The gift of accompaniment

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

The Empathy of Age

I am intrigued by the concept of empathy. Variously defined as caring, psychological identification, or even sharing another person’s feelings, it is nevertheless a quality incumbent upon those of us in the health profession in whatever capacity.

Empathy is a word that has, in some minds, become synonymous with other altruistic traits such as sympathy, compassion, or even pity, but it is broader than those -and perhaps that is what makes it so valuable -so unique as a descriptor. Sympathy, for example, is more restricted in emphasis: more of a feeling of concern for another who is in need; compassion, on the other hand is what we may feel when another requires our help –a motivator.

Empathy encompasses these, and more. I like the definition in Wikipedia: Empathy is the capacity to understand or feel what another person is experiencing from within the other person’s frame of reference.

But is empathy something like a genetic gift? Something that pushes those who possess it to self-select into the helping professions? Or is it more like courage: you don’t know if you have it until it becomes necessary?

No, apparently it can be taught –although I must say I must have missed that lecture in medical school because, along with things like ethics and cultural safety, it was an assumed quantity. If you were going to be a doctor, that meant you had it… But, like St. Thomas Aquinas’ understanding of Time, it was an entity that was only definable when you didn’t try -or the philosopher Krishnamurti’s objection to naming God, because it confined the concept…

Over the years, though, I have tried to confine it –or at least experience its various manifestations. And although these are no doubt legion, I am still thirsty. Readers of these essays have perhaps already had their fill of my insatiable insistence on the art of listening before speaking (For example: https://musingsonwomenshealth.wordpress.com/2015/06/30/when-silence-is-golden/ ) But I’m afraid there was yet another news article that caught my eye: http://www.bbc.co.uk/news/magazine-33287727  and I thought I’d try it out at the first opportunity. I’m always looking for new tricks.

Radical listening –that sounded easy. And familiar: “…be present to what’s really going on within – to the unique feelings and needs a person is experiencing at that very moment” and, in practice, “Let people have their say, hold back from interrupting and even reflect back what they’ve told you so they knew you were really listening.” Perhaps that’s what I have been doing all along, but not consciously aware of it, though. Or maybe not –maybe all doctors think they listen, but possibly what we are actually listening to is ourselves –our prepared judgements, our sure and certain feeling that we have the answers. Or, at least an answer… Science uses inductive methods: start with the data and then establish a theory that seems to fit. But maybe, despite our protestations to the contrary, we sometimes resort to a type of deductive reasoning: start with a theory and then make the data fit -or at least search around until we find some that do. Because if we don’t have an answer… what good are we?

Time for awareness. I thought I’d start with someone with a relatively common problem –a non-gendered one so I could more easily slip into their shoes, as it were. I scanned my list of patients for the day but none seemed suitable. I simply could not easily cohabit a mind filled with fibroids or endometriosis.

Loren was different. A woman with persisting hot flushes seemed initially excludable from my naïvely chosen criteria, and yet it soon became apparent that the hot flushes were a sort of proxy. She was a young looking 62 with barely a wrinkle on her face. Fashionably thin and elegantly dressed, she seemed to have ignored the years that have exiled so many others -stranded them, as it were, on a foreign, uninviting coast. No, Loren was a professor at one of the universities here in the city, and much in demand both for her human rights advocacy and her several books on the subject that seemed to be quoted whenever federal immigration policies were in the news.

“I get these hot feelings in the most unfortunate circumstances, doctor. They usually occur when I’m in a social situation where my reaction to them would be noticeable –giving a lecture, for example. Or an interview. I’ve never embarrassed easily, but if some commentator manages it, I find myself almost overwhelmed by a need to wipe my forhead –not a sign of strength.”

She paused, no doubt waiting to judge my reaction as to whether that was a common feature. Mentally rubbing my hands and determined to try my new tricks, I smiled reassuringly. “So these hot flushes occur in social situations where to acknowledge them would be awkward..?”

She nodded, and then as if she’d been given permission to speak again: “I’m worried, frankly. I never used to be like this.” She considered it briefly, and her eyes turned inward for a moment. “I’m beginning to see it as a type of physiological dementia –a sort of bodily facsimile… an early protoype of things to come…”

The thought seemed to bother her and she studied my face for a refutation. “I can see you’re worried, Loren,” I replied slowly. “I’ve never heard hot flushes described as a type of nascent dementia, though.” Good; I was proud of that succinct encapsulation of her thoughts and looked at her contentedly. This wasn’t so hard.

She sighed, but I wasn’t sure whether it was out of satisfaction at finally being heard, or frustration. “And words don’t come as easily as they used to any more. I’ve been blaming it on the hot flushes because the two seem… coeval.” She glanced at me, her eyes frightened birds huddling in their cages. “Like just now –I couldn’t think of another word that meant ‘at the same time’ quickly enough, so I substituted ‘coeval’…”

Another long pause; I wondered whether this was the time to reiterate –the word ‘regurgitate’ entered my head and I almost smiled, but her face looked so anguished I decided to go for it. “Words don’t come easily anymore –and you blame it on your hot flushes… I like the word ‘coeval’ I have to say.” I blushed at my amateurish attempt at precis this time…

She didn’t sigh this time, but I could tell her eyes were about to leave their nest. “I suppose all of us experience this after a certain age…” She diverted her attention to the picture of a peasant woman leading a horse that hung on the opposite wall. “But words have been my world, and their loss –or at least their current drying up to a trickle- terrifies me.” She continued to stare at the picture, as if the answer lay in the coloured sketch, its almost random lines a reminder of her words. Suddenly she turned to stare at me. No, to study my reaction. I could sense her dividing me into grids, mathematically precise areas for analysis. “Hormones didn’t help before… Do you think it would help to go back on them?”

It was a plea, begging for an answer. A solution. Anything to give her hope. It was going to be hard to stick with my radical listening approach… Or had I already done it? I tried to smile intelligently at her, tried to find some words to help, but like her, I was struggling. “Words…” I started hesitantly, aware that I was blushing at my sudden blank. It was like my head was an empty screen. “…don’t come easily to you anymore…” The look of frustration at my repeated attempts to incorporate her own words into my response was becoming glaringly obvious, and I could almost feel her anger. I sighed and abandoned my tactics. “Words don’t come easily to any of us after a certain age, and its not only embarrassing, it’s frightening. They are my world as well –they’ve been what have defined me not only as an explicator of the arcane, but also as a person. Words are friends I’ve called on whenever the need arose. They’re still there, but as with you, the words that arrive in response are often friends of friends. Acquaintances from books I’ve read and long since forgotten. Clumsy words. Opaque words with only approximate relevance that people merely skip over when they hear them, thinking I’m just being clever. Metaphorical.

“And then the words, like branches floating past in a slowly moving river, make way for others –more familiar, perhaps, but moving all the same. And the conversation continues with probably only me who noticed all the substitutions…”

Loren sat back in her chair with a look of satisfaction on her face. Her eyes, caged once again, sat twinkling at me from their lairs. “You know,” she said, apparently finding her words with ease, “I should go to doctors more frequently.” And with that, she reached across the desk and squeezed my hand. “That’s all I needed to…” -a slight pause, almost unnoticeable- “assimilate…”

We looked at each other and smiled. We were of an age.