Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

The Kindness of Strangers

The Kindness of Strangers

 

“No act of kindness, no matter how small, is ever wasted.”

—Aesop 550 BC.

 

In a medical setting, kindness is especially welcome and meaningful.

 

Even when things seem to be going well, healthcare encounters provoke anxiety. You’re going for your annual assessment and you “feel well”; but what if your doctor finds something wrong? When there’s a documented health concern such as elevated blood pressure or diabetes, is it going to be controlled? Will the lab tests show improvement? Will the screenings tests be normal and reassuring, or will a new and perhaps serious problem be discovered?

 

When one undresses and dons the familiar backless gown, there’s an additional layer of vulnerability added immediately. Status, confidence, and sophistication can vanish in an instant. And, I assure you, when doctors assume the patient role, this same vulnerability manifests. Perhaps it’s even magnified, because we know the imperfections of our profession—or else we know “too much,” and our symptoms seem especially worrisome.

 

Such uncertainties and anxieties exist in the most routine encounters. When a serious illness complicates the equation, the anxieties evolve into legitimate fears.

 

Kindness is never more important than when it is extended to people in crisis. A serious medical illness creates crisis for patient and family alike. With acts of kindness, healthcare providers can soften painful news, acknowledge the vulnerability generated by illness, and level cultural differences through caring interaction.

 

In 1927, Francis Weld Peabody wrote, “. . . the secret of the care of the patient is in caring for the patient.” This simple adage remains a powerful truth in the modern healthcare environment where technological advances strain interpersonal relationships. At each point of interaction, from the receptionist to the billing clerk, kindness and professional demeanor are important ingredients in the care of both patient and family.

 

Naomi Shihab Nye begins her poignant poem, “Kindness,” “Before you know what kindness really is you must lose things, feel the future dissolve in a moment like salt in a weakened broth.”

 

With serious illness, much is lost. Along with losing wellness, one progressively loses independence, energy, connection with the wider world, and capacity for activities of daily living. A planned future is edited (and often abbreviated) in life-limiting illness. Understandably, such losses create suffering for patients and those who love them.

 

In my father’s final months in a nursing home where he disappeared into his advanced Alzheimer’s Disease, my mother witnessed some staff depersonalize him as the demented, mean old coot in Room 212. To be sure, he had become a difficult patient. He was disoriented, belligerent at times, and fearful of the world of strangers who entered his room. To some of the nursing staff and attendants, he seemed to be just one more charge who complicated their days with his many needs and unruly behavior.

 

They avoided him; they joked about him; they handled him roughly; and they broke my Mom’s heart in the process. To her, he remained the love of her life whom she was losing to this unrelenting illness. She suffered greatly seeing her husband diminished in this way. It’s both ironic and understandable that folks on the front lines assisting the most demanding and sickest patients are at greatest risk of compassion fatigue.

 

Kindness moderates the illness experience. It can soften bad news; it contextualizes the experience by introducing compassion and acknowledging suffering. In line with Peabody’s quote, healthcare providers are at their best when they share both their medical expertise and their humanity with patients.

 

Acts of kindness take many forms. A gentle touch, a smile, a kind word, and a listening ear while performing perfunctory tasks can all soften the hard edge of illness. The simple question, “What can I do that might make this a better day for you?” acknowledges the loss of control that many patients feel—especially patients in hospitals or nursing homes. Empathy and acts of kindness are welcome and therapeutic components of any treatment plan.

 

In Tennessee Williams’ A Streetcar Named Desire, Blanche utters her famous lines, “Whoever you are, I have always depended on the kindness of strangers” to a doctor who arrives to transport her to a mental institution. At this point in the play, she is delusional, demoralized, and defeated; her vulnerability is complete. The kindly doctor begins her healing with his gentle demeanor, quiet smile, and offered arm.

 

The capacity for kindness is present in each of us. In later lines of her poem “Kindness,” Nye observes, “Before you know kindness as the deepest thing inside, you must know sorrow as the other deepest thing.”   In times of sorrow, patients and their families are aching for kindness. With such awareness, healthcare providers can forge a powerful alliance with their patients. Kindness is a blessing we give to one another; it’s a compassionate link that can transform strangers into kindred souls.

 

Stephen L Hines, MD

May 2017

 

 

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