What matters to me

When our son was about six years old, my husband and I were faced with a difficult healthcare decision. His rare genetic syndrome made it nearly impossible for our son to keep his attention on anything for longer than seconds at a time, and he moved from activity to activity without landing or learning. (I captured a snapshot of a that time in a blog post here.)

His neurologist recommended that he try medication for ADHD. His teacher was supportive, since she watched his struggle to maintain focus in school. But others weren’t so sure. His cardiologist was concerned about side effects that could affect his vulnerable heart. His gastro-enterologist, endocrinologist and his dietician pointed out that he was already struggling fiercely to grow with the help of a feeding tube and growth hormone shots. Did we really want to jeopardize his growth with a medication that would most likely decrease his appetite?

I remember asking friends, family and other parents of children with complex health care needs what they thought we should do. Everyone had an opinion based on what they would do if they were us. The problem was, they weren’t us; it wasn’t possible for them to put themselves in our shoes. Clinically, there was no one perfect choice, and the professionals couldn’t say for sure, either.

Ultimately the decision came down to us. We thought long and hard and boiled the issue down. What mattered more: physical growth or mental/social growth? What mattered more to him? To us as his parents? To our family? With this in mind, we made a choice. Who knows if it was the right one, though in hindsight it still feels right.

I’m grateful that we were allowed to become informed and to make a choice. But that wasn’t always the case. For many years, patients and families were not given choices, and simply told what to do according to clinical guidelines.

Little did I know that almost exactly the same time, across town at Massachusetts General Hospital (the very hospital in which my son was born!), researchers Susan Edgman-Levitan and Michael Barry were writing about an important shift in health care called shared decision making.

In their article Shared Decision Making — The Pinnacle of Patient-Centered Care, they described a process “by which the optimal decision may be reached for a patient at a fateful health crossroads … and involves, at minimum, a clinician and the patient, although other members of the health care team or friends and family members may be invited to participate. In shared decision making, both parties share information: the clinician offers options and describes their risks and benefits, and the patient expresses his or her preferences and values. Each participant is thus armed with a better understanding of the relevant factors and shares responsibility in the decision about how to proceed.”

Edgman-Levitan and Barry go on to say that to work this way, both patients and clinicians need to change:

“Patients should be educated about the essential role they play in decision making and be given effective tools to help them understand their options and the consequences of their decisions. They should also receive the emotional support they need to express their values and preferences and be able to ask questions without censure from their clinicians. Clinicians, in turn, need to relinquish their role as the single, paternalistic authority and train to become more effective coaches or partners — learning, in other words, how to ask, “What matters to you?” as well as “What is the matter?”

Asking “What matters to you?” as well as “What is the matter?” It doesn’t sound like a big change, but it is. The question of “What matters to you?” has become a rallying cry within healthcare among those who wish for healthcare to become more empowering and inclusive for patients, their families and their communities.

In fact, this week marks the fourth annual ‘What matters to you?’ day, celebrated at healthcare organizations around the world to encourage healthcare ask patients, the public and professionals what matters to them.

Here in Sweden, I’m organizing a digital conference. (Info in Swedish here.) I’m excited to show how the question is being asked and used to improve health and care. In the hustle and bustle of the program, there probably won’t be time to think about what it felt like all those years ago when we were stepping into empowerment and involvement, but it’s there in my heart.

So, what matters to me? Connection, respect, learning. A good cup of coffee and saying thank you. Remembering to take the time to smell the roses (and if I’m honest, sometimes picking one as I did this morning on the way to the office). And of course, being allowed to make choices for me and my family. How about you? What matters to you?

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If the lights go out, just move

Winter field andscape in Sheffield

This past winter I spent a long weekend on retreat in stillness and good company. The theme of the retreat was hidden seeds, the way nature can look as if it’s sleeping or even dead, when in fact it is gathering strength, getting ready to burst forth when the conditions are favorable.

I myself was coming back to life after several months of feeling in the dark, disconnected from myself and the people I cared about. Like the winter landscape outside me, I felt used up and in need of rest. Worse still, I felt disengaged and cynical. I hoped the retreat would help me move through this inner winter.

The retreat took place in England, in a wonderful house filled with quirky landings and hallways, double taps at the sink, with a huge vat of tea standing at the ready. Perhaps less notably English but more eco-friendly were the light fixtures in the bathroom stalls. A friendly note near the door latch explained that the lights were motion activated and what to do if one found oneself sitting in the dark:

If the lights go out, just move.

Poetry filled a special purpose throughout the weekend, allowing us to get to the heart of the ideas we needed to talk about in the way only poetry can. This poem by John O’Donahue closed the retreat.

For a New Beginning

In out of the way places of the heart
Where your thoughts never think to wander
This beginning has been quietly forming
Waiting until you were ready to emerge.

For a long time it has watched your desire
Feeling the emptiness grow inside you
Noticing how you willed yourself on
Still unable to leave what you had outgrown.

It watched you play with the seduction of safety
And the grey promises that sameness whispered
Heard the waves of turmoil rise and relent
Wondered would you always live like this.

Then the delight, when your courage kindled,
And out you stepped onto new ground,
Your eyes young again with energy and dream
A path of plenitude opening before you.

Though your destination is not clear
You can trust the promise of this opening;
Unfurl yourself into the grace of beginning
That is one with your life’s desire.

Awaken your spirit to adventure
Hold nothing back, learn to find ease in risk
Soon you will be home in a new rhythm
For your soul senses the world that awaits you.

John O’Donahue, from To Bless the Space Between Us. 2008, Penguin Random House

Receiving those words that Sunday morning, I realize I have firmly stepped up to the threshold; no, I’ve crossed it. A seed has been lying dormant inside of me for many years, gathering vitality, waiting for conditions within it and around it to be right. The safety and ego that once offered a feeling of competence and accomplishment suddenly felt constricting, bursting at the seams like a jacket that is still considered beautiful but is now too small.

Then, with no effort besides the willingness to be a channel for something bigger than myself, I find myself standing here in delight, ready to head out again with just a few essentials. With spare abundance in both things and company, I trust that whatever I need is here. That there is enough. I trust that whatever I have inside me might just be what someone else needs. That I am enough.

The adventure begins. I notice I already have a map in my hands. I look at it and see that there are several paths; I don’t need to worry yet about which one to take–the exact way will present itself in due time. All I need to do is take a step, and trust. Welcoming what comes next, welcoming myself to come along.

If the lights go out, just move.