“L” is for Listening

In supporting folks with chronic or acute health challenges and at end of life, I find that one of the most important facets of comprehensive care is deep listening. When someone is not feeling well, caregivers cannot provide appropriate support without learning what the patient feels is most relevant, desired, and/or needed. Maintaining all our relations requires careful, active listening. To be mindful and present to our own needs, we must practice listening to ourselves. So, in our Wellness Alphabet, “L” is for Listening! Let’s get started by revving up our “listening eyes, ears, and hearts”.

There are many ways to listen. As you read now, your eyes are taking in the words, your mind is processing, your heart is responding, your feeling self is gathering information, helping to craft the words into something useful or meaningful. Empathic Listening and Active or Deep Listening are skills that can be cultivated to help with your caregiving activities, deepen relationships, and to take better care of yourself. Making a balanced decision depends on our listening to thoughts and feelings. One practice that can be useful when listening is to imagine dropping your mind or consciousness down to your heart center so you can listen from that place. As you hear and feel what others are saying, you may be more able to respond with understanding and compassion.

You know the old saying, “my gut is telling me to ____”? That usually means you are also listening to a deeper truth; perhaps a more feeling oriented place within. Science now tells us that we have a “brain gut” hidden in the walls of the digestive system. The enteric nervous system (ENS) is helping medical researchers to understand the link between digestion, emotional health (mood), physical well-being, and even the way we think! Applications from treating depression and anxiety to reducing risk for type 2 diabetes are discussed in this article from Johns Hopkins.

Marshall Rosenberg

Marshall Rosenberg, the founder and director for the international Center for Nonviolent Communication (NVC), taught that to maintain a healthy, authentic connection to others, we must listen to offer empathy, and to hear needs and feelings. For me, practicing the NVC way of listening has been practical and helpful. The four steps of NVC are: neutral observation; describe feelings; identify needs; make a request. It sounds simple, but it does take practice. You can learn more here.

Marshall suggests that we listen to understand, not to judge, diagnose, or “fix.” This can be tricky territory for caregivers because “fixing” or providing solutions to problems is what caregivers are expected to do. For starters, there are many people to listen to when caregiving. First and foremost is the patient, of course. But also, the doctor(s), nurses, medical technicians, family, friends, neighbors, home care workers, delivery persons, and housekeepers. This list is long; and I’m probably overlooking some folks! The team participants also need to be heard and listening to them can improve the patient’s quality of life greatly.

In one situation, I observed a patient who desperately wanted to stop her cancer treatments as her condition had become unbearable. She was ready for hospice, ready for her life to end. Her family wanted her to “keep fighting” and were committed to her doing so. She asked me to sit beside her when she told her family about her wishes. Using the NVC model, she spoke about her diagnosis, her age, fading agency and exhaustion; her gratitude and love for her family; her need for autonomy in the decision to stop treatment; her request for respect and compassion. At first, her dear ones were not listening deeply. Their own imminent loss was forefront on their minds. Graceful to the end, she spoke softly to them, “I know you will miss me so much, but I will always be in your hearts. Would you be willing to let me do this my way?” There were tears, and then, reluctant acceptance. Her wishes were honored, and hospice care softened her pain. In this case, the dying patient was the one offering empathy and compassionate listening to the family.

For professional or family caregivers, it can be difficult to walk alongside someone as they move from wellness to a declining state. Anticipatory grief will likely be present for some of the journey. You and your patient or loved one may not always agree. Caregiver burnout is real! Whether this is your job, an obligation, or a labor of love, taking time to assess your own situation, feelings and needs is necessary to maintain your own well-being. So much focus placed on the patient means that sometimes caregivers’ needs are lost or overlooked. Ask yourself how you are truly doing (physically, emotionally, mentally, and/or spiritually). Do you need someone to listen to your story for a change? Counseling for caregivers is widely available and there are free support groups in most communities.

Another aspect of listening arises when patients and/or caregivers are in the doctor’s office. These days, most clinical visits are quite short. The physician’s assistant or nurse may gather information to give to the doctor. Once the physician appears, the average time for the visit is 15 minutes (sometimes much less); hardly enough time for deep listening! Some tips for being heard in the clinical setting include to bring a written list of medications and prioritized concerns. Be prepared to talk frankly about your symptoms (i.e., type, onset, status). Another pair of ears listening is always helpful. Consider bringing a family member, caregiver, or advocate with you to listen and take notes. If you feel your doctor was not fully understanding your concerns, you may want to send a follow up email or schedule a second visit.  

I will conclude this entry with a quote from Rainer Maria Rilke: “Since I learned to be silent, everything has come so much closer to me”. This quote speaks to me about so many things related to the Further Shore mission and to my personal journey of late. Sometimes the best wellness practice for me is just listening to the sounds of silence. I’m wishing you a quiet moment today to listen to the silence, or music, birds singing, your own heartbeat or raindrops on the windowsill. May your listening bring everything closer.

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