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…

Such Sweet Sorrow

I kind of figured sugar would sneak back. It always does! Just when you think it should be terminally ashamed of the stuff it’s done, it shows up as somebody else and fools everybody. I mean, forget trying to pretend that you don’t recognize it in a crowd, that you can’t see under its mask. Sugar is, well, sugar, eh? No matter how it tries to sweet-talk its way around you, it is what it does. Period.

But what is that? Apart from fuelling our atavistic requirements for easily assimilable energy, and therefore surviving early Darwinian whittling, I’ve often wondered if there’s more to sugar than meets the tongue. It has too large a presence in our world to be confined to pleasure alone. Almost every organism seems drawn to it. Should this be telling us something?

Every once in a while my overweening, but naïve hunches are rewarded with information that addresses much the same issues but in ways I hadn’t considered: http://www.bbc.com/future/story/20180328-how-sugar-could-help-heal-wounds?

Moses Murandu is a man who grew up in the rural Easter Highlands of Zimbabwe, and later moved to England to work in its National Health System. ‘A senior lecturer in adult nursing at the University of Wolverhampton, Murandu completed an initial pilot study focussed on sugar’s applications in wound healing and won an award from the Journal of Wound Care in March 2018 for his work. […] To treat a wound with sugar, all you do, Murandu says, is pour the sugar on the wound and apply a bandage on top. The granules soak up any moisture that allows bacteria to thrive. Without the bacteria, the wound heals more quickly.

‘In some parts of the world, this procedure could be key because people cannot afford antibiotics. But there is interest in the UK, too, since once a wound is infected, it sometimes won’t respond to antibiotics. […] And a growing collection of case studies from around the world has supported Murandu’s findings, including examples of successful sugar treatments on wounds containing bacteria resistant to antibiotics.’

Well, it’s safe to say that I don’t know how much sugars will contribute to our health and well-being, but they do serve as a reminder that western science is not the sole guardian of knowledge. Or wisdom. Answers are not rare -they are lying around everywhere just waiting for the right questions to discover them. The right curiosity. And we run a risk dismissing traditional enlightenment -folk wisdom- out of hand.

The problem, as I see it, is one of attribution. The credibility we assign each source should be determined by the results of testing its hypothesis, finding the appropriate question to interrogate whatever is proposed as an answer. Finding the key that fits the lock… And the thesis investigated does not have to be of mind-bending importance; science is not the exclusive purview of people in white coats. Nor those of a certain age…

I recently happened upon a Tim Horton’s café in close approximation to a message from my stomach that it needed both a coffee and a bagel. Not being in the mood to argue, I decided to accede, although my loyalties normally lie with Starbucks. I had been wrestling with the question of habit on my walk –my strange unwillingness to explore new ground, consider new sources. Tim’s could be the answer waiting for the question.

Science, if it be considered from the inductive perspective, I reasoned, required the inference of laws from particular instances -answers from the right questions. In other words, Propose, Test, and then validate or refute. It isn’t enough to simply assume…

I had chosen a busy time unfortunately, and I was lucky to find a single table in a corner by the window. It was squeezed between a group of elderly women crowded around a larger table busy consuming their donuts and politely slurping their coffees, and a small table like mine occupied by a harried looking mother trying to bottle-feed a squirming, unhappy baby in her arms and a young boy busily kicking the legs of his chair.

The elders were surprisingly quiet, but not the little boy, so my ears naturally focussed on him.

“Why can’t we go, Mommy?” he kept asking.

I could tell his mother had almost reached the end of her tether, and she stared at him crossly, determined not to interrupt the feeding. “Because I’m still feeding Janny, Tim,” she replied, tensely. “She’s really hungry.”

The boy tilted his head curiously. “She’s squiggling around; she’s not even sucking…”

At that point the baby began to cry even louder-scream, actually- so the mother put the bottle on the table and positioned the baby on her shoulder to burp it.

But Tim still looked puzzled. “But she doesn’t like the bottle, Mommy,” he said, as if his mother should have noticed by now.

His mother shrugged, almost in tears. “I know, Timmy, but you were hungry too, remember? That’s why we came in here instead of going back to the car.”

Tim sat back in his chair for a moment to process the problem. “Well, why don’t you let Janny suck your breasts?” he said, in the rather loud voice of a four year old.

I could see his mother blush as soon as he said it, but Timmy had merely proposed a tentative hypothesis that could easily by tested to see if he had asked the right question, and his face was as innocent as a new nappy.

His mother leaned over the table with Janny so she could show Tim that they could talk quietly about it. “I would if we were sitting in the car…” she said, but he continued to stare at her, still puzzled. “And the car is still a long way away, Timmy.”

Tim leaned over the table like his mother. “Why can’t you breast her here?” he asked innocently.

She smiled and glanced around the room, embarrassed. “Some people don’t like to see mothers breast feed their babies in public.” She tried to whisper but Janny was really screaming now. She glanced at the washroom, no doubt wondering if she could feed her baby in there, but it must have been a small room, because there was already a line of needy hopefuls that had formed at the door

Tim smiled as if he knew how to solve the problem with his initial hypothesis, and he leaned towards me on his chair. “Hey mister,” he said in his best, grown-up voice, “Do you mind if Mommy breasts Janny in here?”

His mother was now beet red, and she glared at her little son and then attempted to smile at me. “I… I’m sorry…I…” But she was too embarrassed to continue.

“I don’t mind at all,” I said, trying to reassure her with a reciprocal smile. “You can use my jacket to cover yourself, if that would help…” I said, beginning to take off my jacket.

One of the elderly women at the next table leaned over and gave a thumbs-up to the frazzled mother. “We’ve all been there, dear,” she said and winked before she turned back to inspect her plate for donut remnants.

I handed the mother my jacket and the baby settled into the welcoming breast somewhere underneath. Propose, test, validate…

I added some extra sugar to my coffee, and settled back in my chair to celebrate the triumph of citizen science that even a child could perform. It’s just a matter of finding the right question, after all…