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…

 

 

 

 

 

 

 

 

 

 

Medicine and Ideology

Some things are more definitive than others –less ambiguous, more predictable. Reliable, in other words. They lend themselves to yes-no answers, right-wrong judgements, good-bad characteristics. And some people prefer to see the world in black and white like this. Uncertainty is uncomfortable for them; they crave cognitive closure in the opinion of Arie Kruglanski, a professor of psychology at the University of Maryland.

It would seem that there are times in a life –usually inter regna, times of transition- when this eschewal of indeterminacy is more powerful: adolescence, retirement, divorce, and so on. And at those times, when everything seems unstable and unfamiliar, shelter from the maelstrom under any unmoving roof seems prudent. Rules and unequivocal, unchanging answers are tempting accessories. That something is either right or wrong can be comforting in times of stress.

One problem with this bichromatic need however, is that things are rarely static. They are continually modified by circumstance and context; the questions that need to be asked, and especially their answers, expand and mutate. They evolve over time, in other words. So, for example, that someone is, or is not pregnant, may be unambiguous and beyond dispute. But whether that pregnancy continues or miscarries, is healthy or complicated is not. Things change, are unpredictable, and answers –facts?- obtained at one stage may not obtain later. Life is flux -an ever moving current.

And, of course, context is almost as relevant as substance. Nothing is separate from its surroundings. A pregnant woman, say, is a member of a group –however tenuous- or at the very least, a member of a society. A culture. There are obligations and expectations unique to her milieu that may not be immediately apparent –especially to someone not a member of that group. And these conditions do not often lend themselves to a one-time appraisal, a permanent and unbending judgement, or a right/wrong approach. A rigid doctrine -established on whatever principles- does not always work. In fact it imprisons; it imposes an unchanging view on a constantly unfolding reality. It is dogma.

So it was with some concern that I read an article in the Sept.16/14 Canadian Medical Association Journal –in the news section- entitled ‘US politics and ideology enter exam rooms’. In it was outlined some of the requirements in certain states that seem to impose political or moral ideologies on both patients seeking assistance, and medical staff trying to provide it –an arena that one would expect to be free of bias and coercion.

There are some American states, apparently, that require a woman seeking a pregnancy termination to be shown –not just offered-  a view of the ultrasound of her fetus. In my opinion, this is just cruel –a punishment thinly disguised as help. Disclosure. An admonition clothed in the scarily garish colours of useful information. That there may have been extenuating circumstances –whether personal or social- that led to her decision to terminate would seem to be irrelevant. The choice the woman has to make is a painful one –it is seldom capricious, rarely if ever carelessly taken. That someone should be available to help her with her decision and counsel her before and after if she wishes is a given. But it should not be an impediment.

As the article observes, ‘In such cases, it’s not just the doctor and the patient in the room. In effect, it’s the state government, too.’  This is the not-so-thin edge of a wedge that seeks to modify behaviour –even behaviour condoned in law- by mandating seemingly reasonable adjuncts to the process. ‘What could be wrong with offering to show the woman her fetus on an ultrasound?’ one can almost hear them pontificate mellifluously with fists all the while clenched tightly behind their backs. But the operative word here is ‘offer’. The term suggests choice.  Not coercion. Bullying. Threat.

I recognize that I’ve chosen a contentious issue –pregnancy termination- to illustrate a much more fundamental point: the relational autonomy that should be a cornerstone in our dealings with others. And yet it forms –must form- an essential foundation if we are to reach out to those who, constrained by their own beliefs or cultures –their own experiences- are reluctant to seek our help. It seems to me that it is only humane to enable them -actively encourage them- to access whatever aid we are able to provide. It is not merely magnanimity on our part. Not generosity. Not accommodation. It is empathy; a recognition that despite our differences, we are all struggling. All seeking some path through the chaos of one transition or another. And the cognitive closure need not be punitive. Nor dogmatic.

In fact, it can be instructive. Insightful. As Shakespeare observed, It is not in the stars to hold our destiny, but in ourselves. And we must help others to see this. We must enable them, and so enable ourselves.