Aug 20, 2020

Letter to a Hospice Volunteer

A worry that is often raised by volunteers is that they aren’t having any impact, or that they aren’t being a “good” volunteer. This concern was raised by one of our Zen Caregiving Project volunteers who served at Laguna Honda Hospital’s S3 Palliative Care ward. Alistair Shanks, our Volunteer Program Manager, wrote this response to the volunteer, which touches on the very core of our approach to serving at the bedside. It has been edited to remove certain personal references and protect privacy.

Dear _______,

Your doubts are not an indication that something is wrong but a natural reflection of the difficulty of this work. Doubts are an invitation for self-reflection. Being with another human being in a volunteer/patient relationship is simultaneously an artificial construct and a natural, fundamental, human undertaking, a meeting of two spirits. Volunteers process and navigate this relationship in a variety of ways. And it is rarely easy. 

Very often we don’t know what our impact is on the people we serve. The residents of S3 Palliative Care Ward have all kinds of conditions; many have varying degrees of cognitive impairment; all are struggling in one way or another with disruptive life transitions, fear, uncertainty, and doubt. What we offer to them may be nothing more than our simple presence, perhaps a brief moment of connection, feeling less alone for the duration of the visit. Or it may be much more.

I frequently point out that volunteering is about relationships, that what we do at S3 is form relationships and I believe that to be true. We meet people, we get to know them a little, become witnesses to their stories, and in some cases form deep bonds of affection and regard for them. We even fall in love with them. But we are still volunteers, constrained by the role.

The precise nature of the role of volunteer is one that I have reflected on frequently and its complexity still surprises me. We are not friends, nor are we family. This gets to the heart of the question of the role of a volunteer. We are neither/nor. We are not friends because we do not have a long history, common experiences, and social connections that bind us. We meet them as they are, seeing only a sliver of a long and unimaginably rich life. We do not have the obligations of friendship though we should always strive to be constant, reliable, trustworthy, and kind. We make ourselves available emotionally in the way we want our friends to be, but there are lines we do not cross. One of those lines is that of reciprocation and expectation. We do not expect to be able to rely on the people we serve, to meet our needs or to be available for us. We may even be met with rejection or dismissal. In this sense there is not the customary social contract. 

This is not to say that deep, meaningful relationships of true tenderness, regard, and even love  don’t develop. They absolutely can and do, but they are circumscribed by ethical constraints. We cannot give or receive gifts of any value. We don’t give advice. And perhaps most significantly, our contact is limited to one regular five hour shift per week. 

The act of sitting at the bedside of someone who is terminally ill is incredibly intimate. It is a privilege. As volunteers, we are given the opportunity to interact with strangers in ways that are profound and rare. It can be painful, gratifying, surprising, and deeply nourishing. But we can’t necessarily know what our impact has been on the people we serve. This may be the most important lesson. Our actions will have consequences yet we are not often privy to them. It always reminds me of the metaphor of casting a stone in a pond. The ripples fan out in concentric circles eventually reaching all of the shoreline. We don’t know how our ripples will impact a life after our contact with someone has ended. 

Part of the practice of volunteering is the ability to engage in self-examination, to look deeply at our own struggles, doubts, and edges. This is what we do in shift change meetings and is a critical aspect of the volunteer experience. It is the self part of mutuality and it is the practice of self-knowledge that in my mind is the cornerstone of spiritual practice and inquiry. Being vulnerable in this way and verbalizing it in front of peers is a way to see what is true for us but just as importantly allows the people who witness us to feel comfortable doing the same. Vulnerability begets vulnerability. Everyone is served. I have witnessed you doing this, so thank you for being a model for your fellow volunteers in this way.

Thank you for your service to the residents of S3 and keep in mind you may never know the impact you had on the people you visited but I can assure you it made a difference.  As it says in the Tibetan Book of Living and Dying, “Whatever we have done with our lives makes us what we are when we die. And everything, absolutely everything counts.” I believe this to be true. People so often despair that they are not making a difference, that what they do is not enough. I take the opposite view. I believe that everything we do matters; it all makes a difference; it all counts, a smile, a kind word, an acknowledgment. Thank you for the difference you have made.

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