In inpatient oncology, the pace is sustained but rarely as frenzied as in the ICUs. Our cancer patients tend to stay longer for treatment, or return when fevers or blood counts need monitoring. Working here as a chaplain gives me the time and continuity to begin a conversation around pets, families, recipes, and local sports, and channel the flow into faith, suffering, mortality, and meaning. These encounters provide a fertile environment where bodhicitta—awakening heart—can blossom, but they also tend to jerk me right out of my “feeling-enough-to-be-effective-without-being-over-or-underwhelmed” comfort zone. Permeability can be painful; sometimes I wish I could swaddle my heart.
Our cancer patients are Tex, a bull rider with gold front teeth who was thrown one time too many; as they were patching up his bones, they found malignant melanoma. Felicia, who has been raising her teenage daughter’s twin toddlers while the daughter “goes out and parties,” but who will likely die of pancreatic cancer before the twins’ next birthday. Lee, who fled Gambia on a leaky boat, was working 7/7 in a noodle shop, and now battles esophageal cancer alone; he’s beating the odds and doing well. Gray-eyed Tess, with multiple myeloma, who loved trees, her sons, and scripture, and who asked me to dedicate her Bible. I was rooting for Tess; it ripped me up when I learned from a “condolence card” list that a last-chance clinical trial up north had been unsuccessful and she’d died just before Easter.
Our cancer patients could be you; they could be me. It isn’t easy to embrace the terrible truth of this and remain emotionally accessible. The temptation to swaddle the heart or simply disconnect can be awfully persuasive, but then you remember that you’ve taken the bodhisattva vow countless times. You manage to shift your focus from just how exhausted and fed up and raw you feel to just how much need there is, and you keep going. With any luck, your motivation, self-awareness, self-care, and the resilience you’ve built on the basis of your practice will help you keep burnout at bay.
One of the practices that I turn to time and again has its roots in a simple verse of the eighth chapter of the Bodhisattva’s Way of Life, where Shantideva, that 8th-century paragon of bodhisattvas, writes:
Whosoever wishes to swiftly provide
Deliverance for themselves and others
Should practice the sublime mystery
Of exchanging self and other.
Also part of the lojong [mind training] transmission, the exchange of self with other is not quite the same astonglen, or sending and taking. It’s a deceptively simple contemplative exercise that can be used in all sorts of challenging situations, including conflicts, resistance to suffering, empathic distress, and traffic jams. It can be as straightforward as creating the space to put ourselves in someone else’s skin to the best of our ability, imagining what they’re going through and how they perceive us, and identifying how we might help. A side benefit of seeing ourselves from another’s perspective is that it’s a great way to keep the ego in check. Though Tex, Felicia, Lee, and Tess had very different backgrounds and narratives, by sliding into their skins, dissolving boundaries, and remaining as permeable as possible, I could feel our stories merge. By holding their heartbreak, I could also share in their unique humanity and beauty.
Sometimes, though, the suffering we encounter leaves us gasping for air. We don’t have the energy or emotional space for our usual practices. At times like these, miraculously, we may be saved by someone who simply puts herself in our shoes, wraps her arm around our shoulders, and says the right words.
Late one stormy afternoon, the oncology nurses called me in to pray with the family of a young teenager whose brain cancer had triggered increasingly violent seizures. They were waiting for the chaplain to arrive before withdrawing artificial life support. When he breathed his last, his mother was in bed with him, sobbing, and two younger sisters wailed with grief nearby. As I left the room, I felt utterly depleted and inadequate, and my empathy had made itself scarce. I didn’t plug in to my compassion practice; I didn’t try to put myself in the skin of any of the people in that room. I wanted nothing more than to go home, drink a good porter, and watch pudgy puppy videos for an hour or so.
A pediatrician about my age, composed and kindly, was standing behind the nursing station. I took a deep breath, gravitated toward her, and we chatted for a minute. “Why would anyone choose to do the job you’re doing?” I asked. “It can be so unbearably sad. . . .” She put her hand on my arm and was silent for a few moments. “We do it because we can,” she finally answered. She explained that she believes that it is a gift to have the qualities and motivation that enable us to be with these situations, and it behooves us to make use of that gift.
She saved my skin that day. I’ve carried her simple statement with me from patient to patient, from heartbreak to recovery. I don’t always rise to the challenge, but I’m learning to recognize that it is, truly, a gift to be able to trade places and remain fully present. And that usually, I can.
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