About the Author: Ms Sarada Lingaraju, is a counselling psychologist at Sparsh Hospice, Hyderabad, for the past five years.
Ms Lingaraju has completed several courses in palliative care and End of Life Care (EoLC) from Stanford, Glasgow and others.
Ms Lingaraju is a strong believer of the psychosocial model of hospice care and in delivering integrated palliative care. Additionally, she also supports patient autonomy. She therefore works closely with families to advocate for the prevention of aggressive interventions in EoLC, and also engages in extensive community outreach programs to propagate the uptake of palliative care in rural areas.
Working in a palliative care centre or an end-of-life care centre is often viewed as a very ‘special kind of work’ by the society. Though many ‘choose’ to work in this field for ‘a career’, the community often interprets this ‘career option’ as ‘divine’ or ‘noble’ work. Another common perception is the expectation for healthcare providers (HCPs) to have some level of divinity or be spiritually very evolved, due to their everyday interaction with death and serious health related issues. The reality however is that a majority of the HCPs are not so spiritually evolved.
I have frequently observed that ‘hospice work’ can become an addiction for HCPs for varied reasons. These reasons could vary from receiving disproportionate praise from the beneficiaries for the routine paid work, the organisation’s philanthropy being attributed to the team working in patient care, the delicate mental state of the beneficiaries, the organisation’s inflow of donations in recognition of the work that the team does, and many more….
In reality, the above mentioned factors may actually decrease the ‘spirituality domain’ of the HCP. The ‘I’ factor becomes the focus of the palliative work that the HCP does. The HCP begins to view their personal worth in terms of what is attributed to them by their beneficiaries. The HCPs presence is acknowledged with a reverence by the beneficiaries. The combined effect of this ‘larger than life’ value along with the acknowledgement accorded towards this work, leads to an addiction for many HCPs working in this field. While this addiction is seen in in-patient, out-patient and home-care services, it can be observed more dominantly in HCPs working in in-patient services.
From this addiction comes possessiveness, wherein the HCP does not want to share the patient space with other team members. This is where an internal struggle for exclusiveness of the patient space starts. The need for a patient’s healing to be routed only through ‘ME’, then becomes a daily necessity and the need to be exclusively acknowledged by the beneficiaries gets heightened. Though this won’t be evidently displayed by the HCP, it distresses the HCP and brings about an internal struggle with a shade of self absorption. This struggle thereafter happens in three phases: Succumbing, Fighting and Overcoming. It can take years or months, depending on the value and the acknowledgment that the HCP receives from outside their work, and their professionalism. The professionalism component cannot be over ridden by the above mentioned observations unless the HCP really understands the meaning of multidisciplinary work with the need to always keep the patient at the centre.
When the HCP exercises team spirit, is aware of one’s own work-life balance and their professional goals, this struggle can evolve itself into spiritual growth. With spiritual growth, one also gains objectivity in patient care. An awareness about one’s own mortality also helps bring objectivity and compassion. When professional boundaries are established along with genuine effort to overcome selfishness, the sufferings / struggles and the subsequent death of a terminal patient, can uplift the spirituality of an HCP.
An HCP can use two of their very important emotions, their Empathy and Compassion, to their advantage to understand the highest form of spirituality.
The initial ‘Empathy’ or the ‘non-duality’, helps relate with the distress of the patients and their families. Patients are however actually helped when an HCP exercises compassion.
In Empathy, we experience ‘Advaitha’, wherein the distinction between an HCP and their patient (and families) is blurred and the HCP becomes one with the patient. Here, the pain is common and the problem is common, leading to the HCP to have reduced clarity towards the solution or the path for solace. This situation might lead to the patient and the family into thinking that the HCP is absolutely kind and that they are in the ‘best hands’. The issue with empathy / Advaitha is that it needs the HCP to have the strength to sustain ‘oneself’ and be ready to attend to another patient. The experience of Advaitha by the HCP increases the patient’s dependency on them and also leaves less scope for ‘self-heal’ or ‘self-cope’ for the family and their patients, along with an added disadvantage of professional burnout for the HCP over time.
The ‘Compassion’, Dvaita, introduces the ‘duality’ wherein two truths exist simultaneously; the HCP and the patient. This concept allows for the HCP to be emotionally close enough to the patient and their family to understand the distress, yet be distant enough to objectively offer the patient the best care plan. This can help the HCP to practise self-care and stay focused, to either help the same patient multiple times or to attend to the needs of a new patient, all without imposing one’s own judgement.
In conclusion, at the end of the day, it is one’s personal choice to use their experiences in palliative care to elevate their spiritually as they move forward in search of one’s own path to higher thoughts.