musingsonwomenshealth.com

Reflections on 40 years as a doctor in Women's Health

By trying, we can easily learn to endure adversity…


I was never much of a skier; I could do the beginner slopes and even remain upright on the occasional mogul if I followed Girard’s coaxing, but I never enjoyed the challenge like many of my friends. Girard, however, gloried in dares whether on ski slopes or in his rather eclectic social life choices. He owned a motorcycle and treated it like a movie stuntman… until he couldn’t.

He was involved in a horrendous crash with a truck on a curving coastal highway; he was thrown over the railing and down a 50 metre rocky cliff; everybody was surprised he even survived. But survive he did, and I went to visit him in the hospital as he was recovering from a series of surgeries.

I remember that he looked terrible: every bone seemed either to have a cast on it, or was in painful traction. And yet, true to form, he mounted a genuine smile for me when I walked into his room. I hadn’t seen him since his accident, and I didn’t know what to say. I mean, after an embarrassed ‘hello’ as I put the flowers I’d brought on his bedside table, I couldn’t just say he looked terrible… although he did.

I was encouraged by his smile and the twinkle in his eyes when he saw me though. He kind of jiggled the one casted arm he could move and apologized for not being able to shake my hand.

I suppose I saw his greeting as a hopeful sign, but not being able to think of anything hopeful to answer, I said, “God you’re incredible Girard! You just seem to be able to handle anything that comes along…”

His face changed briefly before he could correct it: before the smile returned. “You mean, because I’m still alive…?”

I was caught off-guard with his reply. “No…” I wasn’t sure how to answer him. “…because even if things change after the accident, you’ll still be you.”

He blinked at my discomfort. “ Really? I wonder if I’ll ever think I’m me again…”

That answer took me aback, and for some reason I’ve thought about it for years. I’m now of an age when I’m supposed to exhibit resilience: prove that although I’m Old, I haven’t left the stage yet. I suppose it has more to do with my own vanity than with what the mirror mistakenly reveals. But does resilience mean I haven’t changed, or that I’m still here despite the obstacles I’ve overcome?

In engineering, resilience has a precise meaning: how quickly a system returns to baseline after a disturbance; the resilience of ecosystems is also measured as return time to equilibrium. But in the 1970s, the ecologist C. S. Holling pushed the concept in a different direction:  ‘He argued that real ecological resilience wasn’t about snapping back, but about persistence: the capacity of a system to absorb disturbance, reorganise and continue – retaining its identity, often in a changed form.’[i]

Still, in real-life situations, ‘Part of the appeal is that calling someone resilient in the endurance sense sounds kind. It feels like encouragement rather than judgment.’ Using the word resilient ‘reassures the speaker that they’ve done their part.’ And yet surely endurance (resilience) is getting through; recovery is getting better. ‘Whereas endurance can be demanded of someone, recovery requires support. Glorifying endurance shifts attention away from systems and places expectations on to individuals.’

As the author points out, ‘In science, the whole point of a disturbance is that it changes the system. The hurricane that batters the coast doesn’t make the beach ‘resilient’ in the colloquial sense. It reshapes it, resizes it… The fire that engulfs a forest doesn’t return it to what it was – the land is reshaped, and what grows back is something new.’

And there is also something that hadn’t occurred to me:  there is  a quiet statistical trick embedded in resilience talk: survivorship bias. ‘Modern culture celebrates the people who make it through hardship and treats them as proof that the system works. Too often, we fail to count those who didn’t have the support, safety or luck to endure it at all… Modern society attributes the survivor’s status to grit, ignoring the invisible scythes – such as bad advice or simple misfortune – that harvest the rest. By focusing only on those who reached the podium, we validate a filter that selects for the fortunate and calls it excellence.’

To me, the article I’ve been quoting suggests that ‘When we call ourselves resilient, we hide the truth that growth hurts and leaves marks. We act as if nothing happened, as if experience should rinse off like sweat. But our bodies remember. Our relationships remember. Our communities remember.’ Perhaps we should stop measuring strength by how little we flinch and start measuring it by how well we heal…

Or, in the words of the author again: ‘When we tell people to be resilient, we ask them to stay the same. When we talk about recovery, we invite change. One hides pain; the other honours it. One imagines a spring snapping back; the other imagines repair through time and care…’ Or in another way of putting it, ‘resilience says ‘return’. Recovery says ‘grow’.

I only see Girard on rare occasions nowadays, even though he’s fully recovered. He walks with a pronounced limp and a cane is never very far from his seat in a restaurant. But apart from some scarring on his forehead and his head and neck restricted in their movement, his smile is still the trademark Girard smile.

The last time I saw him, though, he toughed his way through our banalities and then stared at me, the way he used to when he wanted to convince me of something: correct something he needed to get off his chest. “G, I’ve been meaning to tell you something after all these years…”

I smiled, hoping he wasn’t going to reprimand something I’d done  or said to him during his recuperative years.

“I want to tell you what it meant to me that time you visited me in the hospital right after my accident… How you tried to reassure me…”

I met his gaze and shrugged. “The flowers, you mean?” I was trying to be funny; what I felt was apprehension. Embarrassment that I’d made some sort of gaffe visiting him with flowers that time so soon after the accident.

He blinked, obviously aware of my discomfort.

“No. It was because you didn’t say I was ‘resilient’ or something -as if the worst was over, and I was showing you I could win; you also said something that meant a lot more; something none of my other friends thought to tell me…” His still scarred face relaxed and a smile resurfaced, Duchenne lines still intact. “You said that after all my bandages and casts came off I would still be me … albeit maybe a new me…!” He reached over the table with still some difficulty and took my hand. “That meant so much to me…” he said softly, as a single tear trickled down his cheek.

Mine, too…

[i] https://psyche.co/ideas/true-resilience-is-not-about-bouncing-back

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