Reflections on Palliative Care

Expectations.

We all have our expectations. They channel our relationships, our very lives. They are what we anticipate. Our doing. Our very being.

But they remain sequestered deep within, unless acknowledged. And of course . . . the requisite expression.

And so enters communication. That first time. The awkwardness of exposing expectations.

Our expectation of the other. The other's assumed expectation of us.

Perhaps it is a well thought out, well constructed phrase or question or statement of presumed fact. Perhaps it is some spontaneous stupid utterance that fails in every expected way. Perhaps it is simply a smile, the expression of openness, the signaling that that first expression will be welcomed by the other. No matter. That first pregnant exchange will subsequently be remembered with a smile, perhaps even with a laugh.

Quickly, the expectations are focused.

And as quickly, tuned, as that initial exchange is initiated.

The tone of voice. The voice itself. The nuance of simultaneous non-vocal signals. It instantly changes the expectations. The dialog becomes easier . . . flows . . . becomes the continuation of some long-lost conversation from another world.

Or.

An awkward silence ensues.

Expectations are in rapid flux.

A try again.

The sensed barrier is breached. A sense of relative comfort is established.

The expectations become realistic.

The points of shared-common are explored. Amplified. The connection is reinforced. The boundaries of the sensitive are ascertained . . . and breached so very gently if they in fact must be breached. Safety must be secured. The expectation of trust enhanced.

That initial conversation. The transition from the unknown to the known.

To learn of the sojourner's expectations.

The expectation of living. Of dying. To be understood. Respected.

Ascertaining the progress of the journey. The denial. The frustration. Perhaps anger. But then, the sojourner may have transversed that valley and has come to a vista point of acceptance. But still with guilt. Resignation. Defeat. Despair. Or perhaps, now, has the expectation and longing of that blessed reward.

This conversation is different.

It is not the conversation of the parent kissing the scraped knee of the little one and assuring that it is "All better now."

It is not. For this knee will not get better.

Rather, the kissing of the scraped knee is expressed in different ways. Mutually acceptable ways that bring a sense of worth and value and respect and love and empathy. And validation of the sojourner's spot on his or her own sauntering trail.

For certain, that kissing of the bruised knee is to break the bane of loneliness.

To give care to the spirit when there is no cure for the spirit's bruised knee.

To share that understanding with those others, if there are others, that also love the spirit of that unfixable knee.

It is then, that expectations are fulfilled.

The Refectory Manager

Weathered old-looking crevasses in a radiating face . . .

His face had the look of oldness. Embellished in time weathered creases. Separated by contours of résistance to weathering.

I would look up. Look into his face. And feel the warmth of his radiance.

He had heard I was a dietitian. Somehow he sensed I could be trusted.

So we were seated at a round, wooden table. Four chairs. Two of them had cushions on the wooden seats.

We gathered to plan a meal. The next Group Dinner.

I discovered he was a chef.

His first act was to bring out a leather embossed folder. I opened it. His graduation certificate from a culinary arts program. The physical manifestation of his sense of personal value and worth.

But it was the book he laid before me. Green plastic ring binder. Tabs. Lots of tabs. And plastic document protectors protecting his work of several years.

The business plan for his restaurant.

Quite frankly, I was stunned! And told him how I wished my former students in their assignments would have been as comprehensive in their work as he is in his.

I gawked. Marveled. Turning pages revealed more incredible detail.

I would look up.

His face.

Beaming.

Radiant.

He has plans. He, along with another at that table. Another chef.

Plans.

And those plans transcend the history of why they are now planning a Group Dinner for recently released convicted felons.

But his face. Those crevices. Knurled and weathered they would seem to be.

But deep within those facial creases the emission of the radiance of hope. Of value. Of meaning.

Weathered old-looking crevasses in a radiating face . . .

The Refectory Manager