Often, Palliative Care, just doesn’t seem that complicated; but exhausting. Frequently, patients and family say something like “We really need to talk about this. We didn’t want to talk about it but now we know what we are facing.” We have spent an hour, our little IDT group, talking because as Adrienne Rich says, “It’s necessary.”

We start these conversations often by saying, “We read your chart, looked at the labs and x-rays, talked to your doctors so we know a lot about your illness. Let’s put that aside for a few minutes, we will come back to it, but we want to hear about the you not in the chart.” I have noticed that this is often hard for people to do. Sometimes, a deer in the headlight look. Different people have different prompts. One that a colleague often uses when we have a couple, we are talking to is “How did you meet and get together?” Usually there are at least two versions of the story, different people chip in to fill out the narrative and share that tidbit that the main players may be a little embarrassed to share. We are all transported back to a different time before cancer, heart failure or this painful present.

You start to notice that this gives everyone a little distance from which to look at the present. This is where we were, and this is where we are now. Tears, this is the time for tears. Me too, as I am a very easy crier. I used to carry a handkerchief with me but now with COVID we must do with tissue. Then from this vantage point people start to hear the update on their medical situation and map out a plan, a way forward that reflects and honors who they are.

It was after one of these conversations that I read Adrienne Rich’s poem. (I get a poem every day in my email from the Poetry Foundation. It’s free!). I was struck by the lines I use to title the piece. Deep listening is deeply knowing and deeply knowing is the route to compassion and empathy. It allows us to carry a bit of that burden. “It’s necessary.”

https://www.poetryfoundation.org/poems/51092/what-kind-of-times-are-these

What Kind of Times Are These

BY ADRIENNE RICH

There's a place between two stands of trees where the grass grows uphill

and the old revolutionary road breaks off into shadows

near a meeting-house abandoned by the persecuted

who disappeared into those shadows.

I've walked there picking mushrooms at the edge of dread, but don't be fooled

this isn't a Russian poem, this is not somewhere else but here,

our country moving closer to its own truth and dread,

its own ways of making people disappear.

I won't tell you where the place is, the dark mesh of the woods

meeting the unmarked strip of light—

ghost-ridden crossroads, leafmold paradise:

I know already who wants to buy it, sell it, make it disappear.

And I won't tell you where it is, so why do I tell you

anything? Because you still listen, because in times like these

to have you listen at all, it's necessary

to talk about trees.