How Storytelling Inspired a Career in Social Work
Most people search for a calling, a reason to get out of bed in the morning and seize the day. But even the most dedicated seekers can go a lifetime without finding that one thing they were born to do. Sometimes, though, if you’re lucky, inspiration can strike in an unlikely place. Just ask Lisa Vitucci, Prospero Health’s National Director of Social Work Training and Education.
Lisa supervises and trains all the social workers in Prospero’s nationwide network of providers. She coaches them on how to build trust with the people under their care, and how to navigate sometimes-challenging conversations about serious illness. Twenty-odd years ago, before Lisa found her home as a helper and healer, she was a young banking professional who wondered if there was another path for her.
“I realized that I didn’t really care about people’s checking or saving accounts,” she said. “But I just loved their stories and was always so curious about who they were and their backgrounds. That curiosity brought me into social work.”
An interaction with one particular client helped convince Lisa that her talents for empathy and listening would be better served in a different profession.
“She was sitting at my desk at the bank and sharing about her advanced illness,” Lisa explained. “She had come in to do normal banking, but she was going through chemo, and I just wanted to help her” beyond her financial issues.
A decade after graduating from high school, Lisa went back to college. While pursuing a bachelor’s in social work, she volunteered at a local hospice agency because she was “just drawn to end of life care and people with serious illness.” She had never been one to shy away from the realities of sickness and death, even as a child. As she tells it, she “was always curious about angels and wasn’t afraid when people died.” When Lisa started working in the hospice field, some people responded with confusion and even a bit of judgment. They didn’t understand why she would choose to do something so “dark” and “draining.” She felt slightly stigmatized, but she knew that her interest came from a place of deep reverence.
“When we’re at the end of life, we’re so much closer to the universe and whatever we consider God, if we have that belief system,” Lisa said. “I just felt that was a very sacred space to be in — to listen to someone reflect on their experiences, and their regrets, and their joys.”
After Lisa earned her master’s in social work, she returned to the hospice agency where she had interned in graduate school. Because of a (since-changed) law requiring that hospice social workers have at least one year of professional experience, Lisa found a role as a bereavement social worker. That opportunity solidified her personal mission as a clinician: to protect patients and their families from the pain and trauma that can occur when they’re not given the right information to make healthcare decisions.
“The stories I heard in bereavement were heartbreaking,” Lisa said. “Someone once told me, ‘My mom was put on hospice and died two days later.’ That’s trauma. If the caregiver and loved ones had a team around them with the skills to have these conversations appropriately and walk with them as the illness progressed,” that story would have had a different ending.
By this point, the word was out in social work circles that Lisa was a rising star. One day, a good friend told her about the opportunity to serve her community through ProHEALTH, the project that later became Prospero. Having spent a decade living just three miles from her office, Lisa was not keen on the idea of commuting across Long Island twice a day. On the way to the interview, her mind was admittedly elsewhere.
“You know how you’re supposed to be there 15 minutes early, prim and proper? I was literally doing my nails in the car,” she said with a laugh.
The physician who interviewed Lisa put any skepticism she had to rest: “She was talking about breaking down silos in healthcare, and what did that mean? How do we provide person-centered care? How do we have a team that’s going to care for a patient and listen to what they want instead of telling them what they should do?”
Lisa and her colleagues have spent the last six years answering those important questions. From her perspective, a respect for patient self-determination lies at the core of the Prospero model, as well as her approach as a clinician. Lisa and her team believe their job is to create space for the people under their care to decide what’s best for them, not lead them to a specific outcome. Before Lisa became a supervisor and stopped making home visits, she made an effort to communicate this stance to patients as soon as she met them.
“This is their home, and I walk in with the utmost respect,” she said, describing her mentality. “I don’t sit down until they tell me where to sit. I come in with the approach of being person-centered, of knowing I’m there to empower and not enable. I’m not there to fix. I’m actually there to sit in that discomfort.”
The discomfort might come from walking into a home that’s dirty and in disrepair. Or from realizing that a patient would really benefit from a home health aide but can’t afford one without enrolling in Medicaid, which they make too much money to qualify for. Discomfort can also come from recognizing that someone is unaware of how quickly their health is declining.
In explaining the balance between offering expertise and allowing patients to guide the conversation, Lisa recalled a patient she met during her early days with Prospero.
“I worked with an older man who had ascites, so his stomach was expanded and distended, and he was getting tapped three times a week to remove the fluid that was building,” she said. “I was so worried about him. In my head, I’m thinking, ‘We need to talk about this serious illness and how there’s been a change here.’ But that wouldn’t have been the right thing. What I said instead was, ‘What are you most worried about right now?’”
It turned out that the older man, as well as his son, was most worried about his worsening vision. Lisa interpreted that this was such a pressing concern for him because it related to “his loss of independence.” She suggested that he speak to the nurse practitioner on her team about his eyesight. Eventually, once they had addressed the vision issue, Lisa and her colleague could broach the more difficult subject of the man’s physical decline.
In a world forever altered by COVD-19, where loss is seemingly inescapable, Lisa knows that far too many people are struggling through the fog of grief. Still, she is confident that she and her team members at Prospero can accomplish the goal she set for herself when she became a social worker.
“Sometimes the people under our care don’t know they can say ‘no’ to chemo or say ‘no’ when something doesn’t feel right,” she said. “We go in and have the privilege of educating people and putting this warm blanket of support around them. That’s how we’re going to change stories.”