Abstract
Random happenings, pure chance encounters. Life can appear as a moving “carousel” of purely random events.
Those of us that do clinical research know the beauty of randomization: our medical interventions, our scientific involvement is dictated and possessed by luck, by the simple and arbitrary movement of a pair of dice. Between two groups of individuals enrolled in a clinical trial, randomization does the work and distributes characteristics, age, gender…the randomization dilutes all the data in a beautiful and simple way. Randomization can be called the keeper of science's beauty.
In life, like in science, there is a beauty in life's randomized encounters. Sometimes, our life circumstance feels in no way “random” but rather seems to be a very engineered and manipulated sequence of events that connects and joins people together in the same place, at the same hour. If it were random, it would seem that this “random carousel” works without mistake: speeding and slowing to allow different rides, emotions, experiences, and people to cross one another's path.
This flawless “carousel” movement happened in Lisbon at the European Association Palliative Care Congress and began with a simple tap on the shoulder. “Are you Miguel Julião?” I turned toward the woman with surprise. She continued, and said, “I was looking for you. I would love to talk about our experience with Dignity Therapy.”
Pure chance? Here was Lori Montross, a psychologist from San Diego, California, who was versed in the same unique psychotherapy I performed at my Palliative Care Unit in Portugal. There are fewer than 70 people in the world who are trained in this end-of-life treatment, and fewer who engage in its implementation on a regular basis. It is a brief therapy focused on allowing patients to reflect on their lives, to honor their experiences, and to create legacy documents they can bequeath to loved ones.
So here she stood, 5708.2 miles from her home, at the precise place and time that I was viewing her research poster on the topic of Dignity Therapy.
Incredulous at the coincidence, we agreed to sit and talk. Initially as strangers, but soon as friends, we conversed for a couple of hours with ease. It was a deliciously rare opportunity to talk with a like-minded clinician, one who was committed to valuing each patient's story. We readily exchanged our points of view, as well as our feelings and ideas about performing Dignity Therapy for nearly two years in our separate countries.
Afterward we felt energized and exhilarated by the “random destiny” of our encounter. She said, “Let's meet again tomorrow and continue our Dignity Conversations.” We did, and the next day, at a small coffee table, we shared our reflections on the meaning of dignity in palliative care. She working in San Diego, me in Portugal. Would we have similar experiences? Would we have experienced the same difficulties, the same joys?
To our amazement, our experiences were deeply related, and filled the air of the coffee shop with connection. As we spoke, we could see the common threads of our experience emerging. What were the basic elements of providing Dignity Therapy – and what did it mean to our patients as well as us? The following paragraphs highlight those connections. Ones you may relate to as part of your work in this sacred art of palliative care.
Opportunity
Dignity Therapy affords an uncommon and exceptional opportunity to truly “see” a patient. As a clinician, you are graciously allowed to see the fears, the joys, and the proudest accomplishments of the patients lying before you. You are given a sacred window into how people see themselves.
Through compassionate and sincere conversation people have the opportunity of revisiting their lives, thereby creating The Opportunity to be reborn, to rejoice, to become alive again.
Meaning
Dignity Therapy helps one to understand the meaning in all things big and small. This shared moment provides space to hear patients' moments of heartache, moments of elation, or even their commonplace moments whether they are miniscule moments or mountainous moments; all are captured in Dignity Therapy and sculpted to display a larger meaning. The patient's meaning helps flourish our own meaning as therapist and human being. Meaning becomes changeable and palpable.
Connection
There is an interconnectedness that is honored when performing Dignity Therapy. As the stories unfold, a connection readily emerges between patient and therapist. This connection happens by design. However, this dignity moves forward and soon even larger connections are revealed: connections to families, to friends, to foes; connections to the past, connections to the future; and even connections to things unknown or yet unseen emerge. The larger tapestry of life begins to take shape, and then suddenly the therapist pauses…in a greater moment of clarity and sacredness both human beings are connected and actively reshaping themselves.
In this moment it becomes clear: the patients' stories mirror our own stories. These unknown people help us see how their struggles reflect our own, and how their fears mimic the ones keeping us awake at night. Soon the lines between therapist and patient begin to dissolve and we all become humans. We see ourselves as made of the same hopes, dreams, doubts, and vulnerabilities.
This new awareness opens the door to beauty and the universality of experience is recognized. Far beyond the connection between the patient and the therapist, Dignity Therapy connects each of us as frail and vulnerable human beings.
Lack of Fear
A knowingness that this moment was sacredly chosen allows dignity encounters to have the purpose of commemorating and sharing people's stories with their beloved ones and the world. As therapists we have ceased to doubt the wisdom of these encounters, nor do we doubt the ability of spirit to ensure all that needs to be said will be told.
Flow
A spirit-filled wind carries the interaction, much like a magic carpet ride. You can float through the story without care for whether the grammar is correct, whether each question is being asked appropriately, or if the sentence structure is accurate. You simply focus on the sanctity of the moment and the rest unfolds. In Dignity Therapy the therapist is a facilitator, like a light tower that gives gentle and consistent marks for those reaching a final destiny.