room to meet a patient accompanied by her husband. Their primary language was Spanish however both understood English, perhaps the patient less so than her husband. I told them that I spoke little Spanish. They nodded saying that was OK. The patient was wearing a necklace of the Blessed Mother. I shared with her that I was born on the Blessed Mother’s birthday and that my mother had prayed to her often.
I said that the only prayer I remembered in Spanish was the Hail Mary. They both smiled broadly. I asked if it would be OK if we prayed together before beginning the appointment. We held hands and I recited the prayer in Spanish. Months later, she presented to the oncology urgent care clinic. Her appearance had changed so dramatically I did not recall her. She was accompanied by her son, who presented her history. I was able to manage her symptoms and she was discharged to home.
I wheeled her to the lobby where a car occupied by her husband and other son was waiting to pick her up. Her husband greeted me knowingly and began speaking in Spanish to his son. He told his son that I had cared for his mother previously and that I prayed with them. He told his son how much that meant to them. I was embarrassed that I hadn’t remembered that encounter sooner but grateful that my compassionate presence was remembered and valued.
Compassionate presence can look different with each encounter. I was able to draw on childhood learnings to offer an encounter that may be meaningful to a patient and her husband.
I know my fellow APs and I could share countless stories of our presence with patients. They enrich us and keep us moving forward. I challenge my fellow APs to continue to explore the opening for compassionate presence that is not taught but is inherently within us, waiting to be embraced and shared.