Silence is golden; it can also be difficult. Many of us find it uncomfortable -awkward if it continues for too long. In communication, silence is a benefit that diminishes with time, a value that becomes a penalty. A schism that is counterproductive.
We all want to be heard; we all need to be recognized, and yet that acknowledgment requires reciprocation. Otherwise, we might as well talk to a wall. Listening is not just silence; it is attending. Listening is not the same as merely being in the same room.
A doctor is often called upon to be a multifaceted creature: she must first be sensitive to her patient’s concerns, and attentive to the sometimes lengthy explanation. She must demonstrate some empathy and understanding of the problem and yet remain calm and reassuring. Equanimity in the face of seemingly intractable issues is usually seen as a hallmark of competence. But, after a suitable time spent listening and incorporating all of the relevant symptoms into a reasonable diagnosis, it is the doctor’s turn to speak. And the art is so often in the timing.
As soon as I saw her in the waiting room, I could see she was going to be difficult. She was an older lady, probably in her late fifties, who was sitting in the corner by herself like an angry statue. Cemented to her seat, the infants crawling on the rug in front of her might as well have been ants on a lawn for all she noticed. Her face was puckered into a tense scowl, her hands were clasped into a tight, unmoving ball on the lap of her long black dress. Were it not for her short, white hair, she could have been mistaken for a shadowed monument, a memorial placed inconspicuously in the corner so as not to frighten the children.
Only her eyes betrayed her presence and they fixated on me like a hawk as soon as I entered the room.
“Gladyce?” I said walking across the carpet and trying to avoid the toddlers.
Her eyes hardened into marble slits and her face into granite. “Mrs. Ardess,” she said, italicizing the sirname through lips that barely moved. I’m surprised she could actually speak through them.
I extended my hand to introduce myself, but she barely touched it. One of my maternity patients across the room rolled her eyes.
I started to walk down the corridor to my office, expecting Gladyce to follow, but she remained seated, perhaps waiting for instructions. “Mrs. Ardess,” I said, turning to her with a smile. She sighed noisily and stood up. She seemed reluctant, though.
I indicated a seat across from my desk and waited for her to settle into it. And as I busied myself with the computer, I could feel those eyes on me again, burrowing into my skin. I returned the favour once I had opened her chart and discovered there was no referral letter.
I was about to ask her why she had been sent to see me, but before I could even open my mouth, she hardened again. “You doctors never listen, do you?” She almost spat the words through her clenched teeth. “I saw a new GP, and I told her I wanted to see a woman gynaecologist!”
This is not new to me, and certainly not an unreasonable request, but sometimes my female colleagues have longer waiting lists than me. I’ve learned not to take it personally. “There is a woman gynaecologist that works with me in the office,” I said with a slightly forced smile. “Would you like me to…”
“That’s hardly the point,” she interrupted. “I told the GP I wanted to see a woman in the first place, not waste my time being shunted around. Doctors never listen. They ask a lot of questions, but it’s like they just pick out what they want to hear from what I say and discard the rest. My first doctor didn’t even seem to understand that I was really worried.
“I told her I have an itchy red lump and that it’s in an area that is very personal. Very scary.” She scanned my face for a reaction, but I was too intent on what she was saying to react. “I’m not very sexually active anymore, so I try to be careful with my partners. You know, ask them questions, assess the risks…”
I only had time to nod before she continued. “So I was frightened that the lump was related to that… encounter.” She almost whispered the word. “It came up a few days later, so I phoned him to reassure myself again.” She softened her expression briefly and for a moment I saw a different woman. “He was so gentle with me, I didn’t really suspect he’d been lying, but I had to check. I was really worried.
“I waited a few more days thinking everything would go back to normal, but when it didn’t, I began to panic. What if it was syphilis or something? Or that HPV thing everybody’s been talking about?” Her eyes, now far from angry, fastened on my face like birds clinging to a branch. “I phoned my GP, but her receptionist said she couldn’t see me for almost a week. When I asked her to check with the doctor to see if she could fit me in sooner, I could hear them talking and laughing about it in the background.” Gladyce was silent for a second, and even unlatched her eyes from my face.
“Doctor Forster eventually came on the phone to ask me why I needed to come in so urgently… But I couldn’t convince her to change her mind. She just told me to take warm baths for a few days and if that didn’t help, to phone her back.” Suddenly Gladyce pinned me to my seat with a glare. “Dr. Forster was just too busy to listen to my concerns. I could tell she was having a bad day herself. So I managed to find another doctor –another female doctor- at a walk-in clinic.
“Maybe I chose the wrong place, but they were so busy at this one they could only see me for a few minutes.” She looked up at the ceiling for a moment. “Actually ‘see’ is probably the wrong word: the doctor never examined me. Didn’t have time, I guess. And when she asked me why I had come to the clinic, I got about two or maybe three sentences to explain and as soon as she heard the word ‘lump’ and ‘non-healing’ she began mumbling about sexually transmitted infections and grilled me on prevention. Then it was PAP smears and how necessary it was to have them regularly. Finally, she managed to segue into cancer and after hemming and knotting her face up said I needed to see a specialist. When I insisted it be a woman, she merely shrugged and said she’d try but that I needed to see whoever it was as soon as possible.
“But she obviously wasn’t listening either. No time. She had other patients to see…”
Gladyce studied me for a moment, obviously thinking about something, her eyes painting wide swaths across my face and chest. Analysing. Deciding. And then her demeanour suddenly changed and a different person emerged. I thought it might be an opportunity to ask her a few questions –finally meet her, in fact. “Well, Mrs. Ardess,” I started somewhat hesitantly, “I can see why you’ve lost some faith in us…”
“Gladyce,” she interrupted with a smile. “Call me Gladyce.”