Last week I mentioned the first agreement in Don Miguel Ruiz’s book The Four Agreements, be impeccable with your word. Today’s post is about agreement #3, don’t make assumptions.

photo by: eplisterra

Being a Palliative Care doctor helped me learn to be more direct in my speech. One of the keys to this was to stop making assumptions. I didn’t know if someone would be hurt by something I said. I didn’t know if they would get angry. I learned to ask nonjudgmental, noncharged questions. Genuine curiosity unlocked the door to better communication.

It wasn’t a magic formula, though. I could still be blindsided. Once, I talked to the daughter of a woman with advanced dementia. We discussed the pros and cons of placing a feeding tube in her mother’s stomach. I told her that people often misunderstood the downsides of the procedure, like the risk of infection at the site of tube insertion, like the fact that having the tube didn’t prevent pneumonia from aspirating oral secretions.

Blindsided

Suddenly, the daughter burst out, saying, “You’re abandoning my mother! You just want her to die like all the other doctors. I can’t say goodbye to my mommy now. I want her to live.”

The strength of her outburst startled me, but I regained my composure quickly. Another aspect of learning to be more direct is being able to face the consequences of what I need to say.

I stopped. As calmly as I could, I said, “I’m not abandoning your mother. I want you to understand the facts about your decision for her.”

“I want to do everything to keep her here alive and with me.”

“Okay,” I said. “I’ll let the GI team know that you want the procedure. They’ll go over more details with you when you sign the consent form.”

Assumptions

I assumed that the daughter was able to hear what I was saying. I assumed she was in a different place than where she was. It didn’t matter how calm and logical I was. She was fearful, desperate, and unwilling to see that wanting to prolong her mother’s life could cause suffering.

Other members of the medical team characterized the daughter’s decision as selfish, but I didn’t see it that way. She was misguided, maybe. She clearly loved her mother and wasn’t ready to let her go.