Episode Summary
Kath Murray welcomes renowned palliative care leader Phil Larkin to explore the transformative power of compassion in palliative care. Together, they illustrate that every team member’s contribution is essential in creating a holistic, compassionate care environment that goes far beyond treating physical symptoms. Their engaging conversation, enriched with powerful metaphors and personal stories of resilience, offers a heartfelt reminder that every little act of kindness can build a safe harbor and transform the caregiving experience.
Episode Guest
Since August 2018, Philip Larkin has held the Kristian Gerhard Jebsen Chair of Palliative Care Nursing within the Palliative and Supportive Care Service of the University Hospital Centre (CHUV). He also directs the Master of Science in Advanced Nursing Practice at the Institute for Higher Education and Research in healthcare (IUFRS), University of Lausanne.
An Irish national, Philip Larkin has over 35 years of experience in the palliative care sector, both clinically and academically. He has become an important figure in the field in Ireland and elsewhere: As Professor of Palliative Care at University College Dublin, he has led the development of the All Ireland Institute for Hospice and Palliative Care, a public health project bringing together The Republic of Ireland and Northern Ireland to improves palliative care outcomes for all citizens. He was President of the European Palliative Care Association (EAPC) from 2015 to 2019.
His research has focused on access to palliative care for vulnerable populations, with a particular focus on patients with mental health issues, disability, children and palliative care needs in rural isolation, groups often marginalized in accessing palliative care. The place of compassion in palliative care is also part of his academic scholarship.
He currently leads a palliative care nursing research team at the CHUV and continues to lecture nationally and internationally on nursing care, palliative care and compassion in care.
Transcript
Kath Murray: Good morning, Philip Larkin. It is an honour to be here with you today.
Philip Larkin: It’s a joy. Thanks. Nice to see you again. Thank you for inviting me.
Kath Murray I want to introduce you. You are one of my favorite international hospice palliative care nurses. You’re an educator, professor, advocate, clinician, researcher, leader. At one time, you were president of the European Palliative Care Association. You’re chair of the Palliative care, nursing and Supportive Care service at the University Hospital Center, and currently director of the Master of Science and Nursing Practice at the University of Lausanne, Switzerland.
Philip Larkin: That’s me. I have all of those things.
Kath Murray: Wow. And you are from Ireland, as we can tell from your accent. And there you led the development of the All Ireland Institute for Hospice Palliative Care, a public health project developed to improve palliative care for all citizens.
Philip Larkin: That’s correct. Absolutely. That is, again, a past life. That was my job.
Kathy Murray: So therefore, you went to Switzerland for just a little bit of time, and then Covid hit and you remained there. Let’s go Switzerland. I know that one of your passions is looking at the place of compassion in palliative care, and that is what I want to talk to you about and focus with you on today.
Philip Larkin: Delighted to talk about compassion.
Kath Murray: My name is Kath Murray. I’m a hospice palliative care nurse and educator and author and co-founder of Life and Death Matters. And I, like you, share a passion for hospice and palliative care, in particular resources that help stimulate and develop excellent, compassionate, competent palliative care providers. So let’s talk. Tell me what. When you think about this term integrating a palliative approach, what does that mean to you.
Philip Larkin: So I think all people who provide a caring service. I’m not talking about people who have professional training and qualifications and PhDs. I mean, anyone who is in a role where they are working with people of families who have a life limiting or life threatening illness, has the capacity to provide a palliative care approach. And in some ways, for me, it’s about a way of thinking differently. So what can I do with you? Rather than what can I do for you? Because obviously we always do for other people. But one of the things that’s really important for me when I think about the palliative care approach is it doesn’t matter what disease you have, it doesn’t matter, you know, what type of symptoms you have.
We can treat those. We can manage those. But it’s that I and you both understand the palliative care, the care of that other dimension. Not just the physical, but the psychological, the social, the spiritual. All are equally important. And whether I’m the person who is providing your meals, whether I’m coming to clean your room, whether I’m, a care attendant working with you or professional nurse or a doctor, we each carry something really important in that because we all we can’t do it alone. We need to do it as a group. And for me, the integrated palliative care approach is when we learn the value of each other so that we all bring something to the table, we all want something to the table to improve the situation for the patient and the family.
Kath Murray: That’s a lovely way of thinking about it, both the earlier things, but also the idea that one of the key pieces is working together.
Philip Larkin: Yeah, I mean, I often use the metaphor of a diamond. You know, we talk about the fractals of a diamond. Well, a diamond so beautiful when it all glistens together. And in it we are all parts of that diamond. We’re all little parts of that diamond that work together. But right at the center of that diamond is the patient and the family. And so we all have to glisten and glitter together for that, that thing to dovetail. We know we’ve got a really super diamond of great carats.
Kathy Murray: So that reminds me a little bit of one of Balfour Mount’s comments when he says, if you work as a team. Show me your battle scars. Yes, because aren’t diamonds developed under pressure?
Philip Larkin: And I love that you have to dig them out first of all. And then you then then you’ve got, you’ve got to, like, clean them up. And. Yeah, there’s a lot of work to a diamond. It just doesn’t happen, you know? Really? Yeah. The diamond. I like the diamond metaphor.
Kath Murray: That’s a really a good one. A friend of mine, Elizabeth Caston, talks about the heaven and hell of team. I think sometimes there’s a there’s some of both. But what I am convinced is that if we desire to work together, if we. If we’re good to one another, if we show one another some grace, if we communicate well, I really do believe that we can shine and polish that diamond.
Philip Larkin: Yeah, absolutely.
Kath Murray: There is a word I said earlier. I want to talk to you about a word. Not just a word. A whole way of being a whole. Whatever is compassion. Tell me about compassion.
Philip Larkin: Wow. How long have we got? So, Well, compassion. Often compassion is misunderstood. So often people think of compassion. Empathy. They think of it as a way of being. Now, that’s a bit of that. Correct. But actually your compassion is the action that you do in response to the way you feel. So I often use I like metaphors. I talked about the diamond. Now let me talk to you about the empathy compassion thing. So empathy is the key which unlocks the door to compassion. So if you imagine a door, you unlock it with your empathy. You’re looking at somebody who is suffering. You know that you want to do something, and to do that, you will do an action. So there’s a couple of things in that. First of all, compassion is real when we witness the suffering of other people. So you have to witness the suffering. You have to, just not understand their pain, but appreciate that they’re in pain, whatever type of pain that is.
And you have to witness that the witnessing is really, really important, as in almost acknowledging, I see that your suffering. And then with that empathetic response, you put the key in the door, you open the door and you cross the threshold. And crossing that threshold is the action that you do. And it can be the smallest action ever, which is the really important thing. People assume you have to become some sort of like omnipotent Buddha like being to be compassionate. It’s the little things that you do that make the difference. And I might talk about this guy later, but I want to mention him now. His name is Henri Nouwen. He wrote a great little book called The Wounded Healer, but he also wrote a lovely book about compassion.
And one thing he said in that is, it is you that make the difference. You make the difference. So your compassion is you, and you make that difference when you when you do your small action. So it’s not about it’s not about changing the world. It’s about doing one little thing that may improve the experience. When we talked before, you talked about how families, patients, residents are often touched by those acts of compassion.
Kath Murray: Absolutely. So these compassionate acts, they are not big deals. Some of them are very. And you use the word sometimes tiny,
Philip Larkin: Not even small tiny and sometimes Cath you know, you don’t even know you’ve done it. You don’t even know you do it. And nurses particularly will say to me, well, it’s my job. Yes it is. You’ve been trained to do this, but little things like, for example, you know, when you give someone a drink, you hand them the cop, you hand them the glass. They’re you’re working with older, frail people. Maybe holding that glass or cop is difficult. So you help them, you hold it for them. You sit down for a moment with them while they have that cup of tea.
So what are you doing? So you’re sharing something of yourself. You’re making sure they get at least 30 mils of fluid in, because we know that every 30 mils goes to improve their kidney health, their renal health. So you’re doing very, very practical actions, but you’re doing it in a compassionate way. One of the ones I know, we talked about this. I apologize to people listening, but one of the most compassionate acts that I think we do as caregivers is to take someone to the bathroom. If you think about something which is a very, very private, intimate thing that we do ourselves, when you’re sick, you have to hand over your power to someone else to do those intimate things that normally you do for yourself.
So taking someone to the toilet, sitting them down on the loo, walking away. I always talk about the invisible presence because sometimes you have to hover in the background without them knowing you’re there and all the things that’s tied into that. That’s a compassionate act in itself. So, you know, no one’s asking you to, you know, become some saint like creature that is certainly going to change the world.
But the little things that you do, I one of the things I talked about before, but it’s really important, is in our communication. So years ago, I worked with a great lady in the University of Alberta in the nursing school called Brenda Cameron, and she wrote this little paper called “How are You” and I always remember that paper, and I remember that in my practice I never say, how are you? I say, how are you today? Because in palliative care today it could be okay. Yesterday was not great and who knows what tomorrow will be. So the precision compassion also requires a little bit of thinking and a little bit of precision. And eventually it’s a bit like riding a bike. As you get on with it, it just becomes who you are and you will do it.
You will do these things automatic. You are already doing them. You will already being a compassionate practitioner by the things that you do every day. When you go into the work,
Kath Murray: Lovely, lovely, lovely. Now you’ve written something about compassion yourself. A little book about you did,
Philip Larkin: I did, I did, I wrote a book. So when I was a couple of years ago, I was given a Fulbright scholarship. I don’t know why they did that, but they were very kind. And they sent me to the Dana-Farber Center in Boston. I had a year and I wrote a book about what compassion is in palliative care. So I interviewed, palliative care practitioners all across the world, nurses, doctors, social workers, chaplains, care attendants, social workers, all the people who we know are often involved in this care.
And I asked them, what does compassion mean to them? How do they see it in practice? But how do we instill this in the next generation of people who want to be palliative care practitioners? And I learned some really important lessons in that. And one of those is that some days I just need to be a good worker.
I need to be a good nurse or a good doctor. And I haven’t got the I haven’t got the spirit today to push that little bit further because of, I don’t know, you know, the cat’s not well or you know, I’ve got a, I’ve, I’ve got some financial stuff I need to deal with. I got to get to the bank by 12:00. Whatever it is, those things can impact on how we can manage to be present. And I learned that some days I just need to be a good nurse, and that is okay. There’s no problem and no shame in that. You don’t have to be super bad. That’s the lesson I learned.
Kath Murray: Now, you also mentioned there that there was a a person who would just take a breath before going into a person’s room.
Yeah. Just a way to separate out what I’ve been doing, who I’ve been talking to and who I’m entering into and talking to now. And it was just a breath. Yeah, just about that.
Philip Larkin: Yeah, sure. So I was observing, a doctor in a in palliative care clinic in the hospital. I noticed and I think this is the important bit for this person. It was unconscious. She didn’t realize she was doing this. She would stop at each door for a couple of seconds, and then she would go in. So it’s remember my empathy and my my key. So it was like she hit the threshold of the door and she stopped for a couple of minutes and then she went in. And when I asked her why she did that, she didn’t realize that she did. But when she reflected on it, she realized, you know, we’re busy people. We go from room to room to room. We are constantly on the move, but we don’t know what we will find when we go across that threshold. You don’t know where the family are.
You don’t know how the patient is. So you need to be in the in the moment. You need to be in the space so that you go in with a little bit of freshness so that you’re not carrying everything that’s going on. Okay. At some point you need to then reflect on the whole. But at this moment I am here for you. And that’s what she did every day. And she did that as a role model. And then I saw other people doing it, that they realized that this was a way of just taking a moment for themselves, just to think, you know, even it’s just so that they could then they can then have the energy to go into that room.
Kath Murray: Sometimes I’ve heard people talk about when they put gloves on before going into a new room, that that’s when they’ll have their just the time to set. I remember hearing a personal support worker talking and she she was so funny and and she talked about being in one room and and somehow her I can’t remember her name was Sally, but. Or if she adapted the song. But that song, Mustang Sally. Yes. Which is dancing and singing that song with a resident in that room.
And then, you know, a couple minutes later, she’s in another room and she’s just. Yeah, yeah, completely, completely mellowed out to meet the needs there. And to me, that’s that just that listening is just such a beautiful piece of that listening, that compassion.
Philip Larkin: Yeah. I mean, in here in France or in the French speaking parts of Switzerland, where I live, we have a lovely place, but they have two phrases about palliative care, but one of them is adequate, and it means you translate it in English as active listening.
But it’s more than that. It’s more it’s the depth of listening with what you can achieve. And I just want to come back to the point you made about the, the, the, the you, the support worker, the people who I learn most from in terms of compassionate care, other people who are not swathed in qualifications. Okay, so I often use the metaphor to the patients, the person you need is the person who comes in as themselves.
Because one of the things I learned in trying to understand what compassion means, and I’ll just give you the example. So I trained as a nurse in London and then in London in those days, going back a few years now, the female nurses wore these incredible uniforms. I mean, they had these things on their head that were made of lace.
They had these belts with these made of Petersham, with these big silver buckles and badges. Your power was based on the number of badges that you wore on your shoulder. And that was that was the image that was given. And what I learned was that a compassionate approach is when you can take all of that off and when you can be a human being, facing another human being who is suffering and have the courage to stay in the journey to stay with them.
And that, for me, is what a compassionate person is. And and I see that every day and not often with the nurses and the doctors, but with the support workers and the care attendants and the lady that brings the flowers, and the woman or the guy who does the floor. They are the people who show that every day because they’re not bringing the baggage with them.
Kath Murray: You know, they’ve got no baggage in that sense. When you were talking earlier. First of all, thank you for those thoughts. When you were talking earlier about active listening. I was reminded of many years ago, seeing that Chinese symbol for listening. And it includes heart and includes ears, and I can’t remember, but it included heart and worked with a, counselor social worker at the time.
And I got to tell you, my wife, as always, has been so enriched by by working on a team and working with social workers and counselors. And I remember her saying, you are the greatest gift you bring. And get out of the way so that you don’t get in the way of, of doing, of letting somebody do their, do their work and have their journey and,
Philip Larkin: and if I could just add some Kath because I think this is important that we talk a lot about the duty of care that we have to others, to patients and families and all of that. We have a duty of care to each other. And so within our teams, if I see a colleague suffering for whatever reason, I have a responsibility to say, are you okay? Do you need something? And if your team you know, for me, the sign of a good team is when somebody can come into the room and say, don’t ask me to see Phil Larkin today because I will kill him.
He has driven me crazy for two days. I can’t get through to him. He’s rude. He shouts at me, he throws things at me, whatever it is. And somebody steps forward to say, let me take him from you today and will you look after Cath Murray? And that is the real sign of compassion in the team.
Kath Murray: Phil, can you give me one example of when your team has shown you compassion?
That’s a personal question, but just, an example. Can you think of one?
Philip Larkin: Yeah, I can think of a of, of a personal example. So, you know, I, I was responsible for a complicated home care team at one point. Complicated in the sense that, you know, it had a mixture of very experienced and very, junior people.
And, some of the senior people had come from, a position where they felt that they were they were the authority to speak on everything. And therefore, you know, anybody who was in a leadership position was threatening that. So there was a lot of conflict in there, and I hadn’t recognized how much that was having an impact on me until one of the most junior nurses in that team came to me, and she said, I’m really worried about you.
You look tired. And I just fell apart because I was exhausted from dealing with that. But it immediately made me realize that we are all vulnerable and vulnerability isn’t a problem as long as we recognize it and we allow others to recognize it for them, too. And so I was able then to say to the other managers, we need to do something about this, because eventually this is going to seep out into the care that we give, and that won’t be a good thing.
And I’ve also had, you know, jobs where I’ve reflected and thought, is this the right place for me? Am I the right person in this position? Should there be somebody else that would do this? But I think the last time I also spoke to you, so, you know, in the, in the, in the US and actually globally, they also had these things called the Schwartz rounds.
So Schwartz rounds or where people come together as an organization to talk about a case, a clinical case, and not to understand why a doctor made a certain decision, particularly. But what was the impact of caring? And I can remember this story from the from Dana-Farber, from the hospital in Boston, of a nurse from an Iranian patient to come from Iran because they brought many international patients.
And this young, young woman was of Iranian origin, but actually brought up in the United States. And because she spoke the same language as the patient, everyone thought, oh, she can be the primary nurse. She’ll be cool. She’ll be great. Nobody thought about the cultural clash between somebody who is coming from a particular culture, and this young woman who was really an American woman, although she had Iranian cultural background.
In this in this opportunity of sharing, she said, you didn’t hear me. I nearly I nearly burnt out because you didn’t hear my struggle. And that’s why that little compassionate voice at the listening to the voice of fragile silence is if you I mean, they often talk about it. You’ve got to feel compassion in your guts.
It’s not something in your head. It’s visceral, you know, it’s when you think, oh, or, I there’s something there that I’m missing, or there’s something I can’t quite get my hands on. It’s intense. Horrible. That’s a little compassionate voice saying, well, maybe you need to go back. Or is there something you could do differently?
Kath Murray: So we’ve talked about thank you. We’ve talked about, integrating a palliative approach. We’ve talked about many palliative care stories that are are touching, that are hurt and individual stories that are, you know, certainly touch and stir the heart. I, I just I’m closing. I want to just think for a minute about these incredible human beings working in long term care, who in some ways are still struggling with some of the grief they experienced during the Covid years.
And, and, it’s it’s one thing to be able to stand up and, and debrief one case, but oh my goodness. Well, the need for compassion for one another, the need to show grace with one another and and a whole system that is working so hard. So I think that that’s, that’s that’s a big challenge, isn’t that?
Philip Larkin: It is it is a big challenge. And that’s in a way why I say that every little tiny action that you make is the beginning of a compassionate response. Everything, every little thing that you do. And if all you can do on one day is one thing, it really is okay. Every little action is an act of strength.
So that everything that you do is an act of strength. It has the power to change. It has the power to transform, you know, Cicely Saunders, who founded that palliative care movement that we all believe in so passionately, said, you know, the presence of another person is an eye of of security. And the courage that you need, the strength that you have is to stay the ground.
When somebody is in a really bad place and you’re still there, you haven’t hit the door. You haven’t run away.
Kath Murray: We want to be a safe harbor. So as I think as as we finish this today and I think about compassion and I think how little things that we can do for people, we care for little things we can do it for one another. That creates a safe harbor, safe harbor for our team, a safe harbor for our management to practice and to learn. Being managers, the safe harbor for people who come into our care. Yeah, absolutely. When I remember when we were going through the COVID and I’ll just I’ll leave you with this. We had, we have a doctor who comes from the, French speaking, Moroccan countries, the Maghreb and countries.
And he was very big into Rumi, the Sufi poet. And we had a big sign on the wall which said, if I remember correctly, listen with the ears of tolerance, see with the eyes of compassion and speak with the language of love.
Kath Murray: Okay, say that again.
Philip Larkin: It was. Listen, try to remember it. Now listen. With the ears of tolerance. See through the eyes of compassion and speak with the language of love. Lovely. And that really is what we we do every day in our practice.
Kath Murray: Phil, thank you. Very well. Thank you so much. It was this this has been exciting. This podcast is part of a series developed by Hospice Palliative Care Ontario. And we invite you, Phil, your colleagues and anyone listening to go to HPCO.ca for a full range of education opportunities and resources. And please join us for other compassionate conversations. Phil, thank you across the miles. A great big hug for you.
Phil Larkin: And thank you. Thank you for doing these series, these podcasts. They really will make a difference. Really have enjoyed talking with you today, Kath.
Additional Resources
Compassion: The Essence of Palliative and End-of-Life Care by Philip J Larkin
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