Written by Michelle O’Rourke
Much is written about the ‘science’ of good palliative care. This includes elements of pain and symptom management, principles of disease management, and an understanding of the psychological and social implications for the patient and their loved ones with regards to loss and grief. We would all agree that it is important for palliative care to be evidence-based and focused.
However, our skill building must not only focus on the scientific realm. The ‘art’ of palliative care includes how we offer an active, listening presence in all of our care encounters. After spending many years working as a nurse in critical care and emergency, I was drawn into the world of palliative care and soon found out that offering a palliative approach to care was not about fixing or curing, but about presence and accompaniment.
Along the way I discovered the writings of Henri J.M. Nouwen, a Dutch priest and spiritual writer who was also well versed in psychology and pastoral care. Henri lived from 1932 to 1996, writing close to 40 books during his lifetime. He taught at prestigious universities including Yale and Harvard, and lived the last 10 years of his life in Canada, in a L’Arche community north of Toronto, living with adults with developmental disabilities. There he became a caregiver as well as a pastor, and after almost dying in a car accident, took time to reflect on his own mortality. The questions he posed about dying intrigued me and encouraged me to learn more.
Dying is the most general human event, something we all have to do. But do we do it well? Is our death more than an unavoidable fate that we simply wish would not be? Can it somehow become an act of fulfillment, perhaps more human than any other human act.
… Is it possible to befriend our dying gradually and live open to it, trusting that we have nothing to fear? Is it possible to prepare for our death with the same attentiveness that our parents had in preparing for our birth? Can we wait for our death as for a friend who wants to welcome us home?
Henri Nouwen: Our Greatest Gift
It seems indeed important that we face death before we are in any real danger of dying and reflect on our mortality before all our conscious and unconscious energy is directed to the struggle to survive. It is important to be prepared for death, very important; but if we start thinking about it only when we are terminally ill, our reflections will not give us the support we need.
Henri Nouwen: A Letter of Consolation
How could I help people prepare for their own dying? I learned that reflecting on life’s questions for myself, and being more self-aware in regards to my own beliefs and biases was the place to start. Henri also inspired me to think about how I was called to be present with those I cared for, even when I couldn’t fix or cure. Healing takes many forms, and total pain includes many elements besides the physical ones. My ability to listen deeply and not be afraid of the difficult questions became important. Again, Henri helped me to learn more about suffering and compassion.
Compassion is hard because it requires the inner disposition to go with others to the place where they are weak, vulnerable, lonely and broken. But this is not our spontaneous response to suffering. What we desire most is to do away with suffering by fleeing from it or finding a quick cure for it… And so we ignore our greatest gift, which is our ability to enter into solidarity with those who suffer.
Henri Nouwen: The Way of the Heart
Throughout my palliative career, which continues in my retirement as I journey with friends and loved ones, I have been inspired and refreshed not only the writings of Henri, but of others – including Pema Chodron, Ira Byock and Rachel Naomi Remen. Their words remind me of the importance of presence and deep listening, despite my nursing intuition to fix and cure!
The inner life is always a life for others.
When I myself am able to befriend death,
I will be able to help others do the same.
Henri Nouwen
