Hope as the Practice of Presence

Thursday, July 18, 2019

Chris Dethlefs, BSVM 2018-2019
This reflection was originally shared at the 2019 Site Supervisor Retreat. The name of the patient in this article has been changed. 

Hope as the Practice of Presence

Pope Francis on Christian Hope to general audience February 1, 2017

Walk toward the door!
“Christian hope is a shield. When we talk about hope we often think of the common meaning of the term, as something beautiful that we want but that may or may not be attained. We “hope” something will happen; it is like a wish. People say, for example, “I hope we have good weather tomorrow!” But we know that there might be bad weather… Christian hope is not like this. Christian hope is the expectation of something that has already been fulfilled: The door is there and I hope to reach the door. So what should I do? Walk toward the door! I am certain that I will reach it. This is Christian hope: the certainty that I am walking toward something, not just the wish for it.”

Mike came to our hospital in January from a group home that could no longer care for his needs. He was an elderly man with significant mental illness – he experienced almost continuous hallucinations that made communication nearly impossible. He was also very disabled physically – the most I ever saw him do with therapy was stand shakily with assistance. Most of his time at RCH was spent in bed or hunched over in a reclining chair. Mike had piercing blue eyes underneath a pair of remarkably expressive, bushy grey eyebrows. On his forearm was a blurry tattoo of the words “Big Mike”.

In his first couple of weeks with us, my visits with Mike consisted of sitting beside him to make sure he didn’t fall out of bed. He would slowly swing his bent legs over the side like an anchor and roll into a sitting position. Over and over we would place his legs back on the mattress. Given my limited scope of responsibilities, I was happy to attend to this task. Watching him was interesting, and peaceful. There was no need to reassure or to force a conversation, since conversation was impossible. It was enough to just be there with him.

Eventually he became less agitated. In the mornings I started helping feed Mike his breakfast – something I came to cherish greatly. Generally this process was a comical game of me trying to synchronize landing bites of scrambled eggs in his mouth as he reached for imaginary food two feet in front of him and brought it back to eat. Sometimes we couldn’t manage a single bite together. Nevertheless I enjoyed this morning ritual with its strange mutterings, sporadic cackles, and invisible cats.

I noticed several times that when I offered to help the PCT’s feed Mike, they would kindly refuse. I had assumed they would have grown weary of the slow process. Gradually I discerned that in fact they probably received as much peace in sharing this experience with Mike as I did. Mike was serving his caretakers as we served him.

As is my tendency, I spent a lot of time trying to grapple philosophically with the nature of Mike’s reality. Where did he “fit in”, this abandoned man who now lives in some psychological sphere inaccessible to me? How can it be that the infinitely detailed and complex story of his youth has led to this appearance loss of identity and coherence, his life story largely a mystery to his caretakers? What was there to the rest of Mike’s life? He was not going to be restored to some prior youthful self – one who could communicate and direct his fate. All I could know about Mike was there before me.

Our afternoon visits were mostly spent in silence, with the occasional murmur and grasping gestures reminding me the room was not as empty as it appeared. Most days he just slept. When he was awake he rarely noticed me or reacted to attempts at conversing.

There were glimpses of lucidity. On rare occasions he would answer a direct question. “Do you want some applesauce?” “O hell yes!” I eventually figured out he enjoyed listening to Hank Williams – and a couple times he hummed along and tapped his feet to “Honky Tonk Blues.”

As the weeks drew on, I began equivocating on whether visiting Mike was “worth it”. I was tempted towards spending less time with him in favor of more “productive” activity. After all, nothing was really “happening,” was it? Did he even know I was there? There was no measurable value, no visible utility to our shared silence.

Despite my misgivings, I sensed that I was called to be disciplined in offering my presence to Mike, regardless of validation. On days where he only slept, I still sat and watched him in silence for 10 minutes. Some days I would just sit and play music on my phone for him, even if he didn’t react. It felt right to honor him just as I might other patients who visibly benefited from my companionship.

I think my choice to be present, and to receive Mike’s presence felt right because it was a choice born of hope. A hope that something was happening there between us and within us. It was a choice to say: “We are here. Let’s listen.” and to ask nothing more. Even in his desert of isolation, physical suffering, and mental illness, Mike was still here in this world – shaping it, shaping the space and the people around him, shaping me. His doorway invited me to the hope that we might share life deeply, even when the nature of that relationship was clouded in obscurity and uncertainty.

One morning as I skimmed our census summary, I noticed Mike was newly classified as a PCU patient, implying delivery of more intensive care. He had come down with aspiration pneumonia. Upon visiting him, I could see he was suffering in a new way. His furrowed eyebrows had taken on an arch of pleading, and his hand shuddered in the air, reaching for something I could not see. I grasped his hand and held it, unable to do anything more. I stood there, hoping. These were our last moments together before Mike was transferred to MRMC for more intensive care, where I do not believe he recovered.

What to make of it? During the couple months that Mike was at RCH he deeply affected me and numerous other staff. In his disability he offered something powerful – a new kind of presence. He invited me to be with, even if that meant to be confused with. He invited me to trust that we were connected, to hope that something was fulfilled in our midst. Is it enough that we are here, listening to a piece of Mike’s story? Maybe it is enough that this world is a place where souls are combined, if we give them the chance to mingle.