Journal of Sacred Work

            David Whyte, like all fine poets, tells the truth in his poetry. His truth can help we, as caregivers, see ours. Consider his poem, “All the True Vows,” that appears in his marvelous book of poetry: The House of Belonging (julie@www.davidwhyte.com).

I thought about Whyte’s words as I sat in an Emergency Department waiting room recently:

All the true vows

are secret vows

the ones we speak out loud

are the ones we break…

What’s spoken out loud in the Hospital ER is framed in black wood and outlined in gold. A silver & blue cross shines from the corner of this document which adorns the wall of the waiting room. It sits in plain view of both patients and staff, none of whom are reading it. They know it’s just there for show. There are lots of words. I can make out some of them: “compassionate care,” “high quality,” “stewardship.” At the top of the official looking paper in bold letters: “Mission Statement.”

Nearby, a clerk sits behind a Plexiglas shield that appears bulletproof. She checks names on a clipboard, stands, leans her mouth toward a little circular opening. “Johnson!” she bellows. The woman next to me jumps. Her eyes snap open. She has been holding her head, eyes closed, for half an hour. The shout must have hit her like an earthquake. She closes her eyes again. The grimace remains. She is not “Johnson.”

I look around the waiting area for signs of the compassion and high quality trumpeted in the Mission Statement.

All the true vows/are secret vows/the ones we speak out loud are the ones we break.

Johnson is a man in his sixties. He rises, walks with halting steps toward the clerk at the desk. He is holding his side and I hear a low-voiced grown as he passes my chair. He lugs the form the clerk has asked him to fill out as if it weighed as much as his pain. The clerk takes the form looks at it, says into the form, “Okay, take a seat sir.”

I watch the clerk for awhile, wonder about her family and friends, her supervisor, how she has been trained, her low pay level. I wonder about her true vows. Is the truth that she feels beaten down in her job and has made a vow to do the minimum to get through the day?

The clerk stops shuffling papers, stares blankly through the Plexiglas at the wall across from her desk – not at the mission statement, just at the wall. She looks at her watch. I look at mine. It’s 3:33 p.m. I speculate she is counting the minutes until her break, until her shift ends or maybe she’s just verifying that it’s Tuesday and not Friday. Some caregivers, burned out by their work, spend their lives waiting for the end of the day, waiting for Friday, waiting for their retirement day so they can start “living.”

There is only one life

you can call your own

and a thousand others

you can call by any name you want.

I imagine the clerk’s first day, years ago. The dull-voiced welcome at orientation, the half smile of the supervisor before she launched into the standard instructions: “Sit here, make sure everyone fills out these forms, let me know if you have any questions.” Still, during those very first hours behind the desk on her very first day, perhaps she was anxious, excited, even hopeful. After all, in a big ER like this, maybe some exciting things would happen. Maybe she could be of service to those in need.

Somewhere along the line, the energy faded. Perhaps she made an extra effort one day to help out a patient and the supervisor told her “that’s outside your job description.” Perhaps she’s just tired.

In another of Whyte’s books, The Heart Aroused, he quotes from a person in one of his audiences:

Ten years ago…

I turned my face for a moment

and it became my life.

Here is the clerk. I wonder if she thought, years ago, “I’ll just do this job for a few months until I find something better.” She turned her face for a moment and it became her life.

And here is the woman next to me holding her head. And here is Johnson, holding his side, wondering how much longer, how much longer.

Is this scene in the ER the truth the clerk wanted about her life? Is this the truth her supervisor wanted? And what about the truth sought in the Mission Statement crafted by the well meaning leaders in a conference room? Is it all just a string of broken promises, a covenant not kept?

I think about those leaders down the hallway in their offices. After thirty years of both leading and studying hospitals, it’s not hard for me to guess what might be happening – the meetings about budgets, the review of the latest consultant’s report, the negotiations with third party payers. Maybe someone is even meeting to redraft the mission statement. Maybe the JCAHO will be dropping in for a visit.

Mission statements are mostly a fraud, aren’t they? And we’re all complicit. Charities in general and hospitals in particular do a terribly uneven job of providing the quality of compassion, kindness and skill they proclaim. Every American knows the drill in the ER. Everyone expects to wait and most people assume curt treatment from the front desk. When a clerk or nurse treats them with kindness, they’re sometimes amazed.

Yes, there are compassionate people in every organization, but what do leaders do to make the mission come true? How do they support this clerk in her hard job interacting with dozens of people each day? What kind of training and encouragement is being offered to help each staff member treat the patient or visitor before them as a whole human being?

When I’ve asked admitting clerks why their first word to a patient is, “Name?” they say, that’s what my supervisor told me to say. Get the patient to fill out the form. Somehow, the next step gradually becomes staring at the wall as they await another patient. What if the clerk said to Mr. Johnson, “Oh, I’m so sorry you’re in pain. Let me help you fill out that form.”

What is the solution? Tomorrow’s meditation provides ten steps to help make the Mission Statement come true – a promise kept, not broken.