Respect In Extremis

In Extremis definition: at the point of death, at death’s door, breathing one’s last, not long for this world.

When I launched this series in January, I said I wanted to notice “simple, modest, authentic examples of respect among people I interact with daily.” Here’s what I have been noticing.

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I stand outside the closed door, leaning against the opposite wall, halfway down the corridor in a skilled nursing facility. Soft light, quiet female voices, and the occasional deep moan escape into the darkened hallway from behind the door. It is midnight; a passing nurse pauses before me and raises a questioning eyebrow. 

“I’m a hospice volunteer waiting to sit with, uh, keep vigil with Mr. X.”

 “They’re changing him, giving him his meds, and making him more comfortable.” 

I nod. “I’ll wait here ’til they’re finished.” Nurses handling one’s naked body, even at the point of death when we imagine inhibitions have dissolved, is one thing. Having one’s wasted body exposed to a perfect stranger, whether or not you are aware of her presence, is another. I assume modesty does not dissolve at the end of life and do not intrude until Mr. X is dry, clean, settled, and covered up to his chest with a light sheet and warm cotton blanket.

When I step into the room, the remaining nurse gently touches the unconscious man’s shoulder.

“Does that feel better, Sir? I will give you a little more medicine to help you breathe more easily. I’ll just put a couple of drops inside your cheek. That’s it.” She positions the dropper inside his gaping mouth and slowly rubs his throat below his jaw. “Good, now swallow if you can.” He does.  

Before leaving the room, she fills me in on what she knows about her dying patient—his former profession, family members who kept vigil earlier, and his interests. Then, she points to various objects in the room—the essential things his wife wants him to have near at the end: Classical CDs, a small CD player, a book of poetry, and photos. “I’ll be back to check on you in an hour, Sir,” she whispers close to his ear before gliding through the half-closed door. 

The room is dark, the dim light from the adjoining lavatory casting shadows around the bed. I put some Bach in the player, turn the volume low, place a straight-backed chair next to the bed, collect the book of poetry, and sit. I touch Sir’s lower arm through the sheet and introduce myself, giving my first name and saying I will be sitting with him for a few hours. His breathing does not change as I touch him or speak. He is deep in and far along on the journey to the end of his physical life. I quietly read poem after poem, pause for a few minutes of silence between them, and watch Sir breathe. Soon his breath becomes ragged and uneven; it occasionally stops for up to thirty seconds and then begins again, shallow and irregular.

Over the next few hours, the kind nurse comes and goes several times, always speaking softly and respectfully to Sir, touching him gently, and telling him in advance about every act of care she will perform. No callousness, no surprises, no assuming he is no longer entirely there. I watch her ministrations with awe, a tear coming to the corner of my eye at witnessing such tenderness.

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My friend is slumped in her hospital bed, several floors up in a massive building on Boston’s Beth Israel Deaconess campus. She is declining rapidly. The plan is to release her home to hospice care the following day. Today, she shares a room with a mystery woman behind a drawn curtain. During my less than an hour stay, nurses come and go from the room every few minutes. 

My friend is on a breathing machine called a BIPAP, a form of non-invasive ventilation therapy. She can watch its monitor, see the oxygen level in her bloodstream, turn it off when it reaches the desired level, and remove the oxygen mask from her face. But a nurse must come to turn it back on again and reposition the mask to seal it around her mouth and nose. This procedure happens four or five times while I am there. The nurse’s calm composure, concerned smile, and respectful tone astonish me.

The patient behind the curtain is worried that she has not received the proper dosage of her medication. Another nurse repeatedly and patiently explains the doctor’s orders, the times she was medicated, and when she is next due. Finally, after about 20 minutes, the patient thanks her and apologizes for being such a nuisance. The nurse responds, “Not at all; this is important. You should always question us if you feel something is amiss.”

While the BIPAP breathes for my friend, she closes her eyes and rests. She removes the mask when she can breathe on her own, and we talk about her difficult life, sadness, fear of pain, and death. She praises her husband for the care he has given her over the last several years. We say we love each other and are grateful for our friendship. We hold hands in silence. When her eyes are closed, I gaze at her—the whole picture of her crumpled body amid bunched-up sheets, her swollen hands, and her weary face. I think, someday, this will be me.

The nurse returns and gently repositions my friend’s oxygen mask, punches buttons, and the BIPAP whirrs again. Then this guardian of my friend’s humanity glides back into the hallway and on to answer the next call bell—respect in motion.

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For those who die after a long decline in health, the dissolution of respectableness can be one of the most challenging aspects of the journey. Gradually we lose many of the attributes that once earned us respect, approval, and acceptance. As the looks wither, the brain slows and dims, and control of bodily functions dissolves, power over external forces diminishes. We are no longer the sisters, mothers, professionals, neighbors, philanthropists, or activists we once were; no longer the persons others, and we ourselves, considered worthy of respect. In extremis, we will rely on pure, unearned, free respect. Will it be offered? Can we give it now, in anticipation?

Respect Amid Conflict

This is not about Russia and Ukraine. Or is it? You decide.

I find myself in the middle of a conflict. A group I joined several years ago, a haven of peacefulness and mutual support, has encountered a situation that has created disagreement, discomfort, and discord among its members. I’m not going to identify this group or describe the conflict in detail. Still, I will say that the situation developed gradually, in response to the conditions of COVID, without any malintent on the part of anyone.

As with most conflicts, some members are on either end of the spectrum of opinion, and others cluster near the middle. Possibly there are some able and willing to change their behavior to accommodate others, and some unwilling or unable to do so. Some identify their needs as vital and urgent, and others, without strong feelings, are willing to go along with a range of possible outcomes.

The group has a tradition of consensual decision-making. The decision we make will determine the survival of the group and its future incarnation. So, with the best of intentions on everyone’s part, we have entered into a careful, measured process. Our approach involves the honest but gentle expression of feelings and attitudes, listening carefully to each member’s views, trying to understand all perspectives, and seeking a consensus about moving forward. We are encouraged to speak truthfully, listen compassionately, and keep an open mind and heart—hallmarks and essential characteristics of respect.

As I’ve reflected on the conflict, my reaction to it, and the thoughts and feelings of my fellow group members, two dimensions crucial to the consensus-seeking process have stood out for me. First is the vital importance of digging deep inside my own heart to recognize my motivations. Depending on what I discover, this recognition might be comfortable or not, but I owe it to myself and the group out of respect for us all. Second, understanding others. A group member so aptly expressed this as walking in the other’s shoes.

 As I’ve listened to group members describe their experience and express their feelings, I’ve “felt their pain,” so to speak. And, understanding their discomfort, even suffering, I see them as worthy of respect. Therefore, I wish that I might do whatever is possible to ease their distress without abandoning my essential needs. A sense of flexibility and generosity has arisen from trying to see the situation from the perspective of others.

However, by relentless examination of my motivations, I’ve discovered that, while there are some compromises I am happy to make, I draw the line at one accommodation, which I cannot adopt for my well-being. Yet, there is an enormous amount of fertile space between my one need and the needs of others.

I don’t know whether we will reach a consensus or what the outcome of the decision-making process will be. I am trying to stay in it, moment by moment, without predicting or prejudging, and with as much respect for myself and the other group members as I can muster. I am trying to let go of the less important, my need to be understood, and the ridiculous notion that my viewpoint is the complete one. I’m trying to embrace the idea that neither the current situation nor its outcome is static, that everything and everyone are changing all the time.

So, I re-iterate, this short reflection on respect amid conflict is not remotely related to the situation between Ukraine and Russia. Right? The aggression, violence, and impacts are wildly disproportionate in the two circumstances. But I wonder if there is any predicament, however grave, that cannot benefit from sincere self-examination and the attempt to understand the perspective of others—respect.

Just Like Me – Respecting Difficult People

In their 2018 book Walking Each Other Home: Conversations on Loving and Dying, Ram Dass and Mirabai Bush introduce a practice geared to generate understanding, respect, and compassion for others. It’s called Just Like Me. While it can be used with friends, acquaintances, or neutral persons, I believe it is particularly beneficial for identifying with those we think are radically different from us and for whom we find it difficult to feel sympathy.

Calling to mind a person we dislike, disagree with, hate, or hold in contempt, we are encouraged to repeat the following phrases: This person

… has a body and a mind, just like me.

… has feelings, emotions, and thoughts, just like me.

… has experienced physical and emotional pain and suffering, just like me.

… has at some time been sad, disappointed, angry, or hurt, just like me.

… has felt unworthy or inadequate, just like me.

… worries and is frightened sometimes, just like me.

… will die, just like me.

… has longed for friendship, just like me.

… is learning about life, just like me.

… wants to be caring and kind to others, just like me.

… wants to be content with what life has given them, just like me.

… wishes to be free from pain and suffering, just like me.

… wishes to be safe and healthy, just like me.

… wishes to be happy, just like me.

… wishes to be loved, just like me.

I first encountered this practice on a retreat during 2020. I cannot now recall whether the retreat came before or shortly after the US Presidential election, but when the facilitator asked us to call to mind a difficult person, Donald Trump popped into my head immediately. Donald Trump is nothing like me; I protested internally! I quickly searched for another, less challenging person, but I could not quickly come up with anyone. So, I closed my eyes, called up a mental image of President Trump, and began repeating the phrases silently after the facilitator. I encourage you to go back and read them now with Trump or any challenging person in mind.

I was astounded by how many times I could say with sincerity that Mr. Trump was “just like me!”  I must admit I had some difficulty with “has felt unworthy or inadequate,” “has longed for friendship,” “is learning about life,” “wants to be caring and kind to others,” and “wants to be content with what life has given them.” However, I could embrace enough statements for the exercise to reveal our likeness and soften my heart slightly. Perhaps removing the word “just” would make the practice even more palatable.

Next comes the even more challenging pursuit of wishing the difficult person well, using phrases including:

I wish this person to be free from pain and suffering.

I wish this person to be peaceful and happy.

I wish this person to be loved because this person is a fellow human being, just like me.

The point is to consider respecting the other, not for what they have said or done, but because I acknowledge their humanness—their actions and words may have arisen from very human desires, fears, suffering, and losses, as do mine. In this practice, respect does not equate with approval, praise, agreement, or even tolerance but, instead, involves understanding and empathy. Therefore, treating the difficult person with respect may entail giving them the benefit of the doubt and offering compassion rather than mockery, rebuke, denunciation, or bitter criticism.

“And what would such respect look like concerning Mr. Trump?” I ask myself. Perhaps it would involve refraining from posting unflattering pictures of him on Facebook or liking jokes at his expense on social media. Maybe it would rule out repeating plausible but unsubstantiated stories about his actions or words or stoking fires of anger and hatred against him. Such restraint would mean forgoing delicious opportunities for cleverness and self-righteousness. 

On the positive side, it means offering genuine good wishes for healing, clarity, and humility, hoping that his heart will open with understanding and compassion, just as I hope that mine will open. I am convinced that sending positive energy in his direction cannot do the slightest harm.

Does all of this sound pollyannaish? Then take Trump out of the equation and substitute your problematic next-door neighbor, the family member who disrupts every holiday gathering, the boss who criticizes everything you do, or the friend who breaks your confidence. Even the dog who won’t stop barking! How can a dog be just like me? Think danger, fear, boredom, confusion, pain, past trauma, and family heritage.

Religious and secular platitudes about this “just like me” concept include The Golden Rule—do unto others as you would have them do unto you. The Buddhist idea of interbeing and interdependence (no left, no right, no up, no down, no you, no me) also captures the notion. The once-popular song Walk A Mile In My Shoes suggests how we gain respect for those we find difficult or different. (I’d encourage you to listen to this cool old music video.)

The bottom line—to respect those who do not seem to deserve our respect, we must see what we have in common with them. Yes, we are different, but what essential qualities unite us? And how can we act respectfully while disagreeing, resisting, and taking a stand against our opponents?

Building Trust with Respect

One of the people I have come to respect deeply over the last two years is Dr. Nirav Shah, head of Maine’s CDC (Centers for Disease Control.)

Almost weekly, since March 2020, he has held a press briefing on Maine Public Radio, taking questions off the cuff from media journalists in Maine in an attempt to keep the public informed about COVID. Frequently, Maine’s governor, Janet Mills, and its Commissioner of Health and Human Services, Jane Lambrew, have joined Dr. Shah on these broadcasts. Together they have answered questions, explained CDC guidelines and recommendations, and encouraged Maine’s citizens to do everything possible to stay safe during the COVID pandemic.

I have been impressed time and again by Dr. Shah’s communication skills and his command of COVID scientific findings and statistics. In my mind, he is the consummate communicator. He speaks lucidly, intelligently, respectfully, and empathetically. I have only once or twice heard him ruffled by not having information at his fingertips. Throughout the last nearly two years, he has never criticized or showed anger or frustration with those who refuse to follow mandates and guidelines, deny the seriousness of the pandemic, or continue to resist vaccination. He has the proverbial “patience of Job.”

On January 3, he demonstrated his genuine care, concern, and respect for the people of Maine by participating in a Maine Public Radio Broadcast—Maine Calling, hosted by Jennifer Rooks. (Maine CDC director Nirav Shah addresses questions about the pandemic, particularly about vaccine hesitancy) His purpose for this call-in program was to open a dialogue with those not vaccinated against COVID; his stated goal was to build trust. When I began listening to the broadcast, I was nervous that none of those opposed to vaccinations would call in, the ultimate slap in the face to trust-building. However, callers, emailers, and tweeters engaged with Dr. Shah for nearly an hour. Because he entered into an authentic dialogue with each one, asking genuinely curious questions about their views, assumptions, and situations, relatively few callers got on the air. Some were angry, afraid, and belligerent; others were open and curious.

While he acknowledged and lamented that vaccinations had become politicized, he avoided political debate or criticizing others who engage in such discussion. Instead, he stayed with the “facts”—the statistics, the scientific models, and studies. One could hear the sincere emotion in his voice as he spoke about Mainers who had died of COVID. He listened, expressed understanding, acknowledged agreement where he could. Though he didn’t say these words, I could imagine him thinking, “I can’t do anything to change the politics, nor can I force anyone to follow CDC guidance. All I can do is build trust and try to persuade.”

As the pandemic has unfolded, scientific information and best-practice recommendations have changed and developed repeatedly. As a result, early guidance was superseded by the findings of further studies. Dr. Shah acknowledged that the evolving nature of the scientific understanding of COVID has led to confusion and fed into mistrust of public officials and their recommendations. This broadcast, he said, was one attempt to rebuild trust. It was worth the try.

Such a genuine, careful, skilled effort at trust-building could only come from one who respects his fellow Mainers. Dr. Shah demonstrates that he believes each of us wants to do the right thing. Therefore, he is willing to invest the time to understand the convictions of others and is hopeful that offering his best knowledge and sincere concern will make a difference.

I encourage you to listen to the podcast at the link above. Some have heard me say that I wish Nirav Shah would run for President of the United States. I am saying that I want all politicians and public servants to demonstrate the respect that he does for the people they serve.

Noticing Respect: Intro to a new series of posts

In 2022, I want to offer twelve vignettes, one for each month, that illustrate dimensions of respect. These profiles will emerge from persons, encounters, activities, or events that I have noticed during the month. I intend to attend to respect in as broad a swath of experience as possible, so I’m asking myself to see it from new and varied angles.

Professor Harry Lewis of Harvard University, a man whom I respect and from whom I, in turn, have experienced kindness and respect, suggested the title for my blog, With All Due Respect, five years ago. Shortly after I launched, Harry and I had a brief conversation about what the word “due” means concerning respect, whether everyone is due or deserves respect. The noun “due” is defined as a person’s right, something owed. To deserve something is to earn or merit it.

In an early post, Harry and I exchanged comments about respect as a response to human dignity. Since then, those who believe dignity is inherent in all humans have been sorely challenged by events at home in America and abroad. Wars and withdrawal from wars, unprecedented political polarization, hatemongering, challenges to the rule of law, repeated assaults on democracy, and incidents of police brutality have strained our impulses toward respect. A pandemic that heightens our awareness of inequality and unfairness and pits the individual’s rights against the common good has sapped our good intentions about respectfulness. Undeniable and devastating examples of climate change coupled with intransigent denial of climate science’s findings make us impatient with the deniers. A plethora of incredible conspiracy theories has stymied our intent to treat those who espouse them with regard. As a result, it has become harder and harder to offer respect to those whose attitudes and behaviors differ so dramatically and consequentially from our own—to see these others as due or deserving of respectful courtesy.

 Is there such a thing as unconditional respect? Is it possible to respect someone doing demonstrable harm to people, creatures, and the earth you love? And is treating someone respectfully fundamentally different from respecting him, her, or it?

Because I don’t have answers for these questions, I am thrown back to noticing simple, modest, authentic examples of respect among people I interact with daily. This series of posts will explore instances and characteristics of respect that I see around me. I invite you to offer reflections on occasions of respect you are observing in your surroundings. I hope that by doing so, we will water the seeds of respect in our hearts, our thoughts, and our actions.