Recently our leadership team here at MSPC started reading a book called “Standing at the Edge: Finding Freedom Where Fear and Courage Meet” by Joan Halifax. What moved me immediately is Joan’s ability to bring to light the palliative care principles that initially pulled us toward palliative care and sustain our practice.
And just as in our palliative care practice, our values and our way of being in the world precariously balance on the precipice of falling into unhealthy or harm-causing. She refers to the qualities of altruism, empathy, integrity, respect and engagement “Edge States”. When we take the high path or edge, we can facilitate great healing; but conversely, we can find ourselves slipping into chaos and suffering with these same qualities.
Altruism can show up in two forms: selfless altruism and pathological altruism. When we say, “I just did what needed to be done” and have no ego in the outcome of receiving praise for our altruism, this is on the high edge of the quality. However, when we are looking for praise or ego-stroking for our virtuous deeds, this becomes self-serving and pathological. Early in my career, I easily slipped off the edge into fixing, doing for, and sometimes even enabling. As a younger woman, I was rewarded from my family and my community for my altruistic works, and I found that I received more work and commitments to help others as a result. I would fly in with my cape and my magic wand and intervene, even when it did not serve the other person. On the other hand, in my wisdom (also known as operant conditioning) I realize that when I take my ego out of my palliative care practice, most of my peers and loved ones have no idea how much I give to others every day.
Some people mistake empathy for emotional self-sacrifice. This boundary crossing and over-involvement is where we as palliative care specialists can teeter into the realm of burnout and compassion fatigue. However, if we can find a way to walk the high path and balance our equanimity for others by allowing things to be as they are, we give a gift to those we provide empathy to. When we cross over into over-involvement, we unintentionally trample the other person’s autonomy and may no longer be effective. When we identify too closely, our therapeutic alliance and efficacy wanes. I remember a case where a patient dying of cancer was distressed about telling her young children that she was going to die of cancer; I was so overwhelmed by the patient’s feelings that I could no longer support her and hold her distress in empathy.
Integrity reminds me of moral courage. It is the ability to hold true to what you believe is right even when others might say you are wrong; sometimes integrity means following the more difficult path even when no one is looking. Suffering for the person who holds true to their beliefs seems to be part of the journey. When we take the high path and stay true through adversity, sometimes we can make situational or systemic change. When I think of integrity, I think of Rosa Parks, refusing to move out of her seat on the bus. It also recalls times when I was brave enough to call out others’ biases that are impacting patient care.
Respect is a blanket term that has a thousand threads. Walking on the high edge of respect includes being honest and congruent about our feelings in a kind manner, refraining from gossip and “othering” patients by the way we talk about them when they are not in the room, and meeting the patients where they are at without being condescending. Falling off the edge of respect into disrespect can be as subtle as disdain or as pervasive as vertical and horizontal hostility, bullying, and systemic oppression. When we sit with patients and allow them space and time to share their story with curiosity and compassion, we are being respectful. Respect is behaving in a way that says “the light in me sees the light in you”.
Engagement is the final virtue that Halifax describes as an edge state; I think of how often engagement is lacking in healthcare. The antithesis of engagement is business which looks like going through the motions while closing off your heart. As a palliative care community specialist, we see so much suffering and loas that it can be easy to fall off the edge. This virtue resonates with me when I think of my practice each consult with a person living with serious illness. It is close to meditative practice when I am engaged; I take deep breaths, forget about everything but the person or people in front of me, and I am at one with the moment. This can happen when I listen deeply and soulfully to stories of loss, hope, joy, and suffering. We are all more different than we are alike, and our true inner selves are just craving connection. However, falling off the edge of engagement is burnout, where we become overwhelmed by the macro environment of a system, workplace, or the global climate; this causes apathy, emotional exhaustion and inefficacy.
Here is a link to Halifax’s work if you are interested in reading more:
Standing at the Edge: Finding Freedom Where Fear and Courage Meet by Joan Halifax | Goodreads
