BY: BETH PERRY, RN, PhD
Dr. Perry is associate professor, Centre for Nursing
and Health Studies, Athabasca University, Edmonton, Alberta, Canada.
What does it mean to "live one's mission" as a caregiver in a Catholic health
care institution? During three years I spent as a clinical nurse educator in
a Catholic hospital, I often asked nurses to tell me about those times in their
careers when they felt satisfied that they were fulfilling their calling. I
had originally intended the question to be a professional development exercise.
In asking it, I hoped to help nurses reflect on the underlying values that inspired
and energized their daily work. But I soon became fascinated by the consistency
of the responses.
I collected these "stories," and from them distilled an overarching theme:
These caregivers felt most satisfied when they experienced intimate interactions
with patients (or the patients' family members) that allowed them to make a
difference.
Other writers have seen this. One, D. Irvine, acknowledges the need for "deep
human connection" as a central element in personal fulfillment.1He
explains that this connection "promotes honesty with the truest self, allowing
each of us to develop a deep sense of who we are and to discover the passions
that inspire our lives." In other words, caregivers feel a sense of accomplishment
when they experience the living out of their personal mission. For many such
people, their personal mission in life is understood to be a calling received
from God. I believe that, in observing nurses fulfill their missions, I saw
health care provided in a way that was different from that given in non-faith-based
situations. T. Maddix captures this difference when he says, "What makes us
different . . . lies in why we do what we do. . . . Faith-based organizations
come alive when people feel compelled to make tangible an often distant God
in the very ordinary ways of care, compassion, and attentiveness to the events
of daily life."2 What makes Catholic health care different is the
embracing, upholding, and enacting of a set of values innate to the Catholic
faith.
The values that are part of the daily work of the people I interviewed are
exemplified in several themes: hope at work, compassion at work, creativity
at work, community at work, commitment at work, healing at work, and love at
work.3 I have used each of these themes in organizing the narratives
shared in this article. The stories are presented in the words of the people
who lived the experience. I hope the reader finds them emotive examples of hope,
compassion, creativity, community, commitment, healing, and love. Stories are
especially appropriate in articulating values because they "are the juncture
where facts and feelings meet."4
Hope at Work
But now O Lord, what do I look for?
My hope is in you. —Psalm 39:7
To hope is to believe that something good lies ahead. Hope is necessary for
good quality of life. The fostering of hope is thus an essential element of
excellent caregiving to the sick, including care for those who are seriously
ill or dying. This kind of caregiving was revealed in many stories told to me
by the nurses I worked with. Consider the following story, for example:
"Bill was my patient," one nurse recalled. "As I approached his room, I could
see that he was focusing stoically on the wall, avoiding eye contact with everyone.
His responses to my questions were minimal; all the other staff members were
convinced that Bill's final hours were at hand. I wasn't so sure. I could still
sense a dim light in those lifeless eyes.
"As the day advanced, I made certain I visited Bill often. Although he didn't
respond verbally, I chatted as I went about my nursing tasks, asking him questions
about his life, his home, and his grandchildren. There was no response at first,
but, closer to the end of the shift, he did mumble a few replies.
"As I was finishing the charting for the day, I noticed Bill's birth date
on one of the forms. Amazingly, that day was his 80th birthday. In an impromptu
move, I ordered a small cake from the cafeteria and gathered the staff together.
As we entered the room with the cake in hand, we sang him the most rousing rendition
of 'Happy Birthday' I had ever heard.
"He smiled as we placed the cake on his bedside table. When I leaned over
and gave him a little peck on the forehead, he burst into an outright grin.
The other staff followed my lead and all placed little pecks on his furrowed
brow. Then I saw it—the sparkle had returned to his eyes. Bill had hope."
Caregivers who seek to keep hope alive never give up on anyone; they never
abandon a person who is in need. Our task as caregivers is to meet God in everyone,
even those whom others would say are "hopeless." This emphasis on hope resonates
from the foundational core commitment to the dignity of all persons and the
shared belief that all people, from conception until natural death, are created
in the image and likeness of God.
Compassion at Work
One of the nurses told me about a thank-you note she had received from a patient's
wife.
"You probably don't remember me but I wanted to thank you for your care,"
the wife wrote. "My husband and I had been in a traffic accident. The police
called it a 'minor traffic mishap,' and after being checked over at the hospital
we were both sent home. I was a little shaken and bruised, but we were both
pronounced 'just fine.' As the week progressed, I had a very disturbing dream.
I dreamed that my husband was in the hospital and that he was having a cardiac
arrest. I stood hopelessly by watching the team try to revive my companion.
"Imagine my horror when, later that week, my husband did start to experience
some perplexing symptoms, and after a consult at the emergency room was rushed
into surgery for the removal of a ruptured spleen.
"The time was long as I waited, pacing the hallway outside the operating theater.
I was haunted by the strange dream and terrified that my husband was not going
to make it through the procedure. Then I caught a glimpse of you through the
small window in the door that separated the operating area from the room in
which I waited.
"I think you were the scrub nurse during my husband's operation. You were
in your operating clothes, and all I could see behind the green mask were your
eyes. You must have seen the look of concern on my face. As you whisked about,
you lifted one hand and gave me the A-OK sign, your thumb and pointing finger
forming a circle. This gesture took only a portion of one second, but it was
all I needed to know he was all right. I just wanted to say thank you."
When we address those we care for in a compassionate way, we are acting as
the Lord commanded us to. In His words, "I tell you the truth, anyone who has
faith in me will do what I have been doing" (Jn 14:12). In considering the needs
of others and responding to them, we are making life better for someone else,
but in turn we are also making life better for ourselves. The amazing thing
about compassion is that, when one acts compassionately, peace comes to both
parties, the giver and the one who receives.
Creativity at Work
Finding a way to meet each patient's unique needs often requires a measure
of creativity on the part of caregivers, as the following story demonstrates.
"My patient had an ovarian tumor," a nurse said. "She had a very enlarged
abdomen, and the only type of sleepwear that would fit her was the blue baggy
hospital gown. When I asked her what I could do for her, her only request was
for a pair of pajama bottoms. Her family tried to meet her request, but with
no success. None of the hospital-issue pajamas fit her.
"One day at home I found a few meters of cotton flannel in one of my closets.
I immediately thought of my patient, and quickly cut out and sewed a pair of
pajamas that would adjust to her needs. They were simply made, because I really
don't sew very well, but when I gave them to her you would have thought I had
given her a million dollars. She cried in joy, and her family thanked me over
and over. I know my little project made a huge difference to her. It made me
feel so good."
The nurse's story illustrates the mutual benefits of going a little further
to meet the needs of another. Yet it also shows how the smallest acts of kindness,
presented in the spirit of love for another, can positively alter the human
experience in a dramatic way. The nurses who shared their stories with me were
willing to think creatively, outside the traditional boundaries of organizational
structures, to ensure that the needs of their patients were addressed.
Community at Work
The word "community" usually refers to a way of being together that gives each
person involved a sense of belonging. In a Christian hospital community, people
support each other in a search to bring healing, in its multiple forms, to those
who are in their care. In health care, this shared search is directed toward
healing, nourishing, and enriching the sick. As Ronald Rolheiser says, "Community
is manifest in the touch of human warmth."5 The caregivers I spoke
with felt privileged to be a part of the caregiving community, working with
their colleagues and with God to help healing unfold for their patients. Together,
they were the embodiment of spiritual warmth that could reach the seemingly
unreachable. And, in at least one case I was told about, the efforts of a caregiving
community literally saved a man's life.
"Daniel was a pitiful sight," a nurse said. "His sister called our nursing
unit and pleaded, 'If someone doesn't do something, my brother is going to die.'
Daniel had been passed from doctor to doctor and hospital to hospital, labeled
as psychosomatic and psychotic. We were literally his last hope. When he was
admitted to our medical unit, he turned out to be a rail-thin, 30ish, ghost
of a man who lay in his own excrement screaming for something to numb his pain.
We bathed him and soothed him and gave him his prescribed medications, but Daniel
still called out in agony. Tests showed no cause for his distress; psychology
consults offered us little constructive guidance. Desperate, our team met to
pool ideas; we were grasping at possible solutions. Daniel was dying. Together,
we found our answer in the metaphor of the Wizard of Oz. Like the lion in that
tale, Daniel needed courage. We concluded that we had to help him find that
courage within himself.
"I'm not sure whether it was courage, hope, or some other elusive source of
strength, but over the next 104 days we saw an amazing transformation. Each
of us made an extra effort to stop in and chat with Daniel each day. These visits
were not necessary for the provision of medical or nursing care—they were extra
visits, because we cared about Daniel as a person. The visits were short, just
long enough to say 'hi,' ask about his family, acknowledge his pain, and share
a moment with him. The most important thing about the visits was that they were
consistent and genuine. One day, a nurse brought Daniel a little orange plastic
lion and left it at his bedside, explaining the need for him to have 'lion courage.'
"Slowly, the staff began to notice a change in Daniel. Complaining less frequently
of pain, he began to sit up in bed, interact with staff, and even to take a
few shaky steps in the hallway. By day 105 of his admission, Daniel was well
enough for discharge to a convalescent-care facility. I shed a single tear that
day, a tear of team pride and accomplishment, and smiled as I caught a glimpse
of something orange in Daniel's hand as he waved goodbye. It was the plastic
lion."
"Each one of us is merely a small instrument," wrote Mother Teresa.6
Yet, as we unite together in community, the force of those small instruments
joined together is powerful in doing the work of the Lord.
Commitment at Work
Caregivers often express their commitment to their mission—patient care—through
selfless actions that result in their becoming intimately involved in the lives
of their patients. Exemplary care is provided when there is joint transcendence,
when, that is, care is given and is received in a mutually affirming experience.
Caring is a two-way phenomenon. One human cannot touch another without also
being touched. A physician cannot be the first person to hold a newborn without
sensing the presence of God. A nurse cannot deliver a dying person to the next
life without finding her own life more precious.
Caregivers who are committed to living their missions are open to being changed
by those patient-caregiver encounters. The lessons they learn from these experiences
move them towards being more caring, more compassionate human beings. Commitment
leads to fulfillment as the entwining of two human spirits nurtures both. A
story I heard illustrates this fact.
"Marie was my patient," a nurse named Linda told me. "She had already lost
an arm and shoulder to cancer. Always amazed at how joyful she was, I thought:
This can't be genuine. But it was. I learned that Marie had a lot of support
at home. She was really close to her sister and had a strong religious conviction.
I cared for her often over a period of about two years. Whenever we got new
patients with the same diagnosis, Marie would offer to come and help me teach
them about the disease. Using herself as a model, she would just whip off her
shirt and show them her scars and amputation.
"One day Marie told me that her disease had spread and the doctors wanted
her to try experimental radiation therapy. She had decided to refuse the treatment.
I was stunned. I just kept shaking my head and saying, 'Please give it a try.'
But, for Marie, taking the radiation was wrong. When she saw how upset I was
by her words, she put her good arm around me and said, 'The cancer has spread
too much, Linda. I can't do this any longer. I'm OK. I know I'm going to die
and I am OK with that.' But I was shattered.
"A few weeks later we had a call from the nurses in Marie's town, which is
about two hours' drive from our city. They wanted us to tell them how to look
after Marie at home, so she could stay with her family until the end. I asked
to go teach the nurses what they needed to know. Though I was eight months'
pregnant with my first child, I wanted to do all I could for her.
"About 15 minutes into the teaching session with the nurses, Marie showed
up. She wasn't well. She was thin and pale, but she looked at me and said, 'Here
I am, Linda. I wanted to come today and be your model like I have always been.'
"When the class was over, Marie had to go. Again, I wasn't coping very well
with our goodbye, because I knew it would be our last. Again, she nurtured me.
I will never forget what she said. 'Linda, it's OK,' she said. 'In fact, it's
kind of exciting. Here you are going off on a new journey of motherhood and
I'm off on a journey of my own. We are both going to be just fine.'"
Sometimes commitment hurts. To be truly committed to your patients, you have
to be willing to share their experiences, to walk with them in the good times
and, most especially, in the bad. Still, these caregivers said, it was when
they engaged in this shared journey that they were most fulfilled. For it was
during these times of pain and trial that they truly felt they could make a
difference. It was when they came closest to experiencing empathy that they
also were transformed. It was in these person-to-person encounters, they said,
that they knew the presence of God.
Healing at Work
In providing care to the sick and dying, there is one essential lesson that
must be internalized: Health is much more than the absence of physical disease.
Just as a person may be "healed" of his or her physical disease and yet remain
unhealthy, a person whose body is rife with disease may nevertheless be healthy
if he or she is restored to wholeness with respect, dignity, and compassion.
Health care providers should acknowledge these paradoxical phenomena and help
all people, even those who are close to death, to strive for the highest levels
of healing possible. Healing goes much beyond making diseases disappear.
"Often, although we cannot reverse the effects of disease, there is always hope
that we can heal the person of the pain of regret and fear," one nurse told
me. "To do so is equally important in our daily work. We consider this success."
I recall a patient who confided in me that, although he was close to death,
he had, "never felt more well." Through the facing of his mortality, damaged
relationships had been healed, his spiritual self had been renewed, and his
life had become whole.
Love at Work
How priceless is your unfailing love.
—Psalm 36:7
To love means to care for, or to treasure, someone or some thing. God calls
us to love, to "do unto others as He has done unto us." As we receive God's
love and impart it to others, we are given "the power to repair the world."7
Examples of love at work—givers of care doing as God has commanded and loving
selflessly—are many. When I asked Paula why she chose to continue as a clinical
nurse, lovingly giving hands-on care, she replied: "It could be me or my mom
sitting in one of those wheelchairs. If it was, I would want a nurse who loved
me and showed it by caring that I like my coffee black and my slippers powdered."
Love changes things; "love breaks all the way through."8 "If you
are really in love with Christ, no matter how small your work, it will be done
better; it will be wholehearted. Your work will prove your love."9
A story I was told vividly demonstrates the living out of the value of love
at work—a nurse becoming a conduit for God's love.
"Sometimes the process of dying can take a long, long time," a nurse said.
"Mr. Howe had been in the last stages for about two weeks. Tuesday morning came,
and it was clear that his condition was deteriorating. Finding his wife and
daughter in the hallway, I took their hands and said, 'It's time.' I walked
them into the room and placed one of Mr. Howe's hands in his wife's and the
other in his daughter's. My only words were: 'He's going home now.' Their tears
flowed as they said goodbye. I cried, too. No matter how prepared you are for
death, the final moments are always hard. In a short while, all of his other
children arrived and were ushered into the room. They formed a circle around
him, joined hands, and extended their hands to me, inviting me into their family.
Together we recited an 'Our Father' and prayed for his safe journey.
"I can't tell you how special I felt to be part of that intimate circle. It
was a gift that would give me a great deal of strength in the deaths I would
see in the days to come."
Making the Intangible Tangible
One writer has asked: "If Catholic health care is truly different by virtue
of our Catholic identity, how do those differences present themselves within
our organization?"10 For me, the answer is in our stories about the
caregiver-patient interactions that, although they occur every day, often go
unnoticed and thus unrecorded. These stories give our intangible core values,
our mission, a concrete form that then can be shared. These stories capture
the simple gestures that exemplify the values of hope, compassion, creativity,
community, commitment, healing, and love. They remind us that it is often the
simple gestures, the smallest acts, that make the biggest difference for those
who come into our care. By willingly sharing the journey of the sick and needful,
we nurture and nourish others, and in turn we are fulfilled and energized to
continue our personal and professional mission.
The stories shared here help to make tangible the intangible. May they inspire
us all to live our mission as we carry out the work we are called to do. May
we (as Florence Nightingale instructed us) respect our calling, for God's precious
gift of life is often literally placed in our hands.11
NOTES
- D. Irvine, Simple Living in a Complex World: Balancing Life's Achievements,
Red Stone, Calgary, Alberta, Canada, 1997, pp. 16-17.
- T. Maddix, "Spirituality, Work and Life: The Agony and Ecstasy of Daily
Living," a talk given at the 12th Annual Palliative Care Conference, October
23-24, 2000, in Edmonton, Alberta, Canada.
- These themes have been adapted from the mission
and values statement of the author's former employer, Caritas Health Group,
Edmonton, Alberta, Canada.
- R. Fulford, The Triumph of Narrative: Storytelling in the Age of Mass
Culture, Anansi, Toronto, Ontario, 1999, p. 9.
- Ronald Rolheiser, Forgotten among the Lilies: Learning to Live beyond
Our Own Obsessions, Hoddard & Stoughton, London, England, 1990, p.
272.
- Mother Teresa, No Greater Love, New World Library, Novato, CA, 1989,
p. 67.
- Marianne Williamson, Illuminata: Thoughts, Prayers, Rites of Passage,
Random House, New York City, 1994, p. 6.
- Williamson, p. 19.
- Mother Teresa, p. 69.
- Robert G. Porter, "The Essence of Catholic Health Care," Health Progress,
November-December 2000, p. 14.
- See Florence Nightingale, Notes on Nursing: What It is, and What It
is Not, Dover, New York City, 1969, p. 5.
Little Moments
A simple gesture.
Compassion offered.
Peace received.
—Beth Perry, RN, PhD
Copyright © 2003 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.