I shouldn’t have smiled.
Quinn*, one of our social workers, was providing details on a patient’s background and current condition to the rest of the hospice team. The patient, living alone and seventy-something, had numerous health concerns along with her cancer diagnosis.
Our new patient, Quinn suggested, might have undiagnosed mental health issues. She could be easily upset. At times, unexpectedly, she may lash out. It was possible she wouldn’t answer the door and later, when you tried to leave, she might keep talking and talking, making it difficult for staff to leave. Quinn also wondered if the patient would be compliant with medication. (If patients/caregivers forget or refuse the scheduled doses, pain from the disease may spike. Inconsistent dosages make everything for the patient more difficult to manage.)
Why did I smile? Quinn was so, so, so polite when describing this new patient.
As I listened to report, non-medical me thought: this patient is a basket case. Hearing between the lines, Quinn’s “might have mental health issues” meant this woman likely had challenging problems, barely manageable even if she was consistent with her medication regime. A patient ignoring meds for ongoing mental health concerns and pain management was a recipe for disaster! As my smile faded, I also thought: come on, Quinn, give the specific, unfiltered details about this patient. Since we were in a hospice team meeting, behind closed doors, there was no need for polite language about this patient’s obvious parallel to a human ticking time bomb!
My smile had vanished by the time Quinn concluded the patient overview. Quinn is a dedicated social worker, has a good heart, and is part of a caring hospice team.
Of course, hospice knows the details about patients’ lives. And in the case of this troubled and fragile patient, it wouldn’t take much to read her chart and identify the extensive list of mental, spiritual, and physical challenges. But Quinn—and many social workers everywhere in various settings—works hard to be positive and compassionate. Nothing Quinn shared involved sugarcoating that patient’s situation. Instead, I think it had more to do with Quinn advocating and cheerleading for each patient.
It’s relatively easy to chronicle the life-threatening illness or the complex secondary issues that might make a particular patient difficult to manage. What is tougher, and fairer, is to present a patient’s needs in the best possible light. At one point, Quinn stated that our hospice might not be able to continue to care for this patient. If patients refuse medication, or they’re resistant to hiring help or asking a family for more assistance, hospice can’t do its job.
So, Quinn was also a realistic cheerleader.
Some patients and families are a “pleasure” to work with. Some are not. But every patient should have someone like Quinn on her or his side. Whether in a kitchen explaining hospice benefits to a frightened family or in the confidential meeting with hospice co-workers, it’s essential for a social worker to be a patient’s best advocate.
There are many times in each of our lives when we are criticized, categorized or compartmentalized. When facing death, and with a social worker who seeks the best, the “c” words that truly matter are these: giving good counsel and being compassionate.
(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)
*None of our social workers are named “Quinn.” But it’s one of those names used for males or females . . . and supposedly is Celtic in origin and may mean, “counsel.” Not a bad “fake name” for a social worker!by