Practicing Presence: A Nurse’s Advice on “Hard” Conversations for Coaches, Executives, and Leaders

"Instead of the anxiety of anticipating how to act, you become free not to act. And that freedom creates one of the greatest gifts any human can offer to another: a moving beyond listening as a means to reply or understand, to a place of listening to bear witness."

Twenty years ago, in the transition period between being a seriously overworked entrepreneur and becoming a nurse, I found myself working my way through my prerequisite courses as a hospital phlebotomist. I had just turned 30, and had exited what had been at that point in my life, the most traumatizing and exhausting experience of closing down businesses I had nurtured from the ground up so that I could manifest a better and healthier life for myself and my family. I was admittedly still very young, but I had aged internally, having had some extended experiences of loss, unchangeable outcomes, injustices, and suffering.

Very early one morning, while rounding to collect blood samples from patients on the oncology floor, a nurse caught me just outside the door of the next patient on my list.

“You’re going in there? Well, good luck. He’s in a rotten mood. Just get in and out as fast as you can, if he even agrees to the blood draw.”

I must have given her a startled look as she smirked and walked off. I was not quite accustomed to such a response from another care provider at the hospital, let alone a nurse.

With a gentle knock, I entered the room to introduce myself to him and explain the reason for my visit. Across from me in a hospital bed, was a man in his late 50’s to early 60’s. He was burly, with a greying mustache, a deeply furrowed brow line, and a gaze composed of two eyes narrowed sharply into razors.

“What the hell do you want? Blood? How many times do you guys need to poke me? Forget it. I don’t need any more tests.”

He struck me as someone very similar to many men I’d encountered in my small Oregon city. “Rough, gruff, and tough” seemed to be something of a cultural norm there; a once-thriving logging and paper manufacturing town that had experienced a significant change over the years, leaving many aging men behind to gather and remember the “old days” when things were better and they were younger.

“Yes, I am here to get some samples that the doctor ordered. I can come back a little later if you’d like.”

“You don’t need to come back at all, didn’t you hear me?”

I took a steadying breath. “Well, you certainly have a right to refuse the testing. And I will totally honor your choice here. But I do think it’s in your best interest to have the tests, and I’m willing to find something that will work for you, if you are.”

I tried to offer the most neutral, respectful tone I could muster. With the exception of some limited legal circumstances, everyone has a right to refuse treatments and tests. And I certainly wanted to be respectful and demonstrate that to him. At the same time, I always worried about what might happen in that situation, and if there was some way I could gently coax people into opening to the possibility that it would be okay, and that I’d take very good care of them.

“You won’t really give up, will you? One of those persistent guys, eh? Fine. Just get it over. Get it done and get out.”

Taking the cue, I approached him with as much care and tenderness as I could, while also following the lead on his level of interaction. He didn’t seem the type to me, to be too into warm fuzzies and a lot of soothing talk. I moved as quick and efficiently as I could to minimize any disruptions to him, focusing on my work and technique. Nobody like a careless phlebotomist.

While I held pressure on the small wound I’d made in his right arm, gently rocking the test tubes in my other hand to mix the sample with the chemicals inside, he started talking.

“You know, I’m not really as ass****. I just hate all this bullshit. I hate being weak in this stupid damned bed. All of it…it’s all just bullshit.”

Familiarity began to fill my heart. In my mind, I began recalling my own recent traumas: feeling so helpless and trapped; being unable to change a truth that I didn’t like and didn’t deserve; looking like a failure to those who only previously had seen me as strong. As those thoughts flashed through me, I filled the space between us without really thinking.

“I understand.” I murmured.

Of course, that was not at all what should have come out of my mouth. And it took no time at all to realize my error.

“Oh really?! YOU know what this is like? You’ve been down this road?!” He was almost shouting, his face beet red with indignation and rage at the injustice I’d just offered.

Aaron, what were you thinking? screamed loud in my mind as I panicked momentarily, the man’s arm still at rest under the gentle pressure of my hand. Just be honest. Tell him the truth.

“No. No, I don’t know what it’s like.” And I lifted my eyes to meet his. And I felt a small layer of water building up on my lower eyelid, readying to release a single tear from each side; hoping to hold it back.

“I haven’t ever been down this road. But I have been down some hard roads.” I barely choked out the confession, recalling those things in me that related to things in him and a newfound honoring of those things that did not.

And something profoundly moving happened. He brought his other arm across his body and he took my hand in his. And tears fell from his own eyes. And I was looking into the truth behind his anger. I was looking into the whole of his fear.

“It’s so hard, isn’t it? How do you do it? How do you go on?”, and with that he broke into a slow, mournful sob.

In spite of my blundering, I found some kind of primordial ability to become present for him to give him what he really needed. And what he really needed was to be fully seen. To feel safe in the presence of someone who could simply “be with” him in complete vulnerability and confidentiality, totally free from judgment. He needed to not be alone.

I put down the tubes, used my foot to shimmy a nearby chair my way, and just sat with him, his strong hand surrounding mine. No more words were spoken. He just cried. And I was there to be present. There was nothing else I could do anyway. There were no words to make this better. There was no action I could take that would fix things. So, I just practiced silence and caring, letting this man grasp tightly to me while he lived in his fear honestly for what may have been the first time in all of that journey. He didn’t really seem like kind who had ever held the hand of another man; who likely had rarely allowed anyone in his life to see the truth of his heart. As my mind quieted and I fully entered the opening space between us, I recognized it deeply as something sacred and anciently human. Somehow, my horrific misstep only moments earlier had still been transformed into something beautiful. And honestly, it was due to the suffering man who had called me out on my insufficient response to demand more of me with his honesty and need.

It has been nearly twenty years since that fifteen-minute encounter. And I think of the gifts I received from him every time this subject arises. As a means of bringing those gifts forward, I want to share some thoughts about turning into this storm of fear and uncertainty, and learning to not be merely comfortable with these kinds of highly emotional encounters, but even grateful for them. It is my sincere hope that you will find something in these words of value to you. And that your practice of presence as a coach or leader will grow to the benefit of yourself and others.

Psychologists, sociologists, and cultural anthropologists have been studying the unique barriers of western cultures to promote healthy emotional interactions between people for decades. The observable facts are that many of us have grown up surrounded by communications characterized by passive aggression, avoidance, emotional restriction, and denial. When we are confronted by others who are in moments of suffering, we sometimes find that this upbringing combines messily with other culturally inherited beliefs. Beliefs that we should respond by “feeding it”, “fixing it”, “explaining it”, “dismissing it”, or “smothering it”. So, if we don’t abandon the person emotionally and physically in our flight mode, or become frozen in detachment, we try beating their experiences and our anxieties into submission with actions that are far from helpful or healing.

The trepidation we feel about this kind of encounter is evident in the very phrase “hard conversation”. Think about that for a moment. It is likely that when reading or hearing those words, you have an immediate mental picture of a specific situation. You and another person are together, probably in a room alone, and something labeled “bad” is happening or has happened. Are you firing them? Did they just get a dire prognosis about a disease? Did they discover a cheating spouse? Are you breaking up with them?

More to the point, can you conjure in your mind any other way to describe this type of experience as something radically different than a “hard conversation”? With our own minds trapped by a singular story about suffering, is it any wonder that so many of us would rather avoid that kind of situation altogether? How do we even begin to challenge such deeply ingrained thinking? With these questions in mind, I would like to offer the following four pillars that may help you in your own practice of presence.

Understanding is out of reach.

In his bestselling book, “The Seven Habits of Highly Effective People”, Steven Covey offers the often-quoted statement that “most people do not listen with the intent to understand; they listen with the intent to reply.” I certainly find this idea true, compelling, and useful as it causes me to enter conversations and interactions with a certain mindfulness about myself.

And yet, I would like to offer that this thought also has a significant limitation. When we are in the presence of someone who is experiencing so much difficulty, thinking we understand them is dangerous water. You may be able to relate to their circumstances. You may have had similar experience. You may have overlapping shared characteristics, values, or beliefs. And yet, for all the things you think you understand, there are countless things you do not. And unless you have the supernatural ability to inhabit their minds and bodies, their experiences are ultimately their individual mysteries. So, the first pillar I want to share in deepening your practice of presence is the acceptance that the experiences of others are ultimately unknowable.

While it might sound completely unhelpful for me to identify this, imagine for a moment the new possibility this creates for the encounter and connection between you and another. If you accept fully beforehand that complete understanding is impossible, it creates a freedom for you to move into your higher self. You aren’t going to be filling your mind with assumptions, memories, images, strategies while you are listening - you can be fully present with internal peace and silence. Instead of the anxiety of anticipating how to act, you become free not to act. And that freedom creates one of the greatest gifts any human can offer to another: a moving beyond listening as a means to reply or understand, to a place of listening to bear witness.?

David Kessler, the prolific author and lecturer on grief and loss has written, “each person’s grief [and I would add, loss, struggle, suffering, trauma] is as unique as their fingerprint. But what everyone has in common is that no matter how they grieve, they share a need for their grief to be witnessed.” Notice that he didn’t say we need to be understood. He didn’t say we need to be fixed. He didn’t say we need to be rescued. But we need to be witnessed. We need to have the clear and singular social message given from the presence of another that we are not alone. And that we have the freedom of space to be our most authentic selves without fear of harm, judgment, or the unnecessary burden of offering reciprocity to another in a moment where we have nothing to give.

It’s not your pain. It’s not your journey.

The second pillar of practicing presence, similar to the first one, came to me during that same early period of skill building during nursing school. When I was in that phase of moving from a novice toward true competence, I found myself wrestling internally with every single patient for whom I cared, given that in this case, my presence always came with the possibility of pain and discomfort. But one day as I was undoubtedly talking myself off of the shelf in my head, I became acutely aware of my own thinking. And what I heard myself saying internally was, “Aaron, it isn’t going to hurt you.”

Now, that may sound cold and callous initially; as though I didn’t care at all about the experience of the other. But quite the opposite is true. By opening myself to the reality that it was impossible for me to feel their pain and anxiety I felt a new center of calm. It sank deeper and deeper into my mind and body that whatever a patient was going through was not my own path and journey.

After this simple and profound awakening about the boundaries between us, I was able to enter encounters like these with the freedom to be fully present and focused, to “be with” rather than to “do for”. As a result, my physical skills at these tasks greatly improved, and I found that it helped lessen the pain associated with these procedures for my patients. It literally transformed my abilities to see, hear, and be with those around me, not just during fleeting and uncomfortable testing procedures, but in far greater moments of personal suffering and transformation in every context of difficulty, pain, or suffering.

Another benefit of recognizing more fully the distinct boundaries between myself and others, was the realization that I was also increasingly free from thoughts of judgement. I believe that we think and feel judgments about the journeys of others because we are engaged in a war with ourselves. We react to their stories and choices and circumstances with negativity and condemnation in some form as a way to make us feel better about who we are, or to reassure ourselves of safety when confronted by evidence of our own human vulnerabilities. When we grow to embody this second pillar – the awakening that it’s not our pain, not our journey – we are delivered from a fear of harm and the impulse of judgment.

You might say it best when you say nothing at all.

Perhaps the single most specific question I hear from coaches and leaders who are struggling to practice presence with others in deeply meaningful, heartfelt moments is, “what do I say?”

One of the best lectures I’ve ever attended was given by my esteemed colleague, Dr. Mark Merkens, a now-retired developmental pediatrician who dedicated his career to families with children with spina bifida, a neurological condition wherein the spinal column doesn’t fully close during gestation. While in our present day a number of technologies have made the early detection and treatment of spina bifida the standard, there are still cases where the expectant parents are completely unaware before the birth.

Dr. Merkens described just such a scenario one day while we were meeting with a group of our interdisciplinary fellows. He described being the healthcare provider in that moment, when you realize that the new baby exiting the womb is presenting with obvious signs of the condition, knowing that there are a vast number of scary uncertainties and questions you won’t yet be able to answer. And of course, you have a new family looking into your eyes expectantly waiting for you to tell them things have gone well.

“What is the first thing you say to these parents in that moment? The very first thing?” asked Mark.

The intimate group of 20 fellows from medicine, nursing, psychology, physical therapy, and many other disciplines sat in total silence, paralyzed with fear. Mark held that space for what I’m sure many viewed as an uncomfortable length of time and then he instructed wisely, “congratulations. The first thing you say to them is congratulations on the birth of their child.”

It was profound to hear him point out something that should have been so evident. But the deeper lesson was a masterclass in the use of both silence and words. Our communication choices when called to bear witness should be intentional, and always come from a place of meeting the needs of the other, and not the needs of ourselves. It should be a manifestation of “being with” them. And holding a space for truth. All of the truths that may be present in a given moment. It is our interaction with the space we are holding that is the focus of the third pillar: the use of silence and words as healing tools.

If words are needed in such a vulnerable moment, keep to the simplest forms of acknowledgement; for the interruption of silences that might otherwise convey a sense of avoidance, or an ignoring of the person with whom we are practicing presence. Statements and questions such as, “I’m so sorry that you are going through this right now,” or “may I sit here with you?” offer positive affirmations that we are with them, and they aren’t lost alone in darkness. On the whole however, the use of words in practicing presence is something of advanced learning that requires a great deal of trial, error, reflection, and humility. I believe that in the majority of cases, using non-verbal means to reassure others of our presence is vastly superior. The judicious use of open, accepting body language, of compassionate eye contact, or the simple act of drawing your chair to sit beside someone are some ways we show we willingly enter and steward a healing space.

To enact this pillar, I recommend reflecting deeply about your personal relationship with silence and words. Turn compassionately inward and make gentle and honest inquiries about any discomfort you may have. Bring curiosity and creativity forward, and imagine how past encounters may have been different had you applied more centered and intentional use of these tools.?Silent presence can be profoundly healing, and yet it takes a great deal of commitment and courage to create and nurture it.

Presence for others begins with presence for ourselves.

Pema Chodron, the American Buddhist nun, teaches that “The only reason we don't open our hearts and minds to other people is that they trigger confusion in us that we don't feel brave enough or sane enough to deal with. To the degree that we look clearly and compassionately at ourselves, we feel confident and fearless about looking into someone else's eyes.”?

I feel that this final pillar, perhaps more than any other idea I’ve shared, is the most vital connection you can make in developing your practice of presence. All of the barriers to presence that occur within the sphere of suffering encounters are in some way connected to deficits of self-awareness and self-compassion. In order to bring a silent mind, open heart, and judgement-free self to witnessing another’s struggles, we must have first done a great deal of work to identify and work through our own suffering and past. In the US, as well as most Western cultures, we have been conditioned for several generations to do anything but stay present for our own emotional and spiritual difficulties. We have been instructed to ignore, deny, judge, avoid, medicate, and blame to name a few strategies. But in almost no large-scale, integrated way have we been taught to stay fully present with all of these forms of our own suffering. How can we be comfortable witnessing someone else’s suffering if we haven’t witnessed fully our own?

So, the practice of presence begins within us. It begins with deep reflective work wherein we look backward at our failed attempts to “be with” and ask ourselves gentle, but honest questions. Questions such as, “why did I react that way? What was I really feeling? How was I reliving a past experience, belief, or feeling? What healing needs have gone unmet in terms of my own suffering?”

Avoid the temptation to judge your feelings and thoughts, and open a space for you to be allowed to feel and experience whatever it brings up for you. There are dozens of instructive books, lectures, videos, and classes out there about developing your skills of reflective practice and self-compassion. Begin with courage to explore your understanding of your own lived experiences of suffering.

Extending compassion inward allows you to open your heart to others and their own experiences with a growing inner calm. While this will take patience and practice – with many growing pains along the way – the result will be an increasing ability to be present with others. It will move the perception of your healing, helping, leading role from one of giving and receiving to one of lateral companionship. Of this shifting perspective, Pema writes, “compassion is not a relationship between the healer and the wounded. It's a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity.”

Going forward.

I want to commend those of you reading or listening to this work today and to acknowledge the truth that your engagement underscores; that you are seeking to practice an art of presence that has transformational healing power for the world. I believe it comes from a place of wholeheartedness and courage. Ultimately, I believe that presence is a practice of freedom. For the recipient of true presence, it is a gift to be free from judgment, isolation, and abandonment. For the giver of presence, it is a gift to be free from anxiety, fear, and the weight of resolution. It is my sincerest hope that these four pillars I’ve shared will benefit you in your own practice; that you begin internally, extending grace and compassion more fully to yourself for your past or current suffering; that you move beyond the need to reply or understand and bring intention to the act of bearing witness; that you grow in the healthy recognition of the boundaries that remind us all that we can be present for others without fear or judgement because their journeys are not our journeys; their pains are not our pains. I hope you can be excited by the possibilities these ideas and practices will open up for you and those you serve.