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“The finality of death is a powerful teacher. For some patients, being diagnosed with a terminal illness is an experience that lends a tremendous shift in perspective and newfound authenticity. This can be instructive to them and the people around them. As psychologist Charles Garfield says, ‘The living have much to learn from the dying.'”

Farid Alsabeh is a psychotherapist.

He shares his story and discusses his KevinMD article, “What being a hospice volunteer taught me about health care.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Farid Alsabeh. He’s a psychotherapist. His KevinMD article is titled “What being a hospice volunteer taught me about health care.” Farid, welcome to the show.

Farid Alsabeh: Thank you. Excited to be here.

Kevin Pho: We’ll get to the article in a little bit. First off, briefly share your story and journey to where you are today.

Farid Alsabeh: Sure. I got my bachelor’s in neuroscience. I’ve always been interested in the mind, the brain, and treating the mind. After I got my bachelor’s, I took a couple of years off, gap years, and got into some interesting experiences, one of them being what gave you the article today. Then I finally got a master’s in clinical psychology, and I currently work as a psychotherapist in both a private setting and a community mental health center.

Kevin Pho: All right. So walk us through a typical day. Tell us some typical cases that you would see.

Farid Alsabeh: Sure. On my community mental health days, I’ll have a list of all the patients that are coming in that day. One of the tricky things about this particular population is that some of them actually speak Arabic as their first language, not English. So I suppose the first thing I do is kind of orient myself mentally about whether or not I’ll be speaking English or Arabic. I’ll go over what their diagnoses are, and then I’ll start to think about what kind of interventions I’m using.

There are cognitive interventions, kind of thinking about: What are the thoughts? What are the beliefs and assumptions that are contributing to your symptomology? There are affective interventions: What are the feelings that you’ve disowned that are still living in you and that are contributing to your symptoms? Can we create an environment where we allow those feelings to come out, and we can explore them to help you develop and grow for the better?

Then at the end of the day, I like to do something that kind of gets my mind off of the patients, maybe watch movies or read books, and then the next day, it’s all over again. The private setting is a little less severe, but still very much similar in terms of the basics of psychological interventions.

Kevin Pho: All right. So your article is titled “What being a hospice volunteer taught me about health care.” Now tell me how this article came about.

Farid Alsabeh: So the year was 2019, and I was 22 at the time, working, as I mentioned, as a technician during my gap years. Like many people at that stage in their life and at that age, I wanted to do things that would look good on a resume. I wanted to make sure that I was doing things and getting experiences that not only would enrich me, but that prospective grad schools, for example, would find interesting. I had a co-worker at the time who had been a hospice care volunteer and who highly recommended it, and he had eventually gone into med school. So I thought, “OK, he must know what he’s talking about.”

But to be honest, at the time, it wasn’t exactly the kind of setting that I wanted to be in. The best way I can describe it is I wanted something fast-paced. I wanted something acute. I wanted something like, you know, those medical dramas that you see as a Netflix series, where someone’s rushing into the room, and it’s life or death. But I think the interesting thing is what ended up happening: The same reasons that I thought hospice care was something I wouldn’t want to do were actually exactly the reasons why I found it to be such an enriching experience.

Kevin Pho: So tell me about that experience. What did you do as a hospice volunteer?

Farid Alsabeh: The service that I provided was called companion. That’s the name that they gave it. There was a health care team. There was the doctor, there was a nurse, and there was even a pharmacist, and each of these people had their specific roles. My role as a volunteer was just to provide companionship to the patient.

What I found was that the unique thing about hospice care is it’s a setting where, of course, the life-preserving interventions that usually take up so much of the time and effort of medicine are withdrawn. What I found was that in this setting, where those life-preserving techniques are withdrawn, the more interpersonal aspects of care can come front and center, and they’re kind of given a new kind of prominence. So I found myself, as the volunteer who was providing this companionship service, really getting to know people, listening to their stories, understanding their values, and attending to their subjectivity in a way that I’m sure I wouldn’t quite have been able to if I had been in a more acute sort of biomedical setting.

Kevin Pho: So how much time would you spend with each of these patients in a palliative care setting?

Farid Alsabeh: I was scheduled with them every week, and I would usually spend at least an hour. Now, it depended on the needs of the patient. For example, I had some patients who I would see in a nursing home setting, and they were quite sick in bed, so I probably wouldn’t push it more than 15 to 20 minutes. But I had other patients who were quite, let’s say, vivacious, and who were very willing and eager to share their stories, and honestly, sometimes I spent as much as an hour to two hours with those patients. So, like many things in hospice care, you get a sense of the individual patient’s needs, and then you provide that accordingly.

Kevin Pho: Now, is there a specific patient or story that you could share with us that made a particular impact on you?

Farid Alsabeh: Sure. This is the second patient I talk about in the article. I forget what anonymous name I gave him, because, of course, I had to change the name. Essentially, this was a patient who was diagnosed with terminal pancreatic cancer. What I found was that while at first he started talking about some of the side effects of his treatment and some of his concerns about his diagnosis, of course, gradually he started shifting into, the best way I could describe it, a life narrative: sharing with me how he got into his profession, he was a musician, his story about how he got married, and how he raised kids. What I found is that at this person’s stage of life, he was very much preoccupied with trying to make sense of his life and trying to convey to me what he thought the important lessons and moments were in his life.

Now, at the time, I didn’t know this, because I wasn’t in the psychology field, but later on I would learn that there’s a psychologist named Erik Erikson who knew this very well. He called this stage of life the ego integrity versus despair stage, where people start to construct a narrative based on their life events, and either that narrative is fundamentally positive, hence ego integrity, or the narrative is fundamentally negative. So what I found myself doing was helping to co-construct the life narrative of this patient as he looked back on his life in the light of his terminal illness.

What really surprised me is that you think of the past as a set thing: Things have happened, period; they’re in the past. But really, you can think of it as past events are built on the sands of interpretation. You can have the exact same event that two people go through, but depending on the interpretation, they’re either going to see it in a positive light or a negative light.

So a lot of my time spent with this particular patient was, you know, he would express something that he felt was a regret. Let’s say he didn’t take this opportunity to go on a cruise and serve as the saxophone player on this cruise, for example. What we would do is kind of skillfully shift the interpretation, so what looks like a regret or a mistake actually is a success and an opportunity for future growth. So, for example, “You didn’t get to go on that cruise ship, but hey, you got to go on this vacation with your wife, and let’s recognize the ways that contributed positively to your relationship.”

That was probably some of the most fulfilling work I did with patients: creating the space where, because I was companioning with them and I didn’t really have any obligations to do any physical treatments with them, we had this nice space where they could present these life narratives to me. Again, we would kind of co-construct a meaning that is positive to them, so that they can kind of have some sense of closure as they, well, depending on how you think of it, either leave this life or move on to the next one.

Kevin Pho: From your perspective, how important is that companionship to these hospice patients?

Farid Alsabeh: Extremely. And again, keeping with the theme of different patients having different needs, consider a patient with very low social supports. For whatever reason, at this stage in their life, they find themselves with very few people to talk to, and the most heartbreaking thing is, with very few people to convey their sense of dread and despair to, which, of course, are going to be common in this kind of end-of-life stage. So to be able to provide that kind of companionship, where you’re just attending to the person, you’re not there to prescribe medicine, you’re not there to take their blood pressure, you are just there to be with them and to hear whatever concerns they have, I think is crucial, especially at that stage of life, and especially for those few patients who, for whatever reason, don’t necessarily have those kinds of social supports.

Kevin Pho: Now, what can you take from your experience as a hospice volunteer to today, with your profession as a psychotherapist?

Farid Alsabeh: What I developed in my thinking after my hospice care experience was the following: In, let’s call it, the traditional way of thinking about any kind of health care, I think we think of two adjacent factors. We think of the treatment, which is typically a physical treatment if we’re talking about medicine, and then we think of the companioning, which is just your being there with the client. So traditionally, you would say, let’s say you’re a doctor, “OK, here I’m going to give the physical treatment. That’s one aspect. And then also, I’m just going to be nice to the client, and I’m going to hear them out and whatever.” And that’s the companion.

What’s interesting is that adjacent nature is inherent in the way we speak, because we talk about bedside manner. Well, literally, we’re saying the bedside manner is at the side of the bed, so there are two different things: You have the treatment, and then the companioning. What I learned in hospice care, and what was later confirmed when I became a psychotherapist, is that actually the companioning is a form of treatment in and of itself. So we can’t really separate them. You have the physical treatment of what you do, and then you have the treatment that comes from connecting authentically with someone, hearing their story, and then responding to them in an empathetic way. So really, what it is, you have treatment overall, and then one aspect of the treatment is physical, and another aspect of the treatment is what you could call interpersonal.

Psychotherapy is this unique form of treatment, though, where you don’t actually have the physical aspect. If I have a patient or a client coming in, I’m not actually enacting anything physical. There’s no physical intervention. The treatment is the connection, right? The treatment is the way that I attend to the client, the way that I listen to their concerns, the way that I empathetically respond, and their sense that they matter to me. All of these are forms of treatment that come from the companion.

So I think that’s really what hospice care taught me: In medicine today, and in health care more generally today, we have this, I think, misguided view that separates the treatment from the companioning. But in psychotherapy, what’s clear is that the companioning itself is the treatment. There are forms of treatment through connecting with people, and ultimately, that’s what I hope other aspects and fields in health care will start to identify. I don’t care if you’re an oncologist or a primary care physician or whatever specialty; as a health care provider, you are endowed with a certain symbolic weight or significance, and people are looking to you for guidance, reassurance, and support. By connecting with them and listening to those concerns, besides any of the physical interventions that you use, that in itself has a certain healing potential that we can tap into.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Farid Alsabeh: Very similar to what I just expressed: Whatever part of health care you find yourself in, if you are a hospice care volunteer, as I was in 2019, if you’re a psychotherapist, as I am now, if you’re a medical doctor, or if you’re a nurse, please understand that as a health care provider, you occupy a very, very cherished and privileged place in your patients’ and clients’ world. They are looking to you for healing. That is an amazing thing.

Besides the physical interventions that you use on your patients, there is also this companioning that I experienced in hospice care and that I continue to develop now as a psychotherapist, and that is also a very important source of healing with your patients and clients. Pay attention to how you companion with them. Pay attention to the ways that you can heal your clients and patients through simply connecting with them, hearing their stories, and responding in an empathetic way.

Kevin Pho: Thank you so much for sharing your story, time, and insight, and thanks again for being on the show.

Farid Alsabeh: Thanks for having me. I had a great time. Thank you.