Sunday, August 20, 2006

Their story...

“We can make our minds so like still water that beings gather about us that they may see, it may be, their own images, and so live for a moment with a clearer, perhaps even with a fiercer life because of our quiet.”

William Butler Yeats

I see the tag on the back of his sweater sticking out, and notice the wrinkled collar on his shirt underneath…if his wife wasn’t in the hospital with a terminal illness, she may have tucked the sweater tag in before he left the house… she may have made sure his shirt had been ironed before he took it from the closet this morning. None of these minor details matter to him, as he rushes into the hospital to make sure he is with his wife when the doctor comes to deliver the latest update on her health.

I watch him enter his wife’s hospital room; smiling, hiding his feelings of fear and anticipated loss…he makes every effort to keep the energy in the room positive. He yearns to bring healing, even if there are no options for physical healing. Although his wife is emaciated and grey with color from her illness, he can only see the woman he married 30 years ago. She reaches her hand out to him, and he takes it, and then he gently kisses her brow. They are both silently, but painfully aware of the unexplored emotional territory they currently face. There is an unknown destined landscape of grief, loss, and longing before them. Their vow of, “until death do us part,” enters the picture; asking for the ultimate and final promise. A promise, that no one is ever ready to make.

This married couple have individual and collective histories that I have yet to learn. As their social worker, I recognize a supportive and loving relationship, but I have yet to discover and ascertain the checks and balances that brought them to where they are now. My role is to be present and gain trust…gently…allowing a safe place for sharing, reflecting, and discovery.

Every person and family I encounter in my work is unique. My skills as a social worker require flexibility, empathy, compassion, insight and presence. Presence for moments that reveal and expose deep truths. I need to be in tune to those I care for, constantly, and without reserve or judgment. I need to be aware of all that I carry with me to these experiences.

It is my responsibility to be open to hearing anger, resentment, and fear. I must recognize that these difficult emotions are not just about the terminal illness afflicting the person and family. The entire context and meaning in life is altered for the family facing a terminal illness. Who they are and who they have been in life has shifted. They confront role changes, and the loss of family integrity. They must adapt and modify the intricate emotional balance within their family. Unresolved issues from the present and past surface. There is a profusion of complex emotions churning and waiting to be manifested.

As a social worker, I cannot medicate a patient’s pain, or offer appropriate spiritual healing rituals. My role is to see a patient as part of a family system with a past, present, and future, within their own cultural context. My primary goal is to promote and advocate for the patient and family’s self determination. While I respectfully absorb and listen to my interdisciplinary team member’s assessments and input, above all else, my duty is to ensure that the patient and family I work with are authoring their own story.

The Social work value of self-determination comes from the concept of autonomy. “Autonomy” is defined as “the exercise of your sense of values, independence, personal history, life, principles of behavior-who you are and how you exercise your sense of values, independence, personal history, life, principles of behavior-who you are and how you live.” (Dubler and Nimmons, 1992).

Advocacy and allegiance to the integrity of each individual’s choices and decisions…this is the work we, as social workers, are gifted in pursuing and sharing in every day. It’s about honoring a truth that is outside of ourselves, but one which propagates authenticity for those we care for.

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