musings on women's health

I used to think I was a good listener. I could watch the person speak, hear the words, and keep silent long enough for them to finish. And then, if it was a problem, I’d solve it. If it was a question, I’d answer it. It was easy, really: analyse the sentences, watch for ambiguities, filter out the noise -the anxious, non-essential stories, the nervous laughter- and there, stripped of unnecessary clothing and obscuring adjectives was the reason for their visit. It was a conversation reduced to pragmatic algorithms, one-side to be sure, but no less effective for its simplicity…

Or was it? I had occasion to question the effectiveness of my approach only a few years into my specialty. A young woman had been sent to me by her GP with pelvic pain. She’d seen several other gynaecologists by that time, and the usual tests had been done, accompanied by an exploratory laparoscopy or two. All with the same result: no one had been able to find a source for her pain. She had been put on antidepressants by one of them, but she was not happy with this.

As she sat fidgeting in front of me, inches away from tears, I wondered what I could possibly suggest that had not already been tried. She began describing her problem, glancing at me from time to time, waiting, it seemed, for me to interrupt. But for the life of me, I couldn’t think of anything to say, so I kept silent. Ears never get you into trouble, it’s the mouth that usually destroys rapport.

Finally she stopped, her face neutral, and she stared directly into my eyes. “Well, what do you think, doctor?”

Still puzzled about how to approach her problem, I just smiled a sad smile and said, “What do you think, Judy?”

Her eyes seemed to open for the first time. Now she was at a loss for something to say. She sat back and took a long deep breath. “You know, you’re the first doctor who ever asked me that…” She stopped fidgeting with her notes -yes, she’d brought some notes to the office so she wouldn’t forget anything- and leaned forward. “My mother died of ovarian cancer, my sister is undergoing tests…” She stopped for a moment to collect herself. “Do I have cancer, doctor?” There it was.

It occurred to me that many of us are so solution-oriented, we tolerate listening only until we have solved the word puzzle presented to us. No matter that we have been hearing metaphor and have interpreted it literally. The fact that I’d not been able to solve the problem she’d presented, that I’d had nothing to suggest, required me to keep listening -by then hopelessly entangled in her story. And even hearing things that seemed accusatory and sometimes unreasonable, I was forced by the simple fact that I had no answers, to listen further. To understand, more than to solve. Or rather, to hear more than a litany of symptoms, and a list of treatment failures.

But even now, I occasionally think I don’t have the time to remain silent, to hear the story unfold as my patient wants it to. I want to jump in at her first pause and dazzle her with my solution. It’s often myself I’m dazzling. Sometimes it’s the unheard story they’ve come to tell.