“You listen into people’s eyes,” Doc Barham told me.

I said: “What?”

“When you sit down with people what you first notice is people’s eyes and then you look and listen into them for their hurt, pain, fear, anger and terror and when you do, they share whatever it is with you.  And then they exhale, feel relieved and open themselves up to you.  That is your secret sauce,” he explained.

Doc Barham is CEO of Xtraordinary Outcomes (http://xtraordinaryoutcomes.com) a company which identifies what makes individuals, companies and organizations extraordinary and in doing so, helps them to come from that special “tipping point” place to become even better.  He had been interviewing me about how I work with patients and seem to be able to get through to some of the toughest ones.

Like many “talents” or skills that people have, it was spawned out of a terrible experience.  I hadn’t made the connection until Doc identified the way that I listen.

Nearly thirty years ago, I had one of the more awful experiences in my career as a psychiatrist.  I had been paged to go up to a patient’s room at UCLA Medical Center  to “okay” the soft restraints the surgeons had placed on him plus the major tranquilizer they had then put into his IV.  The patient, who I will call Mr. Jones, was a fifty something patient with AIDS (just after it was identified as an illness), with a terrible infection, who had been placed on a respirator.  He had been pulling out his IV’s and then pulling at his respirator and was in a state of what the surgeons called psychotic agitation.

When I entered Mr. Jones’ room, he was lying with his arms and legs restrained.  His eyes were as big as saucers and they seemed to be screaming out to me.  His eyes in fact grabbed hold of mine as I kept repeating, “What are you trying to tell me?”  Because of the respirator, he couldn’t speak.  All he could do was groan in agony.  I put a pen in his right hand close to the restraint on that wrist and put a piece of paper near it so he could write.  All he could do was scribble something that didn’t make any sense.  I again repeated, “What is it?”  And again he couldn’t communicate what it was.

I concluded that what the surgeons had said was true and that Mr. Jones was psychotic and needing the restraints and the tranquilizer.  I told him: “Mr. Jones, you have pulling your IV’s out and pulling at your respirator tubing and we needed to restrain you and have also given you a tranquilizer to help you calm down.  When you calm down we will take you off the restraints.  I will keep checking in to see how you are doing. Do you have any questions?”  All Mr. Jones could do was stare at me with his eyes wide open terror which were now beginning to show the early signs of being tranquilized.

I checked in with him and his surgeons over the next couple days, but he was mostly sleeping.

Two days later I received a page from his attending chief surgical resident who in a curt manner said to me: “Hey, Mr. Jones is up, alert, off the respirator and commanded us to call YOU.  So I think you should come and see him as soon as you are able.”

With trepidation, I went up to Mr. Jones’ room.  When I arrived he was seated up in his bed. In a non-psychotic and very determined he way grabbed onto my eyes with his, said: “Please sit down,” and with those eyes placed me in a chair.

His eyes never left mine and I could not move mine away.  Then in no uncertain terms and with an emphatic voice he said: “What I was trying to tell you was that a piece of the respirator tubing had broken off and was stuck in my throat.  You do need to know that I will kill myself before I ever get into that situation again.  Do you understand?”

My eye winced and teared up as he revealed the answer to the mystery from my original visit.  I wanted to look away, but couldn’t.  Instead I said, “I’m so sorry that I didn’t know that.  And, yes, I do understand that you will kill yourself before you have to go through something like that again.”

And that is when I began to “listen into people’s eyes.”  I just didn’t know what to call it.

Epilogue: I might not have the opportunity to have had this experience if I were at UCLA today, because it is has undergone a transformation in the past four years where they have become completely patient and patient family centric as documented in the NY Times best selling book, Prescription for Excellence: Leadership Lessons for Creating a World Class Customer Experience from UCLA Health System by Joseph Michelli.

Resources:

• “Just Listen” Discover the Secret to Getting Through to Absolutely Anyone (book)
• “Just Listen” Discover the Secret to Getting Through to Absolutely Anyone (audiobook)

Road Back from Hell is meant to be hopeful and helpful to people who might currently be in a dark place in their life and who might find comfort, inspiration and solutions from hearing the stories of others. It is meant for people to share their stories of being in dark places and how they made it back and for visitors to read those stories and take comfort and find solutions to try. It is not a substitute for psychiatric or psychological care. We are not able or staffed to respond to requests for treatment, referrals or to make medical, psychiatric or psychological recommendations.

• Every community has some sort of Mental Health Services- Find Some Help
• Every town has a priest, minister, deacon or elder- Talk to them
• Every school has a Guidance Counselor or Social Worker- Speak to Them
• Every city has a hospital – Go to the E.R. if you are seriously depressed or suicidal or thinking about “ending it all.”
• Every city has a 911 if you are in a dire situation – Call it.

There are resources out there and people who care- Use them.

Des-pair = feeling unpaired in a world where you (mis)perceive that everyone else is paired with intelligence, attractiveness, worth, love and hope.

And when you feel unpaired with anything and all you feel is pain, you begin to pair with death as a way out of the pain. When you’re in that state of mind you fail to realize that “suicide is a permanent solution to a temporary problem.”

For a number of years I used to be a guest lecturer at UCLA in a course entitled: “Death and Suicide” taught by one of my mentors, Dr. Edwin Shneidman. Ed was one of the pioneers in the study and interventions in suicidal thinking and behavior.  He was one of the co-founder of the Suicide Prevention movements in Los Angeles and Washington, D.C.

In my talk at UCLA entitled, “I’m going to kill myself,” I spoke about “Des-pair” and the seven lesses of suicidal thinking:

• helpless
• hopeless
• worthless
• useless
• pointless
• meaningless
• purposeless

I emphasized that what all of these had in common was “-less” as in “without,” without help, without hope, etc.  I also said that the aim of treatment was to give suicidal patients a feeling of “with” to counter the feelings of “without.”  When you do that, they will stop “pairing” with death and may begin to start “pairing” with you, feel less alone and less suicidal.

I did that with one of the most suicidal patients I ever saw in: “The Road Back from Hell”

Wife: “Before I become a burden on my kids, I’m going to take a bottle of pills.”
Husband: “Too chancy, I’d go with a couple of guns.”
- husband and wife after caring for two parents with Alzheimer’s for three years

This is a response I am hearing from an increasing number of white middle class* baby boomers as they face the prospect of becoming old, enfeebled and a financial and emotional burden on their children.

It may also be that they are projecting the burden, drain and resentment they are feeling or have felt towards their own aging parents who have become enfeebled and require nearly round the clock care. And knowing how they have felt towards their own parents, they don’t want their children to carry the burden of taking care of them and feeling the same way towards them.

It may be prescient of them that knowing how impatient** they have been with their own parents and that their Millennial kids have no patience whatsoever, the idea that becoming mentally and physically enfeebled and dependent on these children portends an absolutely horrendous quality of life for both them and their children.

Is there a solution so that baby boomers might go “gently into that good night” instead of taxing their patience challenged adult children? Most likely what will happen is that when the middle class Millennials grow up and are in the position of having to take care of their elderly baby boomer parents, they will find a way (as their baby boomer parents have) to help pay for their care and delegate their caring to third world caretakers who still retain God’s gift of patience towards those in their care (which is why many a middle class baby boomer declares such caretakers “Godsends”).

One highly unlikely alternative is that Millennials will somehow develop patience to calmly follow the admonition of Cicely Saunders, founder of the hospice movement in caring for dying and infirm parents: “Don’t just do something, stand there.” Why so unlikely? Maybe it’s because their baby boomer parents who were the last generation to abandon patience in favor of the race to get more, sooner have been such effective role models.

In closing I am reminded of a quote from Dr. Milton Greenblatt from the 1970′s:

First we are children to our parents,
then parents to our children,
then parents to our parents,
then children to our children.

But then again that was in a galaxy far, far away and a time long, long ago when patience was not just a virtue… it was actually possible.

* This phenomenon may be more of an issue for the white middle class baby boomer, because family is everything for Third World people and the wealthy can and do pay for everything from people (often Third World) to raise their children to caretakers to provide care and loving caring to their aging and infirm parents.

** Another factor involved with the people I have heard these complaints from is the combination of Impatience + Difficult Parent (difficult as in “high maintenance, as in difficult to please, easy to upset).  It’s easy to be patient with parents who are “low maintenance” (easy to please, difficult to upset), generous and gracious even as they lose much of their physical and mental faculties. The takeaway from this is that what goes around, comes around and if you are the one who is “high maintenance,” you might want to change that.

And if this is not sobering enough read how Older Americans Greatest Fear is Outliving Their Money.

Also see: “How Could She Wish Death on the Mother She Loved?”

At 3:15 PM PST today, Friday, May 15, 2009 my long time mentor and beloved friend, Edwin Shneidman, pioneer in the study, prevention and intervention of suicide and suicidal behavior died at age 91 as he would have wished, peacefully at home. To appreciate the magnitude of his being able to do that you need to read:  Waiting for the End, Alone and Unafraid and if you want to read the story behind that story, you will want to read the Neiman Foundation for Journalism at Harvard interview with Tom Curwen.

Ed was the founder of The American Association of Suicidology and Professor of Thanatology at UCLA. He authored, co-authored or edited nineteen books on the topic.

I had the occasion to visit him – not as often as I should have -over the past several physically painful years of his life. I believe one of his greatest accomplishments is that he managed to meet all the ten “Criteria for a Good Death” that he set forth in an article with that title published in June, 2007 in Suicide and Life-Threatening Behavior published by The American Association of Suicidology.

1. Natural. There are four modes of death–natural, accident, suicide and homicide (NASH). Any survivor would prefer a loved one’s death to be natural. No Suicide is a good death. 
2. Mature. After age 70. Near the pinnacle of mental functioning but old enough to have experienced and savored life. 
3. Expected. Neither sudden nor unexpected. Survivors-to-be do not like to be surprised. A good death should have about a weeks lead time. 
4. Honorable. Filled with honorifics but not dwelling on past failures. Death begins an ongoing obituary, a memory in the minds of the survivors. The Latin phrase is: De mortuis nil nisi bonum (Of the dead [speak] nothing but good). 
5. Prepared. A living trust, prepaid funeral arrangements. That the decedent had given thought and made arrangements for the necessary legalities surrounding death. 
6. Accepted. ”Willing the obligatory,” that is, accepting the immutables of chance and nature and fate; not raging into the night; acceding to nature’s unnegotiable demands. 
7. Civilized. To have some of your loved ones physically present. That the dying scene be enlivened by fresh flowers, beautiful pictures, and cherished music. 
8. Generative. To pass down the wisdom of the tribe to younger generations; to write; to have shared memories and histories; to act like a beneficent sage. 
9. Rueful. To cherish the emotional state which is a bittersweet admixture of sadness, yearning, nostalgia, regret, appreciation, and thoughtfulness. To avoid depression, surrender, or collapse; to die with some projects left to be done; by example, to teach the paradigm that no life is completely complete. 
10. Peaceable. That the dying scene be filled with amicability and love, that physical pain be controlled as much as competent medical care can provide. Each death an ennobling icon of the human race.

Ever the articulate humorous iconoclast, I think Ed would have eschewed the pomp and circumstance I ellaborated above and prefer that I had just said that he hoped he had simply followed the dictum of his mentor, Henry A. Murray: “A good death is dying so as to be as little a pain in the ass to your family as possible.”

I will be forever grateful to Ed who early in my career had enough confidence in me to entrust some of the most suicidal patients from the UCLA in patient wards when they needed to be discharged, but were still suicidal. He did it with a simple phone call: “Hello Mark, this is Ed. I am sitting with a lovely young woman. She’s in a lot of pain. You can help her. SEE her.”

I also owe Ed a singular skill to help such people when he told me: “Mark, if you listen for hurt, fear and pain, it is always there. And when the other person feels you listening andfeeling them, they will lower their guard, open their minds and hearts to you, allow you to enter and comfort them and if you’re fortunate, will let you walk them out of hell.”

And Ed, regarding being “as little a pain in the ass to your family possible”… I think you actually pulled that off.

Now it’s time to thank you for how many millions of people your life work has helped to face death and to bid farewell to you Ed, using the same words you would use when I would leave your home during recent visits: “Goodbye, dear man.”

Be at peace, I will miss you.