Curiosity and Compassion

Many of you may be familiar with the childhood phrase, "Curiosity killed the cat[horizontal ellipsis]" This phrase in my memory was usually sung by taunting children with the implication that to be curious was to be trivial or silly or to be the child asking too many senseless questions.

I recently experienced an opportunity to rethink this concept of curiosity through the inspiration of 2 of my palliative care colleagues-Drs Wendy Anderson and DorAnne Donesky. Dr Anderson is a palliative care physician recognized for her valuable work in the area of communication by intensive care unit nurses with critically ill patients and her IMPACT-ICU project training nurses in this area.1 Dr Donesky is a well-respected nurse educator who is a pioneer in interprofessional palliative care education and also in communication.2

Drs Anderson and Donesky and their colleagues have defined "capacities" for interprofessional teamwork in palliative care. They include self-awareness, mindfulness of the other, groundedness, nonanxious presence, compassion, response flexibility-and curiosity. I was really taken by their work and especially by the concept of curiosity, which I had not considered as a central capacity or skill in palliative care. They describe curiosity as having a sense of wonder as we communicate with our patients-What is the patient thinking? What do they feel? They describe our challenge to listen intently, mindfully, with presence-but also as the patients share their story, we should listen with curiosity. We should avoid coming to quick conclusions, but rather we should listen with a genuine curiosity that invites the patient to share more deeply, and that, in turn, leads us to understand more fully.

I am grateful for Drs Anderson and Donesky. As teachers and colleagues, they challenge me to continue to learn and to grow as a palliative care nurse. It is moments like this, when I read their work, I feel like a novice, despite my 41 years in practice.

In considering the concept of curiosity, I came upon the words of Roy Bennett in The Light in the Heart. He wrote:

Listen with curiosity. Speak with honesty. Act with integrity. The greatest problem with communication is we don't listen to understand. We listen to reply. When we listen with curiosity, we don't listen with the intent to reply. We listen for what's behind the words.3

Perhaps, many other Hospice and Palliative Nurses Association members who are reading this journal will appreciate this reminder to return to our "curious" days when we recognized how little we knew. Maybe others will identify with the tendency to advance in our careers to a state where we come to conclusions too easily, we diagnose too quickly, and we stop the patient's story too easily, as we move to "fix" and solve the patient's problems.

Albert Einstein, (a pretty smart guy!), wrote, "I have no special talents, I am only passionately curious."4 In teaching nurses pain assessment skills, I often advise them to be curious and to think of themselves as detectives. Instead of relying only on a pain intensity score or a scan showing the site of a tumor, talk with the patient to understand their experience of pain-What does it feel like? How does it impact their life? What does the pain mean?

Another great teacher for me was a patient I cared for when I was a new hospice nurse. Her name was Florence and I followed her for many months, perhaps a few years. She lived in public housing for seniors and had more chronic illnesses than I could count, including diabetes, heart failure, and chronic obstructive pulmonary disease. Over the time I cared for her, her body deteriorated dramatically as she lost her vision and had amputations bilaterally, beginning with her feet and progressing above her knees.

As her body declined and she seemed to survive one critical event after another (a new breast cancer diagnosis, a stroke[horizontal ellipsis]), she never lost her vibrant spirit. She had a boyfriend (who I helped sneak in after hours to visit) and she was always dressed impeccably with a flair for fashion! Florence was vibrant and very alive, as her body was dying.

One day, as I visited her and after I had bathed her, I became aware of how alive her spirit seemed in such contrast to her physically declining body. I had watched her physical decline, her body parts "disappear," her frailty-yet never did I hear her complain or despair. Never did her spirit succumb to the devastation of her illnesses.

So, as a curious young nurse, after her bath, I sat next to her and asked, "Florence, I have seen you go through so much. And yet, I have never seen you despair-despite blindness, cancer, losing your legs. You are as positive, as lovely, and as vibrant as ever. How do you do it? How do you continue to be so positive?" Florence became serious, something I rarely saw. She was deep in thought. She reached for my hand. And in slow, honest, clear words, she said to me: "Clear conscience." I sat motionless and silent. I realized that this wise teacher had shared a profound lesson with me.

That visit was over 35 years ago, but I remember it like it was yesterday. Florence's words have echoed in my mind, as I have pursued some of my work in the areas of quality of life and spirituality in palliative care. What matters? Clear conscience. It is a lesson for anyone in palliative care.

I wish for every nurse to read these journal pages with curiosity. Visit your next patient with curiosity. Listen to their story with a curiosity that invites learning and deep understanding.

References