The challenge becomes keeping hope based in reality. If hope is not based in reality, patients and their loved ones may miss the opportunity to hope for what is achievable: the birth of a grandchild, a family reunion, a wedding. But how do I do that?  There is no easy answer. But I got some new insight into the dynamics while driving the other day.

I was listening to the radio in the car. As I drove, the road narrowed from 2 lanes to 1 and a sign on the side of the road said, “Yield.” I glanced over my shoulder, knowing I had to be aware of other cars on the road. Simultaneously, the program on the radio was about farming in America.  Several farmers were interviewed about the challenge of farming in the era of large conglomerate farms.  The interview also delved into the variables farmers have to contend with from weather changes, to water and drought, and the use of modified crops. One of the people on the program spoke about the impact of these variables on his crop yield. In this instance, the word yield did not mean to give way but rather had to do with what the farms produced — the quantity and quality. 

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In the course of just a few short miles, my attention was drawn to the complexity of the English language. Yield is one of those words with more than 1 meaning. Not surprisingly, nonnative speakers struggle with the idiosyncrasies of the spoken language. I had never really considered that the word yield had more than 1 meaning, yet as I considered those differences I thought of how this may apply to patient/family interactions, especially when they say they are waiting for a miracle.

There are times when I do not want to yield to their viewpoint. I want to hold to what I know, just as a driver can fail to yield for merging cars.  Yet, if I yield to their point of view, even when I disagree, maybe the yield, in this case what the conversation may yield in terms of insight and acceptance on my part, will be a clearer understanding between us and ultimately some resolution to our differences.

Yield – I love the many dimensions of the English language and the nuances inherent in some words. I love the paradox of yield as a verb, to yield, and as a noun, the yield.

We are a solution based society.  Our focus is on what has to be done to accomplish a task.  There are times when I realize that the way I think about EOL [end of life] is no different. I am trying to get a patient and their loved ones to this point of understanding and acceptance, but it is the point of understanding and acceptance that I believe in.

The insight into the different meanings of yield has allowed me to stop and consider what my goal for a conversation with a patient is. Is it about opening up and understanding what patients and their loved ones have to say, or is it about trying to convince them of what I know? When patients and their loved ones state that they are “waiting for a miracle” as a rationale for refusing to address what I see as obvious, is it a place setter for them? The statement is fraught with complicated responses — how exactly do you dispute a belief? — so much so that it may also serve the purpose of giving them the time to prepare to yield to what is inevitable.

If I follow the logic of yield as a metaphor for complicated interactions, I can think of the car pulled to the side of the road waiting until it is safe to merge into traffic. And, I can think of the variables at play for my patient, those which I may know as little about as I do about crop yield. And I can yield and yield.

Ann Brady is the symptom management care coordinator at the Cancer Center, Huntington Hospital, Pasadena, California.