When Silence is Golden

Silence is golden; it can also be difficult. Many of us find it uncomfortable -awkward if it continues for too long. In communication, silence is a benefit that diminishes with time, a value that becomes a penalty. A schism that is counterproductive.

We all want to be heard; we all need to be recognized, and yet that acknowledgment requires reciprocation. Otherwise, we might as well talk to a wall. Listening is not just silence; it is attending.  Listening is not the same as merely being in the same room.

A doctor is often called upon to be a multifaceted creature: she must first be sensitive to her patient’s concerns, and attentive to the sometimes lengthy explanation. She must demonstrate some empathy and understanding of the problem and yet remain calm and reassuring. Equanimity in the face of seemingly intractable issues is usually seen as a hallmark of competence. But, after a suitable time spent listening and incorporating all of the relevant symptoms into a reasonable diagnosis, it is the doctor’s turn to speak. And the art is so often in the timing.

As soon as I saw her in the waiting room, I could see she was going to be difficult. She was an older lady, probably in her late fifties, who was sitting in the corner by herself like an angry statue. Cemented to her seat, the infants crawling on the rug in front of her might as well have been ants on a lawn for all she noticed. Her face was puckered into a tense scowl, her hands were clasped into a tight, unmoving ball on the lap of her long black dress. Were it not for her short, white hair, she could have been mistaken for a shadowed monument, a memorial placed inconspicuously in the corner so as not to frighten the children.

Only her eyes betrayed her presence and they fixated on me like a hawk as soon as I entered the room.

“Gladyce?” I said walking across the carpet and trying to avoid the toddlers.

Her eyes hardened into marble slits and her face into granite. “Mrs. Ardess,” she said, italicizing the sirname through lips that barely moved. I’m surprised she could actually speak through them.

I extended my hand to introduce myself, but she barely touched it. One of my maternity patients across the room rolled her eyes.

I started to walk down the corridor to my office, expecting Gladyce to follow, but she remained seated, perhaps waiting for instructions. “Mrs. Ardess,” I said, turning to her with a smile. She sighed noisily and stood up. She seemed reluctant, though.

I indicated a seat across from my desk and waited for her to settle into it. And as I busied myself with the computer, I could feel those eyes on me again, burrowing into my skin. I returned the favour once I had opened her chart and discovered there was no referral letter.

I was about to ask her why she had been sent to see me, but before I could even open my mouth, she hardened again. “You doctors never listen, do you?” She almost spat the words through her clenched teeth. “I saw a new GP, and I told her I wanted to see a woman gynaecologist!”

This is not new to me, and certainly not an unreasonable request, but sometimes my female colleagues have longer waiting lists than me. I’ve learned not to take it personally. “There is a woman gynaecologist that works with me in the office,” I said with a slightly forced smile. “Would you like me to…”

“That’s hardly the point,” she interrupted. “I told the GP I wanted to see a woman in the first place, not waste my time being shunted around. Doctors never listen. They ask a lot of questions, but it’s like they just pick out what they want to hear from what I say and discard the rest. My first doctor didn’t even seem to understand that I was really worried.

“I told her I have an itchy red lump and that it’s in an area that is very personal. Very scary.” She scanned my face for a reaction, but I was too intent on what she was saying to react. “I’m not very sexually active anymore, so I try to be careful with my partners. You know, ask them questions, assess the risks…”

I only had time to nod before she continued. “So I was frightened that the lump was related to that… encounter.” She almost whispered the word. “It came up a few days later, so I phoned him to reassure myself again.” She softened her expression briefly and for a moment I saw a different woman. “He was so gentle with me, I didn’t really suspect he’d been lying, but I had to check. I was really worried.

“I waited a few more days thinking everything would go back to normal, but when it didn’t, I began to panic. What if it was syphilis or something? Or that HPV thing everybody’s been talking about?” Her eyes, now far from angry, fastened on my face like birds clinging to a branch. “I phoned my GP, but her receptionist said she couldn’t see me for almost a week. When I asked her to check with the doctor to see if she could fit me in sooner, I could hear them talking and laughing about it in the background.” Gladyce was silent for a second, and even unlatched her eyes from my face.

“Doctor Forster eventually came on the phone to ask me why I needed to come in so urgently… But I couldn’t convince her to change her mind. She just told me to take warm baths for a few days and if that didn’t help, to phone her back.” Suddenly Gladyce pinned me to my seat with a glare. “Dr. Forster was just too busy to listen to my concerns. I could tell she was having a bad day herself. So I managed to find another doctor –another female doctor- at a walk-in clinic.

“Maybe I chose the wrong place, but they were so busy at this one they could only see me for a few minutes.” She looked up at the ceiling for a moment. “Actually ‘see’ is probably the wrong word: the doctor never examined me. Didn’t have time, I guess. And when she asked me why I had come to the clinic, I got about two or maybe three sentences to explain and as soon as she heard the word ‘lump’ and ‘non-healing’ she began mumbling about sexually transmitted infections and grilled me on prevention. Then it was PAP smears and how necessary it was to have them regularly. Finally, she managed to segue into cancer and after hemming and knotting her face up said I needed to see a specialist. When I insisted it be a woman, she merely shrugged and said she’d try but that I needed to see whoever it was as soon as possible.

“But she obviously wasn’t listening either. No time. She had other patients to see…”

Gladyce studied me for a moment, obviously thinking about something, her eyes painting wide swaths across my face and chest. Analysing. Deciding. And then her demeanour suddenly changed and a different person emerged. I thought it might be an opportunity to ask her a few questions –finally meet her, in fact. “Well, Mrs. Ardess,” I started somewhat hesitantly, “I can see why you’ve lost some faith in us…”

“Gladyce,” she interrupted with a smile. “Call me Gladyce.”

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A Patient Named Cindy

I enjoyed Cindy (not her real name); how could I not? Short, plump, with uncertain hair of indescribable colour that was tossed on her head like a salad begging for dressing, she captured my interest the first time I saw her in the waiting room.

She was pretending to look at a magazine, all the while sneaking amused glances at the more staid and nervous patients waiting for their turns on the obstetrical pedestal. Her heavily made-up eyes whispered fashion but her dress screamed Walmart. I could see others in the room look away in embarrassment –confusion, more likely- but Cindy just smiled: a queen supremely aware of the distance between her and her court. Regally bemused at their furtive glances, she would sometimes confront the faces hiding behind their own pretended reading, inadequately camouflaged with turning pages, or pointing out a picture to a curious child.

Something about her made them uneasy. Maybe it was the hem of her sequined dress that she wore distressingly close to the edge of her more brightly coloured panties. Or the tattoos on her legs that stretched ever upwards even beyond the hem. But I suspect it was that she knew they were looking and didn’t care. Relished the attention, actually…

And yet the attention her clothes seemed to invite was as unimportant to her as the screen in a movie theater: you needed to stare at it, but it wasn’t really the center of your attention. It was the vehicle necessary for you to appreciate the show. And Cindy knew she was the show.

It was hard to be formal with her –she was so… out there. She did not invite –she would not permit– the usual power pyramid so rampant in a medical office: she was Cindy, and I was the doctor –with a small ‘d’. She needed advice, and I was its purveyor. Period. If she needed shoes, or a dress, she would have gone somewhere else. I was merely the seller of medical suggestions; she could pick and choose from the assortment offered.

When she sat in the chair by my desk that first time –provocatively again, over-revealingly again- she stared at me for a moment, probably wondering if I would react. But I only smiled, kept my eyes riveted on her eyes, and asked her why she had been referred.

A hint of a smile touched her face briefly and then immediately exploded into a delightful and disarming laugh. “Guys never know where to look when I sit like this,” she said, adjusting her posture to a more socially acceptable form and sliding her hem back down over her knees. “You can judge a man by where he puts his eyes, don’t you think?”

“And..?”

“And I suppose I can trust you,” she said with an expression that seemed older and wiser than her twenty-three years.

“Well,” I said, carefully avoiding the mine-fields she had already sprinkled around the conversation, “what can I do for you?” I thought it was the most direct way to elicit a usable response.

A smile so large it nearly split her face in two suddenly materialized. “You know, doc, your question almost makes me dizzy… It’s usually my question. The one I  have to start with as well.” I have to admit that I shifted uncomfortably in my seat. She noticed it, of course. Cindy would. She straightened politely in her chair and dropped her smile to a category B and shrugged. “Sorry. Everybody says I’m a bit direct. I think it goes with the job.”

“Which is?” I asked when I recovered a bit of my usual equanimity.

The smile turned wicked. Naughty. “I’m a hooker.” She thought about the word for the briefest of moments and then added: “Well, actually I usually use the word ‘escort’ but I figured you’d see through that right away. Most men don’t –or at least pretend they don’t. Guys are like that –they like to pretend that you’re not doing it just for the money.” She stared at me for a moment, as if waiting for me to respond. Then she shrugged dramatically. Theatrically.

I casually picked up my pen as if I were going to write it all down and, as with everything I did, she noticed. It was almost as if she felt she could control me with her words. She did, I suppose…

“You want me to stop wasting your time and tell you why I’m here,” she said with a loud sigh and leaned forward across my desk. Normally I feel a need to protect the space on my desk –over the years it has become an extension of my authority, my personal space- but she did it so naturally, it caught me off guard. Anyway, before I could react she said “I want to have a child,” and sat back, retreating into neutral territory.

I must have looked puzzled –You couldn’t hide anything from Cindy, because she answered my expression before I had even framed a question. “Even strumpets want babies, doc.” Then she smiled at my apparent amusement with her vocabulary. “We also read sometimes…”

“Anyway, I came more just to size you up today…” She tittered at her unintended trade-talk pun. She was silent for a moment –something I came to realize was an uncommon jewel with Cindy – and then her eyes twinkled and her whole body smiled. “I think you’ll do, doc. I think I like you.” Praise indeed.

I never succeeded in helping Cindy with her infertility issues, but all the same, she became a regular distraction in the waiting room. She modified her clothes and hair styles, of course, but I had the impression they were all for the same effect. She found ‘regular’ people banal, uninteresting, and so she teased them. Goaded them, really. She seemed to relish harsh looks, and her body language spoke novels about the seating arrangements she usually provoked. She was the only relaxed one in the room, and she knew it. Loved it. Craved it, maybe.

One day, when I peeked around the corner to see if a particularly obnoxious patient had arrived, I noticed Cindy sitting in the corner seat with a heavy looking briefcase. She had placed it between her lewdly open legs, almost daring anyone to try for it. And she had an oddly satisfied look on her face.

When her turn finally came to be invited into the office, she started talking –as usual- before I could open the chart. Not that I needed a chart for her. After preliminary investigations had suggested that the reason for her failure to conceive was that her Fallopian tubes were no longer open –blocked, perhaps, by one of the many episodes of infection she had encountered in her life on the street- I had tried to refer her to an infertility clinic. She hadn’t liked their attitude after one visit, so she kept coming back to see me.

“Got something for you, doc,” she said, positively beaming. “I wrote a novel,” she said, anticipating my question. “I thought you might like to read it before it’s published,” she continued. My eyebrows must have twitched, because she immediately continued. “Yeah, one of my…friends is a publisher; we did a trade.” I didn’t ask.

But I did read it when I got home that night. It was short –fifteen chapters and more of a novella- but amazingly well-written. It didn’t surprise me – Cindy was obviously bright and a shrewd observer of mankind (I use the word advisedly). What did surprise me, however, was the subject matter: the medical system in general and me –disguised, of course- in particular.

It was a story of the life she knew best: she and her friends in the business –the violence of the street, the drugs, the john-encounters, but more poignantly the unsuccessful attempts of the women to be taken seriously. To be treated as needful humans, not occasionally-moving receptacles. Her words were street-harsh, but no less effective. Certainly no less persuasive. It was a book written from the heart, not from the mind, and this made it all the more compelling to me.

The story was one of suspicion of life outside her world. How it disappointed and disparaged the protagonist and her friends; how they mistrusted outsiders by necessity –survival was knit by acquiescence and tribe. Even in illness and need, they felt themselves alone, bereft of help from a mistrustful and unkind society whose judgments were cruel and who forced impoverished expectations of treatment on them.

Then the woman decides her need for a child is so great, and her attempts to become pregnant so unsuccessful, she needs some outside help. So she visits various clinics where the doctors don’t take her seriously. Her friends just shrug and shake their heads. Of course there’s no help out there for people like her –people like them.

But she persists and manages to get a referral to a specialist –a male specialist is all she could get, but she decides to visit him anyway. The waiting room she finds herself in is middle class and she thinks the women sitting there are so intense she is amused. Not a good sign, she figures, but she has gone this far so she is determined to persist.

When the doctor finally leads her into his office she is struck by one thing: a tall carved wooden statue of a thin native woman holding a baby. It is sitting on his desk and there is a plant beside it through which it peeks with curious eyes. And it is smiling. The carving seems to talk to her about refuge. Safety. And it comforts her. This is the man who can help her, she decides. He’d put the carving on his desk beside a beautiful plant for a reason.

And the story ends with her feeling hopeful. No, he can’t help her, although he tries. But that is the point for her: he tries. And that’s what really matters. Not the result, not the abnormal tests, not even the fact that she probably can’t have a baby. Somebody heard her cry of desperation; somebody listened. And maybe that’s what she really wanted all these years: someone who cared.

I have to admit I cried. My god, is taking notice of someone that important? Is what some of us are searching for merely to be heard? Noticed? To be distinguishable from the background?

You know she never returned to the office after that. Maybe she was too embarrassed, or maybe she had no further need, but I really hope her novel was published. And I hope the man who had promised her a voice, became one and not just another moveable shadow in her life.