The Gyne Codes

We all use codes; sometimes they are simply shortcuts, at other times they identify us as part of one community or another. However, the codes I like are the ones that are attempts at disguise. Camouflage. They offer the challenges that colour my day. I have to say that I was absolutely fascinated by the codes and their uses reported in a BBC news item:

I suppose the codes it revealed that tugged at my heart more than my intellect were the so-called hoboglyphs which are ‘a collection of symbols meant to provide information to travelling workers and homeless people.’ Somehow the thought that ‘Among other things, these could indicate the quality of a nearby water source, or suggest whether the occupant of a house is friendly or not’ goes at least a little way to help those that society tends to shun.

But as I said, we all use codes in one way or another; a difficulty arises when you don’t know you are being coded –or worse, you do, but you have no idea what the codes mean… Or why they are being used in the first place. I usually suspect the worst.

And the non-verbal codes people use are the trickiest: they can often be explained away as random movements –tics- and even to notice them might embarrass the user if they were indeed involuntary. Or, perhaps more awkward, if they arise from the patient’s unease itself. From time to time I am confronted with this dilemma in my practice of gynaecology.

I first met Roseita a few years ago. English was difficult for her at the time, and I remember she seemed to communicate with her eyes a lot. That first day, as she sat entombed in shadows in a far corner of the waiting room, I could sense her presence even before I saw her. She was camouflaged in a green dress on a little chair beside the large Areca palm plant that also seemed to be enjoying the subdued light. The chair –Roseita- was almost hidden under the leaves, but I felt her eyes tracking me like radar all the way across the wooden floor. Large, brown, worried eyes they seemed, already questioning whether I was the person who could help her.

I suppose there’s always that initial doubt in new patients, although most seem able to disguise their discomfort. Roseita couldn’t, and as I approached her with my hand extended in a greeting, her face said hello, while her eyes stared at me like frightened children. I didn’t know which to believe, so I chose to focus on her face. It’s amazing just how much a face can fight with the eyes; so which are mirrors of the soul…?

She trailed behind me, reluctantly I think, on the short journey down the corridor to my office at its end, and I had to fight the urge to keep turning around to see if she was still there. Her eyes certainly were; I could feel them burrowing into my back, studying my gait, judging the whiteness of the lab coat I usually wear. By the time we reached the door, I felt nervous about revealing the front half of my body again, in case it didn’t measure up to the other side she now knew so well.

After a hurried, but I suspect thorough, inspection of the room she seated herself like a monument on the chair opposite my desk. I say ‘monument’, but despite her bravado, she was more like a delicate figurine hoping to fool me with immobility. As if by sitting up straight and rigid, she could project a strength she didn’t feel. Sometimes her hands would slowly drift up to the sides of her head, like she was trying to smooth the dark black curls that dangled on her ears, but otherwise she was a statue with eyes peering out from little cages just waiting to be unleashed.

I could feel her anxiety and tried to set her more at ease with a smile and a compliment on her dress. It really was a thing of beauty and I wondered if she’d chosen it because it gave her confidence, or because she thought it would disarm me.

The compliment seemed to take her by surprise and she dropped her eyes to her lap for a moment as she decided how to react. Then, as if she’d come to the conclusion that I was being insincere –or maybe she didn’t actually understand my words- she launched those eyes at me like missiles. Hard, like stones. They actually hurt, although at the time I didn’t realize that it was my pride they hurt –rebuffing, as they were, my attempts at bridging a gap I was at a loss to understand. Doctors get injured too; relationships are a dance –a clumsy one until both understand the movements of the other. The needs of the other…

I suppose I always found that difficult; I need to feel comfortable before I can provide succour to the other. The therapeutic relationship –the doctor/patient alliance- is truly that: a tie. And what is usually considered an unavoidable imbalance of power, can be a mutual journey of discovery… If both are open to that, of course.

For my part, I wanted to understand why Roseita was so wary of me. Was it merely fear –the strange doctor of opposite gender, disparate culture, and different language pretending to offer help? Or was it more than that: mistrust? I had to know.

Wilting under the constant barrage of her eyes, I had to rest from them for a moment, so I sought refuge in the computer screen. I pulled up the consult note that I had ignored before to scan the investigations her GP had done. Often the ultrasound, for example, will tell me more about the problem than the consult note which will sometimes offer one hurriedly written and often illegible word: Pain! But in this case it was more helpful. Much more! It said that Roseita was deaf, and the effort of trying to read lips in a language she hardly understood made her anxious.

Well of course! I rekindled my smile and pointed to my ears to show I finally understood. The grin that produced almost split her face in half. She pointed to the door, touched her lips, then shrugged in a mute apology before she disappeared down the corridor. She’d left her coat on the chair, so I waited expectantly. She’d be back.

Suddenly, she reappeared with a shorter man in tow behind her. He seemed embarrassed at being in a gynaecologist’s office but was determined to help Roseita.

“Roseita… wife,” he said, hesitantly as he grasped her hand tenderly and held on for dear life. “She… no listen…” He reconsidered the word and corrected himself with a sheepish grin. “She no hear. I… talk on her,” he finished proudly.

And talk we did –although gesticulating and drawing things in the air made it seem like a medical game of Charades at times. We drew pictures on scraps of paper; we pointed; we tried words in both languages; we laughed… But, in the end, I think we all understood more about the three of us than would have occurred with words alone. We do not just speak in code, nor simply write in code. Code is sometimes informal -the inverse of what we expect. It can be what we use to reveal things otherwise hidden, the algebra that explains, the metaphor that illuminates.

I’ve never forgotten that visit. I have learned, I hope, to look beyond mere words. They are only the wrappings that cover the gift offered underneath. To paraphrase Costard, the country clown in Shakespeare’s Love’s Labor’s Lost, I have lived too long on the alms-basket of words.




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