What is a good opening remark for a hospice chaplain when greeting a patient with a terminal diagnosis? Sometimes my mind habitually—lazily—goes to, “How are you doing?” Whenever I say that, I immediately regret it.
The person is dying.
When my family first moved into our home, we were a half block from a notorious intersection where drug sales and prostitution flourished. Poverty was all around. One evening I walked to that intersection and saw a disheveled man wearily put a large, well-worn bag of his belongings on the sidewalk. Cheerily, I asked, “Howya doin?”
He looked at me hard and said, “How the F–K do you THINK I’m doing?”
In everyday use, “How are you doing?” means, “Hello.” No one minds if “How are you?” followed by “I’m fine” works as a greeting, not really as a question and a thoughtful answer. But when I visit a hospice patient, I expect more than that. I hope for some kind of genuine connection, even if it’s wordless and involves only a gentle touch or listening to music together. I do want to know how they’re doing, or at least what’s going on, but I don’t want to begin by placing the burden on them to immediately articulate the status of their health or emotions or spirituality.
I vowed to take a fast from “How are you doing?”
(I did so even though that question once led to a classic zinger. I visited a patient who, though terminally ill, had good mental cognition, and I asked how she was doing. She answered, “I’m livin’ but I ain’t braggin’.” That nugget was an undeserved bonus.)
I can’t, however, walk in there and say nothing. I wanted an opening for when there is no singular remark that the circumstance called for. I wanted something that shows I am there for their benefit, not mine, and that doesn’t imply an obligation on my patient’s part. Something that sets a tone of openness and welcome. Something that says, You don’t necessarily have to say anything.
I chose something very simple—and, you might say, obvious (I’m not going to knock anybody’s socks off here.)—but, for me, that sets a tone and atmosphere that I think is beneficial for my patients. And is calming and centering for me. I chose: “I’m so glad to see you” followed by silence.
I’m not speaking for anyone but me. In facilities I visit, I hear patronizing talk: “We had fun playing bingo, didn’t we?” Which means: You had fun playing bingo. Maybe they did; maybe they didn’t. Maybe that’s just all there was to do.
I was at an assisted living facility listening to a visiting singer with a patient of mine, and just after his performance ended, another resident came around the corner from down the hall, pushing her wheeled walker, and she quickly surmised she had just missed a musical performance (guitar, speakers, chairs arranged for an audience). She scowled and said, “There was music in here? And I was down the hall doing that bingo s–t.”
Most of the patients I see have Alzheimer’s or dementia, but I assume that at least some of what is said gets through, so I dropped the talk that is really designed to make me feel better about myself, such as, “Let’s see a nice big smile.” Those are phony soothing words meant to convince me that everything is better than it is, not to communicate something. If my words to someone else are sneakily trying to relieve me of my anxiety, that is not honest communication.
I’m telling the truth. I am not using a “trick” to get a certain reaction or trying a “technique” that I learned in my training. I am truly glad to see every patient, even the difficult ones (who might glower or shoo me away). I’m glad I’m a hospice chaplain, and I love my ministry. I don’t know how they will respond, but I’m honestly glad to be there in this person’s presence.
A consulting company sent someone to interview employees at my office to get a sense of the culture of the place, and he asked me what surprised me about my work. I replied, “I enjoy being around old people.” For a long time, I had the typical resistance to entering nursing homes. Some, truly, are unpleasant, but I have overcome the discomfort of being around people whose faces sag unattractively, limbs work sporadically if at all, teeth are missing or the replacements askew, and so on. It’s true those sights remind me that someday that will be me, but I have come to appreciate the mutual benefit of being present with these people. Yes, those visits benefit me. (I hope it benefits them, too.) I have learned patience and joy in small things: the rare smile, the look of recognition when hearing a familiar song, the hilarious quip, the “I love you,” the touch of my arm.
So when I enter a room at a nursing home or assisted living facility and say, “I”m so glad to see you,” I mean it. I don’t exaggerate by proclaiming, “You look great” or “We are going to have a great time.” I simply say I’m glad to see them, because I am.
I’m not implying the other person needs to answer. “How are you doing?” usually compels the other person to say they’re doing fine, and I don’t want that dynamic to take place. After I say I’m glad to see a patient, I don’t say anything for a bit. I sit in their presence. Some, of course, are not capable of saying anything and those who are often say gibberish. But that’s irrelevant. “I’m so glad to see you” doesn’t need a response. Some say they’re glad to see me too, and I’m very grateful for that. One woman stared at me after I said I was glad to see her and asked, “Why?” I said, “I just am.” Whatever I get—nonsensical words, sensical words, silence, awkward movements—is a gift.
I’m not implying that the other person has to agree. They might be glad to see me, and they might not. One patient, who the facility staff said needs more company, consistently asks me to leave. I barely get those six words out before he starts waving dismissively, although he never says, “Don’t come back,” and he usually thanks me for coming by. I don’t know if his thanks is genuine or sarcastic, but I use it to try again. I will continue to return for my 45-second visits until he asks me not to. Regardless of his reaction, I truly am glad to see him. He has an interesting life story, and I’m reminded of that when I see him. That’s good enough for me. And one day maybe he will allow me to stay, and when he does I’ll know there’s a good reason, and I’ll be ready.
If I’m visiting an Alzheimer’s or dementia patient, I may get no reply or some jumbled words or perhaps something that actually makes sense. That doesn’t matter. I let my opener sit there. It creates a sacred space where two people are simply together. With these patients, I then engage them verbally as best as is possible with each one’s cognitive abilities, then usually play music that their family has told me they like, and end with a prayer.
With patients who can actually converse, after my opener, I still wait. If nothing else, the waiting helps me resist my innate urge to talk about myself. A man with Parkinson’s disease, after I said I was glad to see him, looked at me for several moments—there was a long silence—then, laboriously, in a whisper, said, “Glad……to……see.…..you…..too.” I’m glad I waited; otherwise, I might have trampled over a beautiful moment of grace. Even with patients who converse, I’m not necessarily looking for a reply, although there usually is one, and I allow that to set the tone of our conversation, which may merely be an act of companionship or may be about how they are dealing with the fact that they’re dying.
As a Christian, I call that waiting a spiritual moment, holy patience. It allows the Spirit to move in the patient and in me. It reinforces in my mind that I’m there solely for that person’s benefit. I don’t feel obligated to fill that silence with my talk. In that waiting, I trust that the other person will find a way to claim what they need, or that the Spirit will eventually jostle something meaningful from our conversation. I trust that the simple, genuine, statement of being glad to see someone has some small healing impact. There is great, subtle power in sharing presence together with no expectation other than gladness.