Analogies

Analogies can be great for creating an image that is within a person’s experience and/or worldview. One of the first analogies I was struck by was in a family conference in the ICU. The patient was a older gentleman with multiple chronic illnesses and history of hospitalizations. He walked into the ED, but now he was in the unit intubated, sedated, monitored: how did he get sicker in the hospital? And the classic hope-filled statement: “he’s a fighter, he’s pulled through before.” The intensivist used the analogy of a building that a bomb goes off inside of: from the outside it looks fine, but inside it’s been badly damaged. Listening, I saw at least some of the family member’s become less angry and defensive, more open to talk and hear what was being shared.

One of my favorite analogies is when people try and get a sense of “how long” someone has. If they are old enough I ask if they have any children. I then use the analogy of pregnancy and birth: that you know it’s coming, and you probably think you have an idea of how it’s going to be, but ultimately it is something that we do not have control over in terms of timing or how it unfolds. It seems to be helpful, maybe just to remind people that they can live with uncertainty, no matter how uncomfortable it is.

This week I came up with a new analogy and I’m rather pleased with it. E and I were explaining about switching him from IV analgesic to a transdermal Fentanyl patch. We talked about the advantages of having a steady state of opiate in his system rather than the up and down with prn dosing, but he was concerned because, if I understand him correctly, he wouldn’t know that it was working if he didn’t feel that immediate effect from IV push (not a rush exactly, but something that lets you know you’ve gotten medication). Finally I said “it’s like a soaker hose” and that seemed to make a connection.

Language is so powerful and so full of layers of meaning, but it can also delight.

What’s with the title?

One of the reasons it took me so long to start a blog (beyond my usual ability to procrastinate like no one’s business) is that I was having a hard time coming up with a name. I didn’t want it to be too cutesy, but I also didn’t want it to be too boring, and I wanted it to say something about who I am and what is important to me. I wanted something that made the nursing and hospice connection.

So, an explanation: Dame Cicely Saunders is commonly considered the “mother of modern hospice.” She has a long and fascinating history, more of which you can read about in many places including here. One of the seminal stories about Saunders his how she was inspired to start a hospice after meeting a survivor of the Warsaw Ghetto David Tasma, who she cared for as he was dying of cancer, in loneliness and anguish. He bequeathed her 500 pounds and said he’d “be a window in your home.” Her conversations with him, and her determination to relieve his pain – not just physical but emotional and psychic was the impetus to her working to create the modern hospice movement.

So I liked the story, and it make a title that was both apt and a bit cryptic. But more than that, I think it reflects one of the most amazing parts of what it means to be with people when they are dying—it is such an intimate time, such an honor to be allowed into someone’s life. And ultimately, the gifts you get from being a witness to this last chapter of their life is beyond measure.