Meaning is always rented, never owned.” (Vygotsky, 1980)

What would you do if a woman – 96 years old, frail and small – lying in a hospice bed asked you to help her eat ice cream because her hands were too arthritic?

What would you do if a woman – 67 years old with dark hair and silver glasses – sitting in a hospice bed asked you to help her drink the orange juice you had poured because her Parkinson’s was so severe?

Now, would your decision change knowing that if you answered “yes”, you were violating organizational norms?

My decision did not change. I answered in silence with a smile and a head nod. For me, it made perfect sense to help someone eat and drink even though I was not “trained” to feed in this type of setting.

Recently, an article described an interesting consult between a patient and a provider making sense of such a situation. The provider and the patient were close family friends but met unexpectedly after many years in the hospital. As the provider finished the consult and started to chart, the patient said, “Tell me something. Is this the first time you have cared for someone from your world outside of the hospital?” It was the first time for the provider. The patient suggested that he get used to it. The provider agreed with “certainly.” Thirty years later, he realized that he never has.

What does it feel like to care for someone from your world outside of the hospital?

What does it feel like to care for someone not from your world inside hospice?

Making sense is something we do every minute of every day. But our culture tends to over emphasize words, discourses, and abstract symbolic systems in making sense of diverse worldviews. With so much “talking”, we forget the importance of physical, embodied interactions such as those when our worlds collide in unexpected and confusing environments, or what Karl Weick refers to as equivocal environments.

Equivocal environments such as caregiving settings are the catalysts that motivate us to organize and make sense. This organizing is often done in ways that seek to reduce equivocality, or the uncertainty in which we often find ourselves. Uncertainty, however, is not always a bad thing.

Silence, for example, helps reduce equivocality through covert actions like a gaze, a gesture, a smile, an uncomfortable movement of which we are often unaware but which carries significant information to an other. For many, silence is seen as an obstacle to social relations, or as the absence of meaning. Furthermore, silence is often uncomfortable and sought to be avoided through our uses of “um” and “ah.” Generally, our norms surrounding silence are negative where people feel silenced, are silenced and considered the “elephant in the room.” Therapy, after all, is about uncovering silent elephants considered negative to psychological health. But silence also opens gaps in equivocal environments where care, rather than the world you’re from, matters.

The consult between the provider and patient and my decisions at hospice highlight challenges and opportunities for care giving. At a time when life produces complex and confusing situations, we must not forget sensemaking that incorporates the whole body and in particular the sounds, touch, smells, and feel of organizational life. Sensemaking is about holding on to some forms of Being while simultaneously letting go of others.

Holding on and letting go describe two keys points in managing the unexpected: expectations and categories. According to Weick, people who constantly rework, refine and replace their categories notice more and catch the silences, the whispers and the utterances of daily life.

In doing so, we become better able to care for someone no matter where they come from.

With thanks to jcolman and cogdogblog for the images.

Carey Candrian