I noticed that my hospice patient and her young adult daughter were unusually quiet as I settled on the couch for my weekly visit; it felt as though they were hiding something, which was highly unusual for this chatty twosome.
“What’s up?” I asked. The patient, a woman in her fifties who was dying from both cancer and the affects of aggressive cancer treatments received twenty years before, averted her eyes to avoid my gaze.
Eventually, her daughter answered, “Guess who went to Walmart the other night – all by herself? We woke up in the middle of the night, and she wasn’t here!”
Her daughter was mortified, and I understood why. It had been a very dangerous adventure. Somehow, with her 86-pound frame, this woman in advanced heart and kidney failure, her torso riddled with tumors, had performed a small miracle. She had lugged her oxygen tank and the yards of tubing (she always had football field-lengths of tubing, because she loved to be mobile) out of the house without a single member of the family knowing. She had loaded it all up in the car and driven, while on a lot of medication, the few miles from her home to the megastore.
Yes, it was rash. Something awful could have happened – a car accident, a fall, confusion about her way home.
I later learned that two members of my patient’s family went into near panic when they realized that she was not in her bed. Two others, however, did not. They were able to calmly develop a plan for finding the patient and returning her home.
The two in a panic were reacting to the situation, while the two who remained calm were responding. Indeed, as we sat in the living room that day, my patient’s daughter still seemed to be in reaction. Her agitation and fear were palpable.
Psychologist Matt James, PhD has this to say about the differences between reactions and responses:
“A reaction is instant. It’s driven by the beliefs, biases, and prejudices of the unconscious mind. When you say or do something “without thinking,” that’s the unconscious mind running the show. A reaction is based in the moment and doesn’t take into consideration long term effects of what you do or say. . .
“A response on the other hand usually comes more slowly. It’s based on information from both the conscious mind and unconscious mind. A response will be more “ecological,” meaning that it takes into consideration the well-being of not only you but those around you. It weighs the long term effects and stays in line with your core values.”
(you can read this helpful article at https://www.psychologytoday.com/us/blog/focus-forgiveness/201609/react-vs-respond)
In providing care for another, it is important that we attempt to respond rather than react in almost all situations. The ways we can move ourselves out of reaction and into responsive mode are simple and well-known. In fact, most of us learned about these tools by the time we entered kindergarten:
Slow down.
Take deep breaths.
Count to ten.
BUT . . . that can be very difficult. Sometimes, we simply are unable to utilize any of these tools; our thoughts, emotions, and sensations can get in the way of our ability to be present to the situation. Our capacity to respond rather than to react lies mainly in our own self-awareness, our knowledge of what beliefs, biases, and prejudices might lie in our unconscious minds.
We increase our ability to respond to acute situations such as the one with my patient by consistently excavating what lies under the foundation of our conscious mind. There are a multitude of ways to do this; therapy, writing practice, spiritual direction, artwork, and dream analysis are just a few.
It is challenging work. And it is foundational work in any caregiving relationship.
The most encouraging thing to remember may be this: we do not need to get rid of the thoughts, feelings, memories, and sensations that cause us to react rather than respond. We need not pretend they do not exist. Indeed, to do so often causes them to be even more potent in interrupting our ability to respond. Truly, by acknowledging these beliefs, biases, and prejudices we bring them out of their hiding places in the dark shadows of our psyches. We are then able to experience them, work with them, shift them -- or merely to allow them to be. From their new location in the light of our consciousness, they no longer have the same power to affect how we act in challenging situations.
AND. . . sometimes we are absolutely incapable of not reacting. That is why teamwork is essential in caregiving. My patient’s daughter’s fears about her mother being in danger, her anticipatory grief regarding her mother’s approaching death, and the anxiety she had been experiencing watching her mother’s sharp decline in health all stood in the way of her being able to remain calm and “take into consideration the well-being” of all involved. Thankfully, there were others present who were able to do just that in the moments following the discovery of my patient’s absence from her home.
Many wisdom sources advocate for us always responding rather than reacting. And that would perhaps be most beneficial, if it were possible to do so.
But perhaps not.
I have been on the receiving end of many “responses” that felt disconnected from me. I have experienced people whose care was so calm and measured that it felt entirely detached from me and my particular situation. This rarely happens with professional caregivers; rather, it is more prevalent in my life in terms of people with whom I share personal relationships.
I love these people and know them well. I often can feel their reactions to our situation whether they express them or not. So when they share them with me (preferably not in a moment of crisis), I actually feel closer to them. To forego all reactions seems to me to deny who we are and who we are in relationship with the person with whom we are sharing care.
That day following my patient’s Walmart adventure, I chose to allow some of my own reaction to appear. And I shared it with her. Finally, after her daughter had shared her detailed account of that scary night, I caught my patient’s eye; our faces both broke into smiles that quickly turned into full-on laughter, the belly-hugging, tear-wiping kind of laughter that can be so healing.
If I had been present that night, I hope I would have responded calmly and thus been able to help the family find this beloved person. But, now that she was safe, I was released from that responsibility. And I was able to allow my own experiences to affect the way I received the story. I have spent months in hospital beds, tied to machines and unable to move. During those times, I have longed for something as simple as a shopping trip or a walk outside, one great adventure like the one my patient had that night.
While I could not condone her choice to do something so potentially dangerous, I could feel it. I could understand it. And I could empathize with her desire -- all because reacted by connecting with my own experience rather than pretending it did not exist.
