musings on women's health

I remember it from my medical practice; I remember it from dealing with friends with incurable illness: the feeling of helplessness in commiseration. The recognition that my often naïve suggestions, intended to help, were not what was required, nor even wanted, for that matter. Sometimes there are no solutions; sometimes presence –listening- in itself is enough… No, not enough, but at least comforting.

I suppose some people come to this realization naturally -instinctively understanding what is needed- while for others it is absorbed only gradually and after much trial and error. Some issues require solutions, guidance, and expertise, but some require the simpler yet more difficult task of companionship. Being there, often with wordless compassion. Silent empathy.

Not trying for control and directing things can be difficult, but usually there is a time for silence. Sometimes, there is an inevitability that simply has to be accepted. It’s a subject that many of us would rather not confront, and yet we have to -it is important. Perhaps that’s why I was drawn to the short essay in Aeon written by Nicholaos Jones, department chair and professor of philosophy at the University of Alabama in Huntsville. https://aeon.co/ideas/at-times-of-suffering-the-greatest-gift-is-accompaniment-by-another

Jones writes about the issues that often accompany suffering: ‘despair, dissonance and desolation: despair as hopes for the future confront the inevitability of fate; dissonance between an imagined future and present reality; and the desolation of being alienated and isolated when others withdraw.’ We want so badly to solve the problem, and console the suffering person that we find it hard simply to listen without interfering. Indeed, their despair can become our own.

A remedy he suggests -if that’s an appropriate word to use- is one of ‘accompaniment’, and his way of illustrating the process is, in itself, helpful and imaginative. ‘In music, the accompaniment is the musical part that supports the melody or main themes of a musical performance, as when an organist or guitarist accompanies a choir, or a drummer and bass player accompany a lead singer… accompanying another involves lending support to the other in ways that amplify or strengthen their efforts… accompaniment aims to acknowledge and engage with the efforts of another – not for the sake of helping the other achieve some goal that’s impossible to achieve on one’s own, but for the sake of enriching, and making manifest the value of, the other’s efforts.’

So, ‘To accompany another is to give companionship against despair… one who accompanies offers consolation, being with another in their solitude by creating opportunities for testimony, listening and hearing without judgment, and reinforcing the other’s dignity by acknowledging their experience and struggle.’

There’s something about that which strikes a chord, don’t you think? There are times when we need to recognize that not everything can be solved -an exceptionally difficult concept to accept. But, it’s important to embrace a truth the other knows all too well, and in so doing, embrace them. Indeed, ‘It succeeds not by resolving problems but by aligning with the other – experiencing the other’s suffering in common, allowing the other’s struggle to matter.’

I learned something about that in my early years of medical training when, as a third year medical student, I was assigned to the gerontology ward of a general hospital. In fact, it was a sort of bribe, I suspect: in turn for doing entrance physical exams and handling the nighttime preliminary calls by the nurses for the elderly patients, I was given free room and board.

There wasn’t really that much to it, so I spent a lot of time reading, and talking to the patients. One patient in particular, still stands out in my memory, however. Jane was a 94 year old, frail looking woman who always seemed to have her wheelchair placed near a window overlooking a little park in front of the hospital. Loosely strapped in the seat so she wouldn’t fall out when her head occasionally fell forward in a medication-enhanced somnolence, she never seemed to bother with any of the other patients who talked to each other while similarly positioned by the same window.

I was new to gerontology, and, apart from my recently retired parents, I had never before had much interaction with the elderly, so I wandered over to talk to her. I have to say I was a little unnerved by the thinness of her skin, the sparsity of the spiderweb hair remaining on her scalp, and the degree to which her cheekbones were so prominently on display. She kept grinding her gums together, almost as if her tongue was searching for some teeth and she barely looked at me as I pulled up a chair beside her.

“Hi,” I started, a little nervous about how to talk with someone so old. “My name is G -well anyway, that’s what everybody calls me- and I’m the medical student assigned to your ward…”

She turned enough to allow me into her head through two large rheumy eyes that rotated in their sockets as easily as well-greased ball bearings. A tentative smile appeared briefly on her thin lips, and then quickly disappeared. “How do you do?” she answered -rather formally, I thought. “My name is Jane… Did they send you over here to cheer me up?” she added, as if it was what the nurses did if they remembered.

I shrugged, rather embarrassed at the thought that I had been sent on an errand. “No… I’ve just seen you sitting here day after day, and thought I’d introduce myself.”

She studied my face for a moment and then blinked. “I thought perhaps they sent you to convince me to take some more of their pills.”

I wasn’t sure what to say to that -I was just learning to be a doctor. “Pills for what, Jane?”

Her face relaxed into another brief smile, and she looked away again. “Cancer, and pain, mostly…”

“So… Are you not taking them?”

“Sometimes -when the pain gets too bad, I relent a bit.”

“But…”

Her smile broadened and she finally turned her head to look right at me. “But you can’t convince me, G.”

I was confused. “But why don’t you take them?”

She sighed and her eyes softened as she tried to decipher my question. “I’m 94 years old,” she started, her voice soft and confident. “And I’ve had a good life. There’s no cure for Age, nor is there a cure for my cancer. The pills just make me miserable…”

“Are there no other pills they could try?” I was trying to make sense of her rebellion and she must have seen that.

Like two little birds, she sent her eyes to slowly circle my face before she allowed them to rest on my cheeks. I could tell she was trying to read my expression. I must have looked puzzled, because she reached over and grasped my hand to reassure me.

“I’m sure this is hard for a young doctor like you to understand, but I don’t fear Death…” she said, smiling at the notion. “…No more than I fear Life at any rate,” she added.

The idea of accepting death was new to me, and I suppose it showed on my face because she squeezed my hand more strongly this time.

“None of us can live forever, Dr. G. Life’s not a battle we have to keep on fighting… Eventually, we’re allowed to walk away if we want.”

I smiled and stroked her fingers with my hand. It was her eyes that smiled at me in response.

Thinking back to that time, I realized I had learned something they’d never covered in my lectures. Of course, Jones was right in his essay about the value of accompaniment, but I have to wonder if it was Jane who was actually accompanying me…