Communication rules when caring for the very sick.

The care goes in. The crap goes out.

I wrote this article a while back looking at how we can behave whilst caring for someone in hospital undergoing a major healthcare episode. Sometimes they just need to vent.

Susan Silk is a clinical psychologist who is also a breast cancer survivor.
In a story for the Los Angeles Times, her friend Barry Goldman recounts the day a friend wanted (needed) to visit her immediately following surgery:

Susan didn’t feel like having visitors, and she said so. Her colleague’s response? “This isn’t just about you.”
“It’s not?” Susan wondered. “My breast cancer is not about me? It’s about you?”

Following her experiences at this time, Susan developed a technique to help people stop communicating un-skilfully, unhelpfully or even harmfully to the wrong people during times of crisis. She calls it, The Ring Theory.
As communication is such a important ingredient in care delivery, I have modified Susan’s rings slightly to fit over our own healthcare environments.

This is what it looks like for the person undergoing medical care:

Draw a small circle in the middle of a piece of paper. This is the centre ring. This is you (or the person recieiving care).
Now draw a larger circle around the first one. In that space goes the people closest to you. Your immediate family, your closest friends.
Then draw another ring. In this space place other friends and more distant relatives.
In the next ring out, place the main nurse caring for you and the doctor who is your primary care giver.
Next ring out. Other nurses and medical staff you are in close contact with.
Next. Other doctors and healthcare professionals involved in your care.
Next. Other staff, wardsmen, cleaners, cooks etc.
Managers. Executive.
Etc. Etc. You get the idea.

The Rules:

The person in the centre of the ring can offload or vent, whinge or complain to anyone in any of the circles.

This is one of the very few perks of being in the centre ring.

They can complain and feel sorry for themselves. They dont have to. But they can.

They can get angry, and frustrated, and say bad words. They can whinge and whine, and complain some more. All the way out.
If you are in an outer circle, you do not have to like listening to it. But you are in an outer circle, so here it comes.

If you dont like it, you can whinge about it. But only outwards.
Everyone in the outer circles can do likewise. But only to people in larger rings.

When you are talking to someone in a ring that is smaller than yours, the goal is to provide support, compassion, care and your fullest attention.

Likewise, you should ideally receive the care and support of EVERYONE in larger rings.

Go back up to the rings and see who that is.

So. You should not dump your personal communication crap, into a ring smaller than yours.

But to be clear here, I don’t mean people shouldn’t be accountable for what they say.
And I don’t mean it is OK to be verbally abusive or aggressive or hurtful to those in outer rings. These things are NOT OK.
No, we are not talking about violent communication here, what Susan is referring to in her ring theory is Kveching.

Kveching is a Yiddish word meaning chronic complaining, nagging, grumbling.
If you want to scream or cry or complain, if you want to tell someone how shocked you are or how icky you feel, or whine about how it reminds you of all the terrible things that have happened to you lately, that’s fine. It’s a perfectly normal response.
Just do it to someone in a bigger ring.

Also, it’s helpful to remember you are in different rings in different situations. Perhaps you are in the centre at one time, and in an outer circle at another.

Its all common sense really. But I’m sure you can remember times you have witnessed the crap going IN (or perhaps been guilty of dumping inwards yourself ).

So I think it makes a useful visual map to remind us……that it is OK for people experiencing stress or crisis during times of illness to dump their crap out. And it is OK for people caring for them to dump their crap out as well.
We just need to be mindful of not dumping it IN.

Archived original article (worth reading) in the Los Angeles Times: How not to say the wrong thing.