Thanksgiving For Sweet Nothings

Living in Texas, I am blessed to rub elbows with the Mexican culture. No matter how hard I try, it seems impossible for me to learn Spanish, but I still love their language. When someone thanks me, I say, “You’re welcome.” Thank a Mexican and you’re likely to hear, “De nada.” It’s nothing.

When I’m shown a kindness, I find myself overwhelmed with gratitude. When I do the same for someone else, it seems like such a pittance. De nada; it’s nothing.

For a time I trained new hospice staff, and in those sessions I would sometimes ask them to pick a partner and provide a brief neck and shoulder massage. Then I would ask two questions. Of the recipients I would ask, “Now, how do you feel about your partner?” They always responded with the most effusive praise. Of the practitioners of the massage, I would ask, “How do you feel about what you’ve just done?” They always responded with some version of, “It was nothing.” De nada.

I think about this paradox often, because I see recipients of care who suffer from the lack of reciprocity in their relationship with caregivers. They feel like they receive such a bounty and have nothing to give in return. When we receive a gift, we just naturally want to respond in kind.

One of the most important things we can do for the suffering people in our lives is to be mindful of this imbalance, surface their fruitfulness and receive what they have to offer. Every person carries non-material treasures, sometimes long forgotten, that can enrich the lives of those around them. Capture stories, recipes, old-fashioned know-how from your loved ones while you can. And when you thank them, they will likely respond, “It’s nothing.”


Breaking Bad News

I heard a joke about a man who asked his neighbor to watch over his household while he took his wife on vacation. When he returned, his neighbor was waiting in the driveway.

“How’s it going?” the man asked.

“You’re cat died,” the neighbor replied, nonchalantly.

“That’s not how you break bad news!” the man screamed. “What is wrong with you? Any idiot knows you don’t just blurt it out like that.”

“What do you want me to say?”

“Say, ‘You’re cat got on the roof. We tried everything to get her down, but no luck. We even called the fire department. Still no luck. We put food up there but the cat wouldn’t touch it. Despite our best efforts, I’m sorry to tell you that your cat died.’ That’s how it’s done!”

The neighbor was appropriately chastised.

“How’s my mom?” the man asked.

“Well…Your mom got on the roof…”

Breaking bad news gracefully is a learned skill. In his wonderful book, “How to Break Bad News: A Guide for Health Care Professionals”, Dr. Robert Buckman gives advice that has helped me immensely in this area.

First of all, get it straight in your mind what needs to be said and how you’re going to say it. It’s a good idea to practice. Then, if possible, arrange for privacy. (Sometimes bad news has to be shared over the phone, and it can’t be helped.)

You should always preface the news with a warning, because getting blind-sided amplifies the pain. In my family, if the news comes through a phone call, this is done by asking, “Are you sitting down?” If the news is shared in person, we are told to sit down. This always makes me mad, and I refuse to sit down, but it serves the purpose. I know bad news is coming and I brace myself for it.

The next step is to share the bad news. It should be done as gently and simply as possible. After that, people need the space to express feelings. Standing by, helpless, as someone comes to grips with bad news is a very uncomfortable place to be. But it’s important to allow them to grieve in their own way.

Finally, you need to let them know what happens next; what, if anything, needs to be done in the immediate future.

So, to summarize:

1. Prepare

2. Choose an appropriate setting

3. Give a warning

4. Share the news

5. Allow space for the expression of emotions

6. Share next steps, if any

Breaking bad news is never easy, but we all get better with experience. Approaching the task with a solid plan, gentleness and compassion makes even terrible news a little easier to bear.




Health Care Grudges

When I meet someone who seems to have a chip on their shoulder regarding health care and health care professionals, I think of my husband. He is the worst patient in the universe, and this is directly related to an old grudge. My husband resents a particular hospital, and all hospitals by association, because he had to deliver his own baby. (He tried to tell them the baby was coming!) When he went to check his wife out of the hospital, he expected to get a refund. Instead he got a bill for several hundred dollars more. “What are you billing me for?” he demanded. “Well, we had to clean up, and stuff,” the child at the desk reasoned.  (No doubt she was wearing a nurse’s suit). He’s been holding this grudge for over thirty years!

Every health care outing is a grave adventure with this man. His grudge makes caring for him a monumental task, and as much as the staff suffers from his attitude, it hurts him even more.

Thank God it doesn’t happen often, but when I do have to navigate the health care system with him and his gigantic grudge, it makes me a better nurse. Thanks to him, I can spot a health care grudge holder a mile away, and I know how important it is to tread softly and listen well when I meet one.

Health care offenses leave psychic wounds that remain tender for years and even decades. We all have a soft spot there because of our helplessness when we hand ourselves, or our loved ones, over to mere mortals for healing. Humans make mistakes. Also, as much as we wish it weren’t true, there is no guarantee of a perfect outcome. But more often the grudge is born of the arrogance of practitioners who don’t listen to us. And it happens all the time.

My aunt takes her mother-in-law, who is in her nineties, to get injections in her eye (?!?). This has become a routine; the assistant comes in, numbs the eye, and the doctor follows shortly after, and performs the injection.

One morning, when things were hectic in the office, the assistant failed to do her part. The doctor swaggered in and prepared to give the injection. The old woman objected, “My eye hasn’t been numbed yet.”

“Yes it has,” the doctor said, without looking up from his preparations.

“No, her eye has not been numbed,” my aunt verified.

“Yes it has,” the doctor said, and then plunged a needle into the poor woman’s eye, eliciting a scream that would wake the dead.

Reportedly, the doctor was sorry about the whole thing. The old woman was much sorrier. But get this – she’s still going to him for eye injections! (Personally, I’d find another place to get my eye poked with needles, or give it up altogether as a bad habit.) Now that’s a woman who has learned how to forgive!