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Dr Kathryn Mannix
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Podcast Episode 116: how to listen when you will never be able to fix it

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Kathryn Mannix has spent her medical career working with people who have incurable advanced illnesses.

Starting in cancer care and changing career to become a pioneer of the new discipline of palliative medicine, she’s worked with teams in hospices, hospitals, and in patients’ own homes to deliver palliative care, optimizing quality of life even as death is approaching.

Kathryn has worked with many thousands of dying people and has found their ability to deal with illness and death both fascinating and inspirational.

She believes that a better public awareness about what happens as we die would reduce fear and enable people to discuss their hopes and plans with the people that matter to them.

Her account of how people live while they’re dying, in her book, With the End in Mind, was published to Universal acclaim and was shortlisted for the Wellcome Prize.

Kathryn’s next book, Listen: How to Find the Words for Tender Conversations, starts with a potent story about her early career encounter with Mrs. de Souza.

I encourage you to listen to this discussion more than once.

Kathryn’s listening, it’s well class and the way she explains listening is compelling. I have five copies of Kathryn’s book to share.

If you email with the subject “Tender” and your reflections of this conversation.

You could reflect on the story of Mrs. de Souza.

You might reflect on Dorothy and her listening, or how you think about dancing and listening, the difference between doing and being listening, the impact of listening via video versus face-to-face. This is such a rich and nuanced experience.

Kathryn completely changed the way I think about listening.

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Oscar Trimboli: What’s the cost of not listening?

Kathryn Mannix: There are probably several costs of not listening. Aren’t there? There are costs to those of us who could be listening or afforded the opportunities to grow, to learn that miss because we think we already know the answer and we do into and telling instead of working with and listening.

But not being listened to, for the other person is dreadful

It’s so lonely to be carrying something difficult as a struggle with yourself in conversation in your head, wondering whether you are doing things right, wondering what you’re doing wrong, wondering where the end will that be, and whether that’s your early professional development journey as a teacher, policeman, or a doctor, or whether that’s how you are living your life as you do your exams as a young person choosing your career, life partner, family difficulties bereavement.

Everybody’s got the struggle that they’ve got moment and it fills their struggle cup to the brim.

And when you look back later on in life with really huge struggles and you think, “I don’t know why I got so overwhelmed by that little thing that happened to me 20 years ago,” but it was the biggest thing and it filled your cup.

The cost of not listening to the person whose cup is overflowing is that we leave them in a place of having to get on with it.

If we’re good listeners, we still leave them a place having to get it because we’re not taking over and fixing it, but we walk alongside them in that place saying, “You can either fix this or you can live with it, and I’m going be your buddy while you work it. You can do it.”

So what we do is we change the loneliness and maybe we change their sense empowerment, we don’t do it to them…

Oscar Trimboli: Kathryn Mannix has spent her medical career working with people who have incurable advanced illnesses.

Starting in cancer care and changing career to become a pioneer of the new discipline of palliative medicine, she’s worked with teams in hospices, hospitals, and in patients’ own homes to deliver palliative care, optimizing quality of life even as death is approaching.

Kathryn has worked with many thousands of dying people and has found their ability to deal with illness and death both fascinating and inspirational.

She believes that a better public awareness about what happens as we die would reduce fear and enable people to discuss their hopes and plans with the people that matter to them.

Her account of how people live while they’re dying, in her book, With the End in Mind, was published to Universal acclaim and was shortlisted for the Wellcome Prize.

Kathryn’s next book, Listen: How to Find the Words for Tender Conversations, starts with a potent story about her early career encounter with Mrs. de Souza.

I encourage you to listen to this discussion more than once.

Kathryn’s listening, it’s well class and the way she explains listening is compelling. I have five copies of Kathryn’s book to share.

If you email with the subject “Tender” and your reflections of this conversation.

You could reflect on the story of Mrs. de Souza.

You might reflect on Dorothy and her listening, or how you think about dancing and listening, the difference between doing and being listening, the impact of listening via video versus face-to-face. This is such a rich and nuanced experience.

Kathryn completely changed the way I think about listening.

Tell me the story of Mrs. de Souza.

Kathryn Mannix: The story of Mrs. de Souza is a story that nearly broke me but actually eventually formed me. I was very young doctor, probably qualified, I don’t know, 15, 16 months.

I had been quite used to explaining to the families of patients who were visiting the wards where I worked that the was very sick, was getting sick, had died. These conversations that evolved, they have really sad conversations, but they were conversations people that I’ve met.

This particular day, I was receiving medical officer for our big busy hospital and we had been trying to resuscitate a man who had cardiac arrest at work.

He collapsed in the foundry where he worked and he brought him by ambulance, blue flashing light, paramedics doing CPR. And then we, the medical team taken over CPR in the resuscitation room. My far more senior colleague had come to run the show.

So I was a card player doing my best and eventually it was obvious we weren’t going to restart his heart and they called off the resuscitation, and noted the time as the time of his death.

What usually would happen next would be that I, as the junior doctor, would note down everything that we’d had done in the medical notes.

And the senior doctor would go to find the family.

But for reasons that I still don’t understand to this day, I was sent by the senior doctor to talk to the family. And the family was a woman, his wife sitting in the reception room all harrowing, waiting anxiously because she knew he was critically ill. And I have to tell her that her husband had died .

But I knew what to do. I’ve been trained. I knew that you made sure you were talking to the right person about the right person and then you gave a warning shot and then you didn’t dilly. You delivered the bad news. That’s what I’ve been trained to do. So there I am. I’m in my white coat, it’s starched on.

I’m ready. I’m being a doctor.

And I was terrified.

I was absolutely terrified.

And even as I’m telling you this story, my hands are clenching. And I think they were probably clenched at the time. I don’t know. Were they clenched in my pocket pushed down or were they clenched around my lapels?

But I had to be brave. This was my job.

I went in and I followed the formula.

“Are you Mrs. de Souza?” “Yes, I’m Mrs. de Souza.” “I’m terribly sorry. I got really awful news for you.”

And she was sitting down and I’m standing up, so I’m towering above her.

And I said, “Sorry, we haven’t been able to restart your husband’s heart. I’m really sorry to tell you that he has just died in our resuscitation room.”

And then I don’t really know what happened next. There was a lot of noise. And the noise was somebody shouting, “Liar, liar, liar, liar. He can’t be dead. He can’t be dead.” And there wasn’t anybody else in the room, so it must have been her. And then there was a very bright light and a very loud smack and a very big pain in the side of my face.

And she had stood up and just clocked me in the face shouting, “Liar!” And then she just collapsed back down onto this horrible, unbeautiful hospital plastic chair, just weeping, head on her lap, hands over the back of her head, howling.

I just didn’t know what to do. I was completely overwhelmed. I followed the formula. I’d done what I had trusted would be the way to do it right. And I had just done something terrible to this woman. I hadn’t just told her that her husband had died. I’d done something that completely traumatized.

And as I’m standing there just feeling completely helpless and trying really hard not to be sick, the door opened and the staff nurse came in and I loved Dorothy already. She was calm influence across the emergency department. And she came in and she came, looked at me and she looked at this woman. And she sat down next to Mrs. de Souza.

And I can remember thinking, “Why the hell didn’t I sit down before I started?” And then she said to me, “You might like to sit down, Doctor.” Okay, so I can sit down on the opposite side of the room now and just watch this absolute master class because Dorothy didn’t do anything.

She sat next to this woman and she didn’t attempt to make it better. She didn’t attempt to make it right. She didn’t attempt to console her. She just stroked her arm and said…

Well, in ordinary English it would probably be, “Oh, dear, my nice person.” But in the vernacular of Geordie in the northeastern England, she said, “eee pet.” She’s stroking her arm. “”eee pet.”. It’s terrible, isn’t it, pet?”

And this woman’s still sitting with her head on her knees and her hands over her head, almost in account of the brace position and a plane. And their shoulders are heaving. And gradually, the heaving slowed down and the weeping got quieter. And she gradually sat up and Dorothy carried on stroking her arms. “It’s terrible, it’s terrible.” And she calms.

And then Dorothy did something really interesting. Dorothy started to ask her questions, “Had he been poorly kept?” And the sister Caesar said, “Well, he had a heart attack a few years ago and they thought he was going to die that time. They were really amazed when he got one enough to go home and go back to work.” “eee pet.”. So you didn’t know. Didn’t you? You didn’t know. You didn’t know. And did you think you were on borrowed time?”

“Yes we did. We knew we were on borrowed.” “So had you noticed a change in him recently?” “Well, he’d be under great stress at work. I told him not to go into work today. I thought he did very well. When the phone rang at home, I wasn’t surprised that it was work to tell me that they’d sent him to the hospital.” “eee pet.”. Terrible, isn’t it terrible? Would you like to see him?”

And what struck me ever since about this is the emergency room is frantic. The nurses have no time. Dorothy sat down and looked as though she had all the time in the world, and then she made time by which I mean only she manufactured time by the way she dealt with the situation.

And by the time she’d finished and was leading Mrs. de Souza out of the room to go and see her dead husband, it was as though the awfulness of the assault that I had perpetrated hadn’t happened.

And Dorothy gave me a job that I could be trusted with. She told me to go and make everybody a cup tea. So I went round to the little kitchen area and I took three cups of tea because she told me to make sure I made one for myself.

I took three cups of tea into the little room where they by now had Mr. de Souza covered with blanket over him and the chair and his wife was sitting next to it. She was talking to him, touching his hand and touching his cheek.

And she thanked me for this cup of tea. It was as though the previous conversation, it was as though she didn’t know who I was, she’d never seen before. And it was just the most salutatory lesson. It had to be alongside somebody in distress. And I realized that the model I’d been taught in medical school was complete rubbish. And it was really a recipe for trauma, and that Dorothy should be training everybody.

Oscar Trimboli: Dorothy had a complaint. She made a complaint to Mr. Rogers.

Kathryn Mannix: She did. So she then, after we dealt with that, she then said, “Right, okay, we’re going to go see the head of department now because I have a complaint to make.”

And I just thought, “Oh God, just when I thought she had my back, she’s going to drop me in it and I’m going to get disciplined.”

And so she marches me into Mr. Rogers’ office. Mr. Rogers was, you know the comedian Billy Connolly? He was like a kind of extreme version of Billy Connolly. And he was a chain smoker. He had this bright white hair, had a yellow quiff at the front from the constant kipper ring that it was getting from the cigarettes. And these hands like plates, but they’re obviously very, very skilled trauma surgeon.

“And Mr. Rogers, it’s just not good enough. You’re going to have to deal with it. This keeps happening.”

And I’m thinking, “Hey, I’ve only done this once. What’s going on here?”

She said, “We can’t send junior doctors to break bad news on their own. We have to take what we have to show them. They have to be chaperoned, they need to be accompanied.

This poor doctor’s done her best and now she’s been bashed in the face.” And that wasn’t what I was expecting at all, although I shouldn’t been really, because Dorothy was a wonder be kind person.

But she was completely outraged at what had happened to me at the hands of my colleagues, rather than what I’d done to this poor woman.

Her reflection on it afterwards was that, because I’d been bashed that would make a good story. And because it was a good story, the doctors and nurses in the department would be more likely to listen to it, act on it, that if I’d just upset somebody. But there had been that kind of violent upswing in it.

So I’m not sure that I felt that I was happy to help. But it was really interesting to see how much Dorothy saw communication as part of the job not an extra and that we needed to be skilled, comfortable, competent, practiced. And to do that, you’ve got to learn, you’ve got to practice, you’ve got to keep practicing.

People have to give you feedback. It’s not a just thing that you can do or you can’t do. I know I’m preaching to the choir here, but that was all the news to me that this is a real thing. T

his is as important as can you stitch a wound so that there won’t be a scar in somebody’s face?

Oscar Trimboli: Later on that day you made a reflection that says surgery seems simple compared to this communication.

Kathryn Mannix: I still think that. I regularly upset surgeons by saying so.

Oscar Trimboli: When you think about communication in this way, we have structured protocols that you probably had. My suspicion is the way you were trained, maybe there needed to be two people present when this news was delivered.

Yet in the reality of life, our best plans evaporate very quickly when reality hits because protocols are structured, they’re sequential, they’re linear, and they lack that organic dance from life.

And you decided to think about the waltz in a completely different way as it relates to communicating, both speaking and listening.

When did you come to the moment that you said, “The way I need to think about this and the way I need to communicate this to others is through that”?

Kathryn Mannix: When I wrote the book, Listen, about tender communications, I was trying to develop a metaphor to carry the ideas through the book. And I for a long time taught medical students that when they’re listening between their questions, they have to add in stop points where they reflect and they just check person that what they heard them say was what they’ve meant. Or a stop point because maybe in shorter time, have I got enough of that part of your story that we can move to a different part the story, so it’s a collaborative subject change rather than an imposement.

And what I discovered in teaching medical students was if I said to them, “Do regular summaries,” and then gave them skills practice sessions, they’d suddenly remember at the penultimate moment that they haven’t done a summary yet.

So I started to talk to them about giving a summary or making a statement after every two questions really to over pudding I guess.

And that way it’s a question, question summary rules. And that’s easy for them to remember.

If you’re going to take message out of class, “Oh yeah, she was that crazy woman who talked about waltzing. Isn’t she? What’s that questions.” If that’s all they took out, that was great.

So when I was developing the book, I included a couple of other kind of ideas around the notion that when we dance with each other, we are cooperating, we’re collaborating, we’re agreeing to do it, but it’s a movement, it’s not static. And that’s why I like the idea of dance. And I was writing my proposal and I asked a few people to have a look at it, and one of my brothers who’s not known as a dancer came back to me.

He said, “I went for a really long walk across the malls yesterday thinking about what you’d sent and you could think about that really richly through this book.”

And he came with this kind of formula for me, my brother John Mannix saying, “You need to decide now whether this book is going to be a dance class or whether this book is going to be a dance exhibition because they’re not the same thing.”

So he’s an educator. And so that was a really, really helpful insight for me because I realized that actually if I’m going to tell stories, what you can do is exhibit the beginners and the really, really polish dancers, the rookies really fantastic

So that’s the exhibition. But then you can do with that what we’re doing with our conversation, which is then to unpick it and use it both as an exhibition but also as a space for reflection that is effective use. So it’s a family effort, Oscar.

Oscar Trimboli:  It always is whether your family is blood relative or just someone as a colleague. And when we think about death as lead and follow, there are steps, there is music, there is a change, there’s a misstep that you need to adjust to. The music is at a completely different tempo depending on the interaction. And yet when you’re on the dance floor, there are other dancers present as well. So it’s not just the one-on-one, it’s also a group interaction as well. When you’ve shared this with others, what has been the most impactful or surprising reflection that people have made back to you that took the combination of dance and listening to another level for you?

Kathryn Mannix:  Oh, that’s a really great question. I use it a lot now in teaching. And one of the things for people who are nervous communicators that they really like is the idea, as you say, dancing is a collaboration. And when we misstep, generally we don’t then fight with each other.

We actually apologize and help each other.

And you can see little light bulbs going on all over the room

. Yeah. So actually having a go, making them stay in all honesty in a transparent way, beginners are able to say, “Okay, this is a process that maybe I can trust because I’m doing it with another person. And that transformation from working with from doing to, to working with is another light bulb moment that in medicine and clinical practice, this is not another one of those things you are doing to somebody. You’re putting in the drip, you’re giving an injection.

This is a thing that they work with you to create. And so that sense of co-creation is the thing that excites people when you’re doing more events, communication skills, training, that sense of I can try something new and they won’t even know, and that’s okay.

But the really advanced practitioners are saying, “Oh, I could try something new and I could tell them I’m trying something new, and could they help me with this new thing that I’m trying on behalf of themself but also on behalf of the other patients that I see and I deal with?”

And I think that’s a real quantum shift for people to be able to say medicine works, psychological practice works because we agree to be in partnership with each for the advantage of the person who the servant is serving.

Because if it’s truly working with, if it’s truly collaborative, that also includes sharing our learning journey and our ability to grow in the role that we are in by trying new things.

And the only way to try them is to try them in real life.

That reflection of I can try something new and I can tell you, I can have the courage to say, “I’ve been on this training course, I’ve been reading this book, listen to this podcast.

They made a suggestion that I just think could fit with what we’re doing right now. Do you mind if I give it go? It might be useless, I might be terrible at it, I just don’t know. But how about it? What do you think?”

People step up. That in invitation is actually an invitation into intimacy in some way. Isn’t it? And it makes the space safer, not less safe, even though we admit that we’re trying something new.

Oscar Trimboli:  So I’ve researched many of your interviews and to some extent there’s a consistent pattern in the interview, and we chose to experiment today.

Have you noticed a shift in the people you work with or yourself when they move from trying to do listening to just being human and trying to unlearn?

Because I think if you connect with your innate humanity, listening is something that you can be rather than something you can do.

Kathryn Mannix:  Yeah, I really appreciate that notion of being.

And recently I’ve been talking to people who are very, very anxious about what words they should use as they progress the conversation. So between them listening when it’s necessary to speak, what should I say?

The concept that seemed to be helpful to that was the idea that we’ve been able to talk, to speak words that say what’s in our mind consistently in a way that helps the other person we’re talking to understand what’s going on in our mind since we’re about three years old.

We didn’t learn scripts when we were three, we just said words. And if people are really focused on what’s the script, what are the words, what should I say, how should I say it, they can’t listen ’cause they’re too busy carrying the words in their heads and rehearsing them and making sure that.

Whereas if you really are genuinely able to get alongside and be curious about them instead of anxious about yourself, then your curiosity elicits the information they’re prepared to give.

That itself might change in people as they trust you more as the relationship develops. But by remaining curious and listening, when there’s a point in the dance that does something was going to be helpful there’s that force that says it’s your turn to speak, the thing that’s going through your mind will declare itself in words.

You don’t need to have practiced a set of words.

hat’s what I did completely wrong with Mrs. de Souza. I had a formula.

I did the wrong thing.

Oscar Trimboli:  Let’s do a process check. How’s this going for you?

Kathryn Mannix:  This is lovely.

I worry that I speaking too much and I always worry about that.

And it’s quite odd the interview podcast format.

I suspect if you were sitting on my sofa just over there, there’d be a lot more silence in this conversation.

There’s something about earphones and a microphone changes the dynamic.

Oscar Trimboli: What surprised you?

Kathryn Mannix:  I’m intrigued. I’m excited that we are going to unpick, we’re going to unpeel the onion of something in particular rather than try talk about everything in general.

Oscar Trimboli: When I moved from doing to being, when it came to listening, I moved my orientation off listening to make sense for me to listening to help them make sense for what they’re thinking.


Then I also noticed a third participant in every conversation, which was the dialogue.


Once I started noticing the dialogue, not just the other participant, a weight lifted off me because there wasn’t the energy between two magnetic poles that were either pulling really quickly together or repelling apart.


I’m curious about your noticing of the third element in every conversation. That’s the dialogue.

Kathryn Mannix: That sounds really, really interesting. So the dialogue is the third participant.

Oscar Trimboli: As you hear me say that, I’m just fascinated what’s going through your mind.

Kathryn Mannix: I’m time traveling, as you’re saying. I’m sitting in a room in a very old mental hospital with the northeast of England on a course. I have training in palliative medicine. And because there wasn’t any proper training, I’m knitting my own training scheme, which is very nice. I’ve been to work with some really wonderful people. In this six months, I’m knitting six months of psychiatry.


The psychiatry team have been really welcoming and watched you with patients and we think that this would be something that would suite your way of practice. So I’m on a cognitive therapy course once a week for whole day. I’m the only non-psychiatric person there. So there are psychiatrists, psychologists, social workers, OTs, they’re all expert practitioners for psychiatry. And then there’s this doctor who looks after palliative care and dying people.


Aren’t they supposed to be miserable? Aren’t they supposed to be anxious? Why are you going to use cognitive therapy? So I’m already trying to justify my presence there. And I’m learning. I’m learning. And what I’m learning is that there’s this process that has a name that is something that I’ve been doing for years, but I didn’t know it was a process and I didn’t know it had a name. And the process is that the person is talking to you about the conundrum they’ve got the situation they’re in.


And instead of trying to solve it, you ask them more about it. You help them to look up from the main issue up and out to notice what else is also going on. Some of which is also terrible, but actually some of it is okay. And some of those things that I’ve been so busy looking down, I haven’t looked up and noticed that may or actually maybe I could solve some of things or deal with some of this if I just look up at that.


So by asking more and more questions, you enable people to notice things they haven’t noticed before. Sometimes it’s other facts and sometimes what you’re helping them to notice is about the way they’re out behaviors or their own way of thinking about the issue rather than the issue itself are keeping them stuck. And once they have that insight, almost always they will have in parallel with it a notion of what they could do differently so it can be less stuck.


All you are doing is staying with it, not trying to fix it, and helping them to understand it better. And when the thing that you are dealing with is the fact that a person’s dying, it’s very humbling because there isn’t anything you can do to fix it. So I guess that part of the training I’ve had so far or the experience was I’m dealing with a situation that people can’t fix.


So my curiosity as the person they’re trusting to listen to their woes is, “How are you living this? How are you continuing to get up in the morning, face the day? How’s your family dealing with it? How are your friends dealing with it? What do you do in your worst moments? What are the best moments like?”


And now there’s somebody in this room who’s telling you, “Well, this is a process, it’s guided discovery. And what you’re really trying to do is help people to exist the way they’re thinking, whether they’re biases in their thinking or their attention, whether they’re just working on assumptions instead of testing it facts, whether they’re using emotional reasoning and they’re just sabotaging themselves, the behaviors that they use intended to help them actually make things worse for them.


And almost like a firework display is going on around this speaker in my head, “Oh, that’s why that works. Okay, this thing that I’ve been doing by the seat of my pants, me and the patient hard work all the time thinking about how to stay present, how to think of another question that’s going to help them to explore a bit more. Me, you: work, work, work, work, work. And suddenly, “Oh no, hang on. Hang on. The thing that’s doing the work isn’t me. And it isn’t really the other person either. It’s the questions, it’s the dialogue, it’s the conversation that’s doing it.”


And instead of thinking, I’ve got to invent it for myself, do you know though every time I go into a room, I realize that the conversation is just waiting for the pair of us to get together. And it automatically is simultaneously present. And sometimes the conversation is just, “Be, pet,” and the stroking of an arm. And that is the right conversation for that moment. And it blew my mind and it did that thing that you just described of I don’t have to sweat this as though I am carrying it as a personal burden anymore.


This is a way of being that is always better

Oscar Trimboli: I’m delighted you invoked Dorothy or Dotty, as Mr. Rogers called her.

If we went back into that resuscitation room and as you stepped from there to visit on Mrs. de Souza, I’m sure you’ve had time to ponder how you would do it now.

Kathryn Mannix: And in fact, I’ve been the person who’s had to do that so many more times as more experienced doctor and it never feels easier. So if I were going back, I know I would be outside that door knowing that one of the things that’s about to happen is that this person’s about to be devastated by the news that I’m going to bring, but also an understanding that it’s the news that’s devastating.

And my job is to allow her to reach an understanding of it without adding trauma to the devastation. And the news is not. So what can we do that enables a person to take in the news and feel the devastation because that is part of their process that’s not avoidable?

But to take it in at a rate at which they can assimilate it. And you think about our police officers and army people have to go family doors and face this kind of situation on a daily basis. And I guess the warning shot for families there is that this policeman at the door, whereas the doctor could be coming in who saying. So what my practice now would be to go in and to ask permission to sit down. “Do you mind if I sit down? And I’m Dr. Kathryn. And if I’m in the right room, you’re Mrs. de Souza. Mrs. de Souza, and you must be,” let’s call him Fred, “de Souza’s wife?” “Yes, That’s right.” “So tell me what you know.”

Because actually Dorothy showed me and since then I’ve used it almost whenever I can remember to. And gradually, that’s become my modus operandi of if this person can tell me their story so far, a few things will happen. They will tell me how much of the story they already understand. So if she says to me, “Well, he was perfectly fine and I was astonished to get a phone call from his factory to say he’d been brought to the hospital,” that’s a different conversation waiting for us from, “Oh, you need to tell me how he is, Doctor. I’m on pins because I know he’s been really, really sick and he’s been sick for weeks. I’ve been so worried. I thought he might be going to have another heart attack.”

And you don’t want to play cats and mouse with that for too long. That’s unkind. But actually, what Mrs. de Souza is doing is if I can help her build a little bridge from where she is now to the place of uncertainty that lives inside her, that there might be something seriously wrong with my husband, that he might be going to have a heart attack, and I’ve been worrying about that for a long time.

And she’s now in a place where she has brought herself to that place wondering, that place uncertainty. And now I’m in a position to able say, “Well you were right to be worried about whether he might have a heart attack because that is what has happened and that is why he has been brought to this facility. And I’m really sorry that your worst dread that it might be more serious is right. And that his heart stopped beating. We weren’t able to resuscitate him. And he has died. And really I’m very sorry.

And there would probably be much longer silences in that where I’m just gauging when she’s ready for the next blow to for if she like.

But what we’re doing is accompanying each other to the place of trauma.

And now she knows the same truth that I told her as a rookie, but she knows it by realizing that it’s possible that that’s what I’m going to say. She’s explained to herself why it possible that that’s what I’m going to say. And now that I’ve said it, she isn’t actually terribly surprised even though she’s devastated. And that’s not so that it’s easier for me and I don’t get hit.

It’s so that it is less traumatic for her so that she can actually process it and take it in and begin the next thing that needs to happen which is her grief, her bereavement, her understanding that her life has changed forever in the way that she hasn’t chosen, in a way that nobody can make better for her, but in a way that she has to learn to accommodate. And that it won’t always feel like this, but today it does. But we are her companions in it ’cause it takes a village to do anything that’s important. And grief is all the things we need a village around us.

Oscar Trimboli:  Thank you for your reflection. If Dorothy was listening to us right now, would she be saying, “Oscar, you should have asked Kathryn this”?

Kathryn Mannix: Now, I’ve really loved that unpicking and that exploration. When I came to write the story, and you’ve heard reading it. Haven’t you? And you’ve heard that actually I’ve got very wobbly while I was reading it. While I was writing it, I realized I’d hidden it. I was so distressed by it that I hadn’t thought about it for 13 years.


And so as I was writing it and re-experiencing it, I was always also completely indignant that any pain sent a child with no experience should do that dreadful thing. And Dorothy was absolutely right to make representation to the authorities and the department that this is unacceptable practice because two people were traumatized that day. And Mrs. de Souza had to live with her bereavement. But I was really surprised how very emotional I felt 30 something years after that event.


So we need to look after each other that we to be each other’s backup. And so the other thing I guess if I was standing outside that door on my own now, I’d be casting around to say, “Has anybody got 10 minutes to come and sit in the in with us, junior doctor, medical students, staff nurse, experienced ward manager. Is there another human being available, please who can just come be with us and the person whose also marking with respect the enormity of the conversation what we’re about to change that’s about to happen in this person’s life.”


And the burdened or the bearer of the news is just a little bit enlightened.


It’s a bit of the village to help

Oscar Trimboli: I’m not a dancer. Yet it’s easy for me to explore listening as an experiment where there are two or more people bumping into each other, not judging their missteps, just staying in tune with the music and continuing to make progress. I’ve listened to Kathryn’s audiobook, Listen: How to Find the Words for Tender Conversation, three times. And I still notice something new each time. As a quick reminder, we are giving away five paperback copies of Kathryn’s book. Just email with the subject “Tender”

and your reflections from this discussion.

As a bonus, if you listen through to the end, Kathryn notices how I was listening to her during this discussion.


I’m Oscar Trimboli and along with the Deep Listening ambassador community, we’re on a quest to create 100 million deep listeners in the world. And you’ve given us the greatest gift of all: you’ve listened to us. Thanks for listening. What did you notice about the way I listened?

Kathryn Mannix:  Your listening has been beautiful. It’s been thoughtful. It’s silent, it’s been encouraging. You’ve been nodding and smiling. And as we’ve gone on, I’ve noticed that instead of looking at you on my screen, which of course is always looking at the wrong place, isn’t it on these things? ‘Cause we don’t look at the camera, we look at the face. I’ve started to talk as though you are in the room and my eyes are drifting off as I do my thinking in my head and I’ve stopped looking at the screen. So what you’ve done is created this really lovely, safe, trusting atmosphere and I really appreciate that.

Oscar Trimboli: If we did any of this again, would you change anything?

Kathryn Mannix: I’d speak more slowly and leave more gaps. I think we talk long enough now that I’m ready to start.


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