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What Matters Most? How to be There for Someone When They Really Need You
By Dr. Erik Fromme
First, You Ask
I work with patients who have life-threatening illnesses, and many of them are facing death. Rather than talking specifically about spirituality, I ask them where they get their strength and what is important to them.
Typically, I’ll take their medical history and hear everything they’ve been through and often it’s quite horrific. And so I’ll ask them, “How have you been able to deal with all of these challenges? What gives you your strength?”
The most common answers relate to their family and friends. Many patients will talk about their faith. Sometimes that faith is tightly connected to an organized religion and sometimes it’s a lot more personal. Here in Oregon, a lot of people’s faith seems to encompass nature and being in nature. Yesterday, a gentleman told me it was his sense of humor that saw him through. He said he was surprised to find that in his ability to tell stories to people and make them feel good, he found the strength he needed.
Then, You Listen…
…Really Listen
It’s not just important to ask about their stories. Listening is key. I had to be taught how to listen. It’s not something that comes naturally to doctors especially; we tend to be focused on our own talking. I am fortunate to have a mentor named Dr. Rachel Naomi Remen, who is also a popular author. She has a practice that she calls Generous Listening.
Dr. Remen points out that when we’re supposed to be listening, we’re often thinking. We may be thinking about whether or not we agree with what’s being said, whether or not we understand it. We may be thinking about what we’re going to say next, or we may be listening competitively – wondering if this person is as smart as we are. As health professionals, we’re taught to listen for what is wrong and how to fix it. In Generous Listening, we don’t do any of this. We listen without an agenda, not necessarily even trying to comprehend, which is not always easy. If you must do something, try to understand how what the person is saying is true for them at this time. When we listen in this way, often the person who is speaking is able to understand something about what they are saying and about themselves that they’ve not even noticed before.
Having had that experience myself, and having been listened to that way, I’m always looking for an opportunity to return the favor.
Helping Family Members to Help Their Loved Ones
Family members of my patients don’t tend to come to me with a spiritual or existential question. They can see that their loved one is suffering and they don’t know what to do. Their question is often “What do I do?” What they usually mean by that is, “How do I care for my loved one? How can I help?”
The advice that I give them is something I heard from an anthropologist in San Francisco, Angeles Arrien, called the Four-Fold Way. It’s general advice because the right answer is usually specific to an individual; there’s not much you can say that is actually true for all people. But these four principles are brilliant in their simplicity:
- Show up, choose to be present.
- Pay attention to what has heart and meaning.
- Tell the truth without judgment or blame.
- Try not to be attached to the outcome.
Of course, they are easier said than done, and each one has its own challenges. But I find the Four-Fold Way to be immensely helpful both in counseling patients and their families and in my dealing with illness in my own family.
Dr. Erik Fromme is an Assistant Director for the Center for Ethics in Health Care and an attending physician on the OHSU Palliative Medicine and Comfort Care team, with a special focus on cancer patients and their families. He earned his M.D. at The University of Oklahoma Health Sciences Center, did his residency in Internal Medicine at OHSU, and completed his fellowships at Johns Hopkins University and Massachusetts General Hospital.
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