Tis in ourselves that we are thus or thus

I must have learned a bit about phenomenology in Philosophy courses at university, but except for the fact that it has something to do with lived experience and consciousness, I have pretty well forgotten almost everything about it in the intervening years, I’m afraid. The name alone was enough for it to merit a place of its own in a dark corner of a barely reachable shelf inside my brain somewhere. Strange names like Husserl and Heidegger stand guard, but in all that time, they were relatively undisturbed by any neuronal probes -any interest whatsoever, in fact.

And now, in my yellow leaf, I’ve stumbled upon it once again, but this time in the context of health, ironically. Given that phenomenology purports to concern itself with experience, and nurses would like -and in fact, need– to understand the subjective experience of those under their care, it seems like a good, if somewhat awkward fit I suppose.

After more than 40 years in Medicine myself (as a specialist in Ob/Gyn) I recognize that it would be an advantage for all of us who deal with people with health needs, to understand how those individuals experience their worlds. But an essay written by Dan Zahavi, a professor of philosophy at both Oxford and the University of Copenhagen helped me to realize how nurses, especially, might benefit by looking at it from a more phenomenological perspective: https://aeon.co/essays/how-can-phenomenology-help-nurses-care-for-their-patients

‘By being interested in patient experience and striving to understand people’s experiences of health, illness and care, the discipline of nursing might have more affinities with the social sciences and its qualitative methods than with medicine and its reliance on the quantitative methods of the natural sciences. Indeed, if the aim is to provide proper care for, say, stroke patients, or patients with diabetes or Alzheimer’s disease, it is important to have some understanding of what it is like, subjectively, to live with such conditions, just as it is important to understand the meaning that patients attach to the events that disrupt their lives.’

This is not to diminish the role of Medicine in any way, but merely to suggest that Nursing and Medicine each have complementary roles in the provision of care. After all, ‘This focus on patient experience isn’t simply about monitoring (and increasing) patient satisfaction. It is about obtaining information that will allow for more adequate healthcare… one reason why nursing science became interested in phenomenology was precisely because the latter was seen as a resource that could bridge the gap between research and practice… It might, in short, help to ensure that the academic field of nursing research actually led to an improvement of nursing practice.’ Medical practice as well, but for now, let’s stick with Nursing.

The issue, however, is not to become too entangled with the competing nuances of the various philosophical movements that call Phenomenology home. Does it really matter, for example, that the philosopher Heidegger stressed ‘the ontological difference, inauthenticity, solicitude, average everydayness, thrownness and fallenness’ -whatever in the world that means? Or that  Jonathan Smith (a psychologist) ‘has argued that his own approach, which is called Interpretative Phenomenological Analysis (IPA), is phenomenological because it seeks to ‘explore the participant’s view of the world and to adopt, as far as is possible, an “insider’s perspective” of the phenomenon under study’?

How about Max Van Manen distinguishing ‘what he calls the heuristic, hermeneutic, experiential, methodological, eidetic, ontological, ethical, radical and originary reduction as important elements of the phenomenological method’? I mean, come on, eh?

As Zahavi sees it, ‘nursing research’s current use of phenomenology faces three challenges: it risks being too superficial by mistakenly thinking that phenomenology is simply about paying attention to experience; it risks being too philosophical by employing too many theoretical concepts with little clinical relevance; and it risks being misled by misguided methodological requirements.’

But, shouldn’t it be enough to extract what value you find in viewing the world from the point of view of the person under your care -call it what you will? A balance, please: a just-right-baby-bear, Goldilockean approach would do just fine, thank you.

As a now-retired doctor, I have worked with nurses all my career; we have always worked as a team, each with subtly overlapping roles, and yet I blush to admit that it wasn’t until I required a minor surgical procedure that I truly appreciated the difference.

One cold night, as I lay in bed with the covers pulled up to my chin for warmth, I noticed some lumps in my neck. Subsequent specialist medical consultation did little to reassure me -despite the delicacy and empathy with which the differential diagnosis was outlined for me. To further clarify whether the lumps were indeed malignant, as the consultant expected -and if so, their origin- a surgical biopsy would be required.

A speedy diagnosis was deemed essential so that treatment, if necessary, could be started as soon as possible. But there was apparently no expeditiously suitable time available in the operating theatre, so the consultant surgeon agreed to do it under local anaesthetic in the outpatient department of the hospital within the next day or so. That was fine with me -I just wanted a diagnosis.

What I hadn’t anticipated, however, was just how very anxious I would feel as I lay in one of the same rooms -and maybe on the same table- where I had performed many of the gynaecological procedures so common in my own practice. I knew the surgeon, and we talked pleasantly enough about our lives, and how often our specialties intersected. I knew he was trying to be empathetic and set me at ease, but we both realized there was an unbridgeable gap that separated us now, no matter the care we both took to disguise it: I was the patient -and not just a colleague. It’s difficult enough to be a patient, but perhaps even more so when the roles are suddenly reversed.

I knew the nurse in the room, of course -she had helped me on many occasions with the procedures I had booked in the department. But that day, her eyes were seldom far from mine, even though she was helping the surgeon set up some of his equipment. I could sense her concern whenever our eyes met -she’d always been attentive when she’d helped me before, and yet it was subtly different this time: she was dividing her attention between helping the surgeon and making sure I was okay.

But I wasn’t; I was terrified, although I tried my best to disguise it. Even though the local anaesthetic was working, I could still imagine what the surgeon was doing because of the subtle pressure changes I could feel on the skin distant from the lumps -you can’t freeze an entire neck. I tried not to tense any muscles in the area, but I suppose panic was starting to set in…

Suddenly, there it was: a hand gently grasping mine. The warmth of it, skin to skin, was soothing, reassuring, and although I couldn’t turn my head to look, I knew it was the nurse. I also realized she was aware of what I was going through –she had been all along, I sensed. She was living it herself in a way.

Until that moment, I don’t think I really understood the true value of rapport in caring for people. Of course I often used touch to reach out and connect with others in my own practice: on morning hospital visits to my patients after surgery or with new mothers and the babies I had helped deliver, and frequently in the office just to show anxious and fearful patients that I was listening and would try to help… That I wasn’t just a voice from the door, or on the other side of the desk.

And yet, that reassuring hand during the biopsy taught me something else: that there is more to compassion than a reassuring smile, more than just an offer of help. Care involves trying to understand what the other person is going through, and guiding them thoughtfully and kindly along the way. We can probably never really know the pain of another, but we can let them know we are trying.

If that is what Phenomenology offers, then by any other name, it would smell as sweet…