Many years ago, as a holistic nurse consultant at a busy New York City hospital, I learned the power of an unconventional question.
Late on a Thursday afternoon, a pre-op testing nurse pages me to her department. When I arrive, she explains her patient, a woman newly diagnosed with a brain tumor, is frantic with worry about the upcoming surgery. The nurse asks me to help calm the woman, so she, the nurse, could complete her list of questions and send the patient to the anesthesiologist, the final exam of the day.
The room is small and stark with just the nurse’s stethoscope on the counter and the woman sitting on the only chair. Not wanting to hover over her, I excuse myself and find an unoccupied stool and wheel it in.
Now sitting, I face the crying woman, introduce myself and say, “I’m a holistic nurse and I work throughout the hospital helping patients who are worried and scared, adding, “And I’d like to help you.”
Tearful and shaking her head she said,”I don’t know what to do! My surgeon wants me to have brain surgery next week and I just got through recovering from lung cancer. It was horrible. I just can’t do it again.”
I nod listening and wonder, what I can say to that?
To gain some time and trust, I ask her what it is she “can’t do again?” She describes for me her year starting with surgery removing a lung, cancer treatments, infections after that, weakness, ending forcefully with, “It’s not living!”
Her surgeon told her this surgery would be harder, she might be unconscious for awhile and that he doesn’t know what her long-term chances of survival are.
I sit with her in silence, letting this sink in.
I do have a question I’ve become interested in asking most people facing serious illness and it’s surfaces in my mind. I like this particular question for two reasons: 1) because the answer is rarely what I imagine it will be and, 2) it usually something people are reluctant to say out loud. Unless prompted.
I decide it’s the right time and ask, “What are you most afraid of or worried about?”
“Not death. I can tell you that!
Transforming Questions into Inquiry
Moments like this pull me into my crowded storeroom of experiences, thoughts and questions. I simultaneously step deeper inside myself and stay present to her experiences, holding her reality like it’s one of those glass balls filled with water, “snow” and a scene inside. Shake it up and the snow starts swirling; hold it still, and the snow settles and the scene becomes more visible.
I pose several different questions to myself. Inwardly I test each one that arises, hearing how I might answer it if I were asked the question, how it sounds and feels to ask the question, and even imagine how she might feel to have this, or that, question to think about.
This process is reflective inquiry in real time. It uses the patient’s dilemma to shape what you ask next, rather than thinking ahead of time about what you want to say and tell.I think about questions that relate to death, family support, her goals. None feel quite right.
Then one question emerges above the others; it’s not what I expect at all and it’s a risk. I take it.
“What would be the benefits of not having the surgery?”
She looks at me inquisitively.
“I mean, that’s an option, too…to not have the surgery. Are there any benefits to that? Not having the surgery?
She pauses. I pause. Then she smiles and tells me how she would take time to enjoy her life in the City, as it is now, with family and friends.
Conventional and Unconventional Questions
I think about how as health professionals, we tend to frame our discussions about treatment options with patients and families using a conventional formula.
First we describe the benefits of the proposed treatment and then go into the possible side effects or potential negative outcomes. But this is framed only within the context of, and the assumption that, the person will agree to have the treatment.
We also might raise our concerns about the negative consequences of not doing the treatment. But what we most likely don’t do, is offer to compare the treatment to, or weigh it against, the potential positive aspects of not doing the treatment.
This can put a whole new spin on decision making and one that is unconventional for many doctors and nurses, because we’ve been trained “to do.” Not, to not do.
Considering these benefits is part of fully consenting a patient. While most people want to go ahead with the medical recommendations made to them, this last question gives people the chance to fully consider all their choices in an open, non-judgmental dialogue with you, without feeling abandoned, if they make a choice that’s different from, (not against), your nursing or medical advice.
I don’t necessarily bring this up to all patients, but it is particularly helpful if they are struggling or opposed to a suggested medical or nursing course of action.
Mutual Process
It’s also O.K. if the person feels your question is off-base. You can follow that up with a simple, “Oh, thanks for letting me know,” and see what might have been more relevant for them.
In this inquiry process you’re simultaneously listening for cues from the person you are with, as much as you listen to own inner dialogue, in a spacious curious way, e.g. waiting for the “snow” to clear, so you both get closer to what the person needs and wants.
Next time you are struggling with a decision, step back and listen to the many possible lines of inquiry that arise within you. Test them out by opening up an inner dialogue and find the question that most wants to emerge. Spend time with the question and the inquiry that follows.
The question that arises, might surprise you and transform the moment.
On that Thursday afternoon, the woman and I took time to frame the questions she had for her surgeon, including how her medical condition might advance if she chose not to have surgery. In the end, I don’t know what she decided; what I do know is, that the unconventional inquiry opened up a new set of possibilities that was equally compelling for her, as the original was daunting.
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Much love to you and to what you do everyday, in caring for yourself so you can take great care of others.
Jackie
Individual Coaching
In addition to the Burst Coaching, I have a few places open for my longer Individual Coaching packages. This is for you if you want to achieve a bigger vision for yourself in your career, your health or your spiritual path. If you have any questions, please email me, and we can set up a time for a conversation.
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Do you have a question or use a process that helps you raise unconventional questions? Please share your thoughts below!