The Obstetrical Celibate

Celibacy seems so counterintuitive and aberrant to me that I’m constantly amazed how close to the surface it seems to float. Its etymology comes from a Latin word meaning ‘unmarried’ and that, in turn, is an amalgam of two proto-Indo-European words meaning ‘to live alone’, but its exact definition seems contextually influenced. For example, despite the fact that it is not the exclusive prerogative of one sex, we tend think of male Catholic priests as the prime examples, even though nuns –their female counterparts- also live a celibate life.  It is also variably regarded as being either the condition of living alone and being sexually abstinent, or merely sexually abstinent. In the Catholic church, although it was only mandated for priests in 1130 A.D., it included both lack of partner and sexual gratification of any kind.

Celibacy is usually seen in a religious context, but it need not be. A more contemporary view tends to focus on the sexual abstinence aspect or on the lack of a regular partner. It may be a temporary phenomenon and not one that is intended to be pursued, or a lifestyle choice. It is seldom related to the condition of asexuality in which the reason for the abstinence is one of indifference or lack of sexual drive –as I have discussed in a previous essay: https://musingsonwomenshealth.wordpress.com/2014/07/03/the-asexual/

Now I don’t wish to sound so dismissive as to reject the concept of celibacy out of hand. We all make decisions based on our wants and needs, often guided by doctrines or beliefs which make sense to us at the time. In a free and open society, what the rest of us may think of the decisions should be of little consequence so long as adhering to them has no adverse effects on any except the participants. Witness the spate of publicity surrounding the late Pope John Paul II and his relationship with the married Polish-born philosopher Anna-Teresa Tymieniecka, before and during his papacy: http://www.bbc.com/news/magazine-35552997  That a very human side was able to successfully coexist with his deeply religious beliefs is both touching and laudable –especially in a pope.

But this prologue was by way of an introduction to Ann, a patient of mine shortly before I retired.

As she sat in my office that first time, she seemed unusually nervous. She had short brown hair and was smartly dressed in a white blouse and grey pant suit. Ann seemed the perfect model of a corporate executive on her lunch break –which indeed she was. But she was perched bolt upright on the edge of her chair like a bird about to launch from a branch. Her face was taut and unnaturally shiny; her lips were frozen in a straight line as if she were trying, unsuccessfully, to fabricate a smile. Only her eyes betrayed a profound mistrust, bordering on aggression.

“You seem rather nervous, Ann,” I said with a smile of my own to break the ice.

She nodded politely, but remained silent. Only her proximity to the edge of her chair changed. I wondered how long she’d be able to stay balanced on it.

I have to say that the laptop screen on my desk is a wonderful tool. It not only provides me with information –consult letters, lab data, and so on- it also gives me something to hide behind when the patient has sent her eyes on a predatory mission. It is a type of blind, I suppose. I pulled up the consultation note from her GP on the screen more for something to do than for information –the day sheet from my secretary had already disclosed the secret: Ann was pregnant.

The note from the GP was rather terse I thought: ‘Pregnant. Angry’. I took a deep, albeit disguised, breath and peeked out from behind the screen. “So, your family doctor says you are pregnant, Ann. Congratulations!” This initial praise for the achievement usually disarms patients -well, confuses them, anyway. But it did nothing to Ann but harden her expression. She mouthed the obligatory ‘thank you’ silently and with barely a movement of her lips. This wasn’t the easiest consultation I’d ever been sent.

I decided to be more direct. “Are you angry about being pregnant, Ann? Or are you angry with me?”

That obviously caught her by surprise, because she suddenly dropped her eyes onto the table –her armour had been chinked.

Then, she broke her fast of silence. “Doctor, I have to explain something to you,” she said, slowly and disdainfully, again with lips that barely moved. I began to wonder if they’d been botoxed, or something. “I am 37 years old, unmarried, and unattached!” She said the last word carefully and slowly, lest I misunderstand. I could feel the exclamation mark from right across my desk. “Further, I am not in a lesbian relationship, nor am I ever intending to be dependent upon a partner for assistance.”

At this point her face actually narrowed and I could sense its muscles trying to avoid spasm. She liberated the predatory falcons of her eyes once again. “I am a celibate by choice, not necessity, doctor,” she said, this time between obviously clenched teeth. “My career is paramount…”

Her minute pause emboldened me to ask the obvious: “And the pregnancy isn’t…?”

It was not intended to be a profound rejoinder, merely an question, but her eyebrows immediately jumped up as she recalled the falcons to their home roost. They watched me from the shadows of their cage as her face gradually softened. An embarrassed smile crept slowly across the once angry lips and I thought I even detected a blush.

“I’m sorry, doctor,” she said, after a rather reluctant sigh. “It’s just that the men at work have been giving me a hard time.” She stared up at a picture hanging on the wall for a moment. “Word somehow got out that I was considering becoming pregnant…” She closed her eyes briefly to decide how to explain. “Men don’t seem to understand that…” She glanced at me quickly, and then corrected herself. “Many people –not just men- don’t seem to understand that wanting a baby is not the same as wanting sex, or a partner, or even a calculated one-night stand.” She retreated inside herself again to pick the words she wanted. “I don’t hate men, and I don’t disparage relationships, I have simply chosen to live my life differently from most: a celibate life…”

She took a deep and stertorous breath before continuing. “You wouldn’t believe the whispering in my office when the rumour spread that I was going to pay for IVF when there were so many willing donors around… The men would wink suggestively whenever I passed by, the women would get that silly smile on their faces…

“Anyway, I decided to take a few weeks off for the in vitro fertilization process, only half expecting it to succeed on the first cycle. But when it did, I didn’t know if I could stand the censure that most men would exhibit when they hear that I did it voluntarily -in other words, without them.” She shrugged and looked out of the window behind me for a minute or two. “So, I asked my GP if she knew of any female obstetricians she could send me to, but for some reason she chose you.

I hate this kind of situation –being blamed for something over which I have no control. A false negative, as it were. I linked eyes with her for a moment. “Sorry,” I said, smiling innocently. “I can probably find you a female Ob if you’d like.”

She sat back in her chair and thought about it. It almost felt like I was at a job interview and my CV was being inspected. After a few seconds, she smiled –warmly, for a change- and sent out her eyes again –this time rather than circling for a kill, however, they perched softly on my face. “After all that anger, would you still be willing to see an obstetrical celibate?”

I nodded. “I’ve always been nonpartisan.”

Have Hypnosis, May Travel…

“You want me to do what?”

Janet’s smile never waivered; it broadened if anything. “Hypnotize my friend.”

I rolled my eyes in a maudlin attempt to emphasize my frustration at her answer. “But your friend is a male, Janet…”

She blinked slowly –her version of an eye-roll, no doubt. “Given that you are as well, I don’t see an ethical problem.”

“I’m an obstetrician, Janet. By definition, we see females. We have nothing against males; we just don’t see them as patients.”

She shifted slightly in her chair, as if this would somehow work to her advantage in the discussion. We were sitting in the hospital cafeteria by a window that mirrored the whole room in the early morning darkness. Neither of us could be mistaken for fashionable in our rumpled scrubs that still bore traces of an emergency Caesarian section.

Now a freshly minted GP, Janet had been present at a class of residents I had been assigned to teach a few years ago. I don’t even remember what I had intended to talk about, but they had taken a vote before I arrived and decided the topic would be hypnosis. I had made the mistake in a previous class of regaling them with tales of my adventures in using it to treat hyperemesis gravidarum – nausea and vomiting in pregnancy. Unfortunately I agreed and promptly managed to hypnotize myself in attempting to demonstrate it with a volunteer using a little cut-glass pendant necklace I borrowed from the student. They loved it.

“You could see him at the end of the day, if that would make it easier for your waiting room.”

I took a deep breath and let it out slowly, but noisily for effect. “Janet, you don’t seem to understand. In the Canadian medical system, we get paid a fee-for-service amount for specific items in our specialty. There are no items in it for men.”

She thought about it for a moment. “Okay, suppose I refer his female friend to you and he just happens to come with her?”

I shook my head.

“He’s willing to pay privately…”

I shook my head again, but less vigorously. I’ve never liked the idea of paying privately for medical services; it smacks of privilege. Of jumping the queue. “You still haven’t told me why he needs the hypnosis so badly. Is he a smoker, or something?”

Her turn to shake her head. “Death!”

My eyes went wide; I couldn’t stop them. “I don’t do Death, Janet.” I considered that response for a moment. “I mean, we’re all going to die…”

She smiled -a thin, made-up, wan sort of lip stretch- and turned on her eyes. “Not like he figures.”

I didn’t like where this was going. In a specialty that deals mainly with new life, I’ve always felt uncomfortable with the other end. “What sort of illness does he have?”

Her smile brightened and her eyes twinkled. “Politics.”

I decided to look at her reflection in the window; it seemed safer, somehow. “I just know that you’re going to explain.”

“He asked me not to.”

My eyes involuntarily sought the source. “Too dangerous?” I was getting into this now.

She nodded, but mischievously. Playfully.

“And might this be… foreign politics?” I asked, attemping to make my voice serious.

She tried to keep her expression the same, but I could see little microscopic worry lines beginning to gather on her forehead. “Well, his sexual orientation is domestic…”

What did that mean? Janet was exasperating and I was tired, but she still pulled out the big gun: “Look, will you do this as a favour for me?”

I stared into my empty cardboard coffee cup for a moment. “Well, make sure he brings his partner…I’ll figure out some condition for her so he doesn’t have to pay.” I thought about it for a moment. “Maybe infertility…”

“That’ll work,” she said, but her eyes were much too twinkly for me to ignore.

“Something else you’re not telling me Janet?”

She shrugged. “He’s gay.”

I shrugged back and smiled. I love twists like this. We had an understanding, however –but an agreement that I, for one at least, did not understand.

*

He seemed quite at ease in my waiting room. A short, ebony man with a shiny bald head that reflected the flickering of one of the flourescent lights above him, he was dressed in a dark suit and grey-blue tie. A similarly well-dressed woman sat beside him, quietly reading a magazine from the table in front of them while he smiled and studied the room like a text book.

“Come in Jonathan and…”

“Flora,” he responded in a deep sonorous voice that seemed to fill the room. She smiled and took his hand. The perfect couple.

I led them into my office and seated him in the least-uncomfortable chair somewhat guiltily. But he smiled disarmingly and accepted. Then he nodded to her and she touched his sleeve and left the room. “It is best she leave,” he said softly. “The less she knows…” he added, and the unfinished sentence hung in the air like the sword of Damocles.

And then… nothing. I felt unaccountably nervous and neither of us spoke. He just watched me for a moment and then closed his eyes. “You may proceed, doctor,” he said after a few seconds. “Teach me how to hypnotize myself.”

I took a deep breath to steel myself. I felt like a child chosen at random by the teacher to come and write something on the blackboard in front of the class. “Well, first I need to know a few things, Jonathan. Janet said you’d explain,” I said with as much courage as I could muster.

His eyes suddenly opened and he stared at me like a lion who’d spotted a zebra on the plain.

“Different problems require different solutions,” I lied, and then shrugged in what I hoped was a take it or leave it gesture.

A smile spread slowly over his face, but it was a condescending expression, a bored acquiescence -the smile of a king. “I am running for office in my country,” he said in a booming voice that managed to be soft, yet vibrate the leaves of the plant on my desk at the same time.

I nodded to encourage him further, but I suppose he assumed he had given me what I had requested and he closed his eyes once more. Waiting.

I tried again. “So you need hypnosis to..?” I’ve never been good at unfinished sentences. They always sound like I’ve just forgotten what I intended to say. When his face looked like he’d fallen asleep I thought I’d better finish it. “…To help you to relax when you have to make a speech in front of a large crowd?” That sounded reasonable; I’m afflicted with acute amnesia and random mispronounciations whenever I am asked to speak at a meeting.

Still nothing. Maybe he really had fallen asleep. I decided it deserved one last try, and then I would wake him up if I had to. “What is it that worries you about running for election in your country?” I said, even though I hadn’t the faintest idea what country it was. And he certainly didn’t look worried.

Then, from the depths of his chest, a regal whisper: “Death threats.”

“Oh…” I didn’t know what else to say.

I taught him to hypnotize himself -and it seemed to work. Then for weeks after he left, I scanned the newspapers for foreign political assassinations, but without knowing the country or the office he was running for, it was all to no avail. You’d be amazed at just how many people are getting shot at political rallies around the world. And Janet was no help; she was sworn to secrecy or something.

But I can’t help wondering if it actually worked. Did the hypnosis lull him into accepting danger, or allow him to rationalize his way out of it entirely? There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy… And if he did get shot in that unknown country, would would he still thank me for the lesson if he survived? Or is he angry..?

As for me, I’m much more careful where I go when I travel. Just in case…

 

 

 

 

 

 

 

 

 

 

The Mystery of Pain

Obstetricians and midwives are, at times, unavoidable witnesses to pain; they wade through it, explain it, try to alleviate it, but never experience it because the physical sensation of pain cannot be transferred to anyone else. It is the one constant attendant in the labour room, the uninvited guest that, welcome or not, arrives early and departs late. It is the ghost in the room, invisible to all but the patient. Unsharable. Unprovable. Indescribable except by metaphor, analogy – it is like something: a drill, a knife, a pressure… We all realize it is there -but there, not here. We do not share in the pain; we have to believe it exists because we are told it does. It is not an objective thing, pain; it is entirely subjective –an owned phenomenon.

In a way, pain has no voice. As Virginia Woolf put it [and here I will use Elaine Scarry’s paraphrase and elsewhere, quotations from her extremely helpful book The Body in Pain]: “Physical pain does not simply resist language but actively destroys it, bringing about an immediate reversion to a state anterior to language, to the sounds and cries a human being makes before language is learned.”

It is a cruel proof of the Theory of Mind: although I realize that you may have different thoughts and feelings from what is in my head, I can only guess what they are; I can never know what they are. Scarry again: “For the person whose pain it is, it is effortlessly grasped (that is, even with the most heroic effort it cannot not be grasped); while for the person outside the sufferer’s body, what is “effortless” is not grasping it (it is easy to remain wholly unaware of its existence; even with effort, one may remain in doubt about its existence …).” And indeed, “… if with the best effort of sustained attention one successfully apprehends it, the aversiveness of the ‘it’ one apprehends will only be a shadowy fraction of the actual ‘it’”.

We can only know something of what the other person is feeling if they can verbalize a suitable metaphor that we all can understand. And given the difficulty of descriptions in the setting of ongoing pain, these can be hard to find, let alone verbalize. Pain Clinics will often use aids such as the McGill Pain Questionnaire that suggest words that do other than merely measure intensity: moderate, severe, or number on a scale of ten, for example. So their vocabulary offers a choice of qualitative descriptions as well as quantitative.

But for most of us following a woman in labour, such questionnaires are unhelpful -and except for the vocabulary, almost useless, in fact. We are still left standing on the outside, trying to sense the existence of something we do not apprehend. It is not like Nietzsche calling his pain ‘Dog’ and saying “it is just as faithful, just as obtrusive and shameless, just as entertaining, just as clever as any other dog –and I can scold it and vent my bad mood on it …” For us, the attendants, this is sophistry.

Pain –the verbal reaction to pain, at any rate- seems to have different ways of expression in different languages, different cultures, even different geographical regions. As Scarry notes: “… a particular constellation of sounds or words that make it possible to register alterations in the felt-experience of pain in one language may have no equivalent in a second language.” And yet it is really all about the same thing, and serves to “… confirm the universal sameness of the central problem, a problem that originates much less in the inflexibility of any one language or in the shyness of any one culture than in the utter rigidity of pain itself: its resistance to language is not simply one of its incidental or accidental attributes but is essential to what it is.”

Empathy, which is as close as an outsider can get to the pain experienced, will have to suffice. Or -far better phrased- Shakespeare’s opinion:

A wretched soul, bruised with adversity,

We bid be quiet when we hear it cry;

But were we burdened with like weight of pain,

As much or more we should ourselves complain.

I suppose it is the ‘why’ of some types of pain that is so puzzling. The etymological root of the word itself is poena: punishment. In the end, is that really what it is: nothing more than an  arbitrary abuse meted out by a blind and indifferent Nature?  We may understand the physiology of pain, the biochemical irritants that cause it, the nerve fibers that fire in response; we may even postulate the evolutionary protective purposes it sometimes purports to serve, and yet… And yet we are still left wondering about more than the physical nature of pain. As Scarry says: “… when one speaks about ‘one’s own physical pain’ and about ‘another person’s physical pain,’ one might almost appear to be speaking about two wholly distinct orders of events… Thus pain comes unsharably into our midst as at once that which cannot be denied and that which cannot be confirmed.”

It is a relief to find that I am not the only one who finds these disparate aspects of pain to be numinous -and the ‘why’ of pain as elusive to others as it is to myself. If the only way to describe one’s own pain, as I have already mentioned, is through metaphor, perhaps the only way to understand pain, then, is also through metaphor. Story. Literature.

Nietzsche once again: “Only great pain, the long, slow pain that takes its time… compels us to descend to our ultimate depths… I doubt that such pain makes us “better”; but I know it makes us more profound… In the end, lest what is most important remain unsaid: from such abysses, from such severe sickness, one returns newborn, having shed one’s skin… with merrier senses, with a second dangerous innocence in joy, more childlike and yet a hundred times subtler than one has ever been before.”

I do not understand Pain, but I do not discount it. I will merely rest my discomfort on another of Shakespeare’s observations: that maybe “Pain pays the income of each precious thing.” It’s a start anyway…