Different Flavours

There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy –so says Shakespeare’s Hamlet. I suppose as one ages, there is a tendency to become, if not indifferent, then less surprised at the plethora of variations that exist when they are sought, less amazed at the range of combinations just waiting for discovery. Like ice cream, the world does not come in only one flavour.

But perhaps it is not just the array that so bedazzles, but that we could ever have presumed to define what is normal in anything other than in a statistical way. A Bell Curve distribution confronts us wherever we look –reality is a spectrum no less than the rainbows we all profess to admire. So, then, why is it that in some domains we are less than accepting of mixtures, less tolerant of difference? Why is there the overwhelming need to categorize things as either normal or abnormal? Natural, or unnatural? A macrocosm of only us and them?

Is it just the benefit of retrospection that allows me to notice that no one of us is the same? Or a corollary of Age that lets me thank whatever gods may be that it is like that? That not only do we differ in our tastes and thoughts, but that the discrepancies in our appearance, if nothing else, allow us to recognize each other?

At any rate, I have to say that, as a retired gynaecologist, I was pleasantly surprised to rediscover a world I thought I had left behind –intersex. It was an article in the BBC News that caught my attention: http://www.bbc.com/news/world-africa-39780214 In my day, however, we still hewed to the label ‘hermaphrodite’ if both male and female gonads were present, or even more insensitively, to something like ‘disorders of sex development’, with the medical community taking it upon itself to assign and surgically ‘correct’ the anatomical features at variance with some of the more prominent features of the melange. All this often before the person was able to decide whether or not to identify with either or both traditional sexes. I don’t for a moment believe that this was done malevolently, however, and I think we have to be careful not to apply current sensitivities to another era. Historical revisionism is always a temptation…

But the spectrum of variation is so wide in both anatomy and physiology, not to mention time of discovery, that assignation of gendered roles is fraught. For some, the worry has been that of acceptance –acceptance of any divergent anatomy, any dissonance, by society at large, but also acceptance by the individual themselves (even pronouns become problematic –assigned as they usually are by gender).

It is common nowadays (UN Office of the High Commissioner for Human Rights) to use the (hopefully) neutral term of intersex to define people who ‘are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies. Intersex is an umbrella term used to describe a wide range of natural bodily variations. In some cases, intersex traits are visible at birth while in others, they are not apparent until puberty. Some chromosomal intersex variations may not be physically apparent at all.’

Of course attitudes are as disparate as societies themselves. Not all have been as tolerant or accepting of difference as one might hope. The BBC article, for example, describes the attitude in some rural areas in Kenya that a baby born with ambiguous genitalia should be killed. ‘Childbirth is changing in Kenya. Increasingly, mothers are giving birth in hospitals, rather than in the village. But not so long ago the use of traditional birth attendants was the norm, and there was a tacit assumption about how to deal with intersex babies. “They used to kill them,” explains Seline Okiki, chairperson of the Ten Beloved Sisters, a group of traditional birth attendants, also from western Kenya. “If an intersex baby was born, automatically it was seen as a curse and that baby was not allowed to live. It was expected that the traditional birth attendant would kill the child and tell the mother her baby was stillborn.”’ The article goes on to say that ‘In the Luo language, there was even a euphemism for how the baby was killed. Traditional birth attendants would say that they had “broken the sweet potato”. This meant they had used a hard sweet potato to damage the baby’s delicate skull.’

‘Although there are no reliable statistics on how many Kenyans are intersex, doctors believe the rate is the same as in other countries – about 1.7% of the population.’ But the thrust of the article was really to discuss how  Zainab, a midwife in rural western Kenya defied a father’s demand that she kill his newborn baby because it was intersex. She secretly adopted the baby –and indeed, even a second one a couple of years later. ‘In Zainab’s community, and in many others in Kenya, an intersex baby is seen as a bad omen, bringing a curse upon its family and neighbours. By adopting the child, Zainab flouted traditional beliefs and risked being blamed for any misfortune.’ But she represents a slow, but nonetheless steady change in attitudes in rural Kenya.

‘These days, the Ten Beloved Sisters leave delivering babies to hospital midwives. Instead, they support expectant and new mothers and raise awareness about HIV transmission. But in more remote areas, where hospitals are hard to reach, traditional birth attendants still deliver babies the old-fashioned way and the Ten Beloved Sisters believe infanticide still happens.’ But, ‘It is hidden. Not open as it was before’.

I suppose it is progress… No, it is progress –however slow, and frustrating the pace may be, as long as there are people like Zainab there is hope. But it still leaves me shaking my head.

For some reason Robert Frost’s poem, The Road Not Taken, springs to mind, in a paraphrase of its last verse: I shall be telling this with a sigh somewhere ages and ages hence: two roads diverged in a yellow wood and she, she took the one less traveled by, and that has made all the difference

Please.

Blow, Blow, Thou Winter Wind

There is a time, a dark time, when normal daylight thoughts are banished. A time when what remains are skeletal shadows, atavistic remnants of ancestral fears, unbidden fragments of anchorless dread which in the fullness of a sunlit day, are sheer cotton. -translucent at their best. It is when doors are left ajar and watchmen sleep. It is a time when filtering is impossible, and  vetting unreliable. It is the time of night when even the moon is asleep, or hiding…

And normally, so am I, but age and diet sometimes conspire to rearrange diurnal rhythms –shuffle the deck- and if I allow the shards of my imagination any attempts to organize unsupervised, the resultant patterns are not ones I would recognize in the light. Nor accept. It is an existential angst, a dark time of the soul.

A few weeks ago, I awoke sweating, and in the nocturnal silence of a moonless night, seemed trapped in an airless blanket of dread. I couldn’t see, and everything around me was still. Unmoving. Mute. If it had been preceded by a dream, I couldn’t remember it; all was numbed by the intensity of the terror, and I was helpless in the current swirling noiselessly around me. Suddenly, the sure and certain knowledge that I would be blinded from complications of impending cataract surgery gripped me like the jaws of an unseen, unexpected predator, and the ensuing silence convinced me of the extent of my coeval deafness. I was, and would be for all time, trapped in a silent darkness -solitary confinement on the authority of cast dice.

Of course the feeling passed, and my daylight remembrance of the event was suitably tailored in the sun, but the feeling lingered. What would it be like to be forever trapped in both silence and darkness, I wondered? What would be left of life? And for that matter, what would be the use of a gift I could no longer use? No longer experience… except as a living, solitary hell?

I suppose I’m being overly dramatic about a highly unlikely confluence of events, but even the possibility makes me shudder -makes me fearful about the fragile egg-shell in which I am encased, and the delicacy of the components it is charged with protecting. It is perhaps a wonder that we as a species –and more specifically, I as an individual- have survived at all, let alone this many years.

With this in the back of my mind, I am surprised I had not heard of Usher syndrome before, although perhaps my specialty of Obstetrics and Gynaecology quarantined me from an extremely rare condition that results in both blindness and deafness as well as a host of other non-gynaecologic impairments. But it was the subject of a BBC article that caught my eye and quickly brought back the horror of my panic attack: http://www.bbc.com/news/disability-38853237

It’s the story of a young girl, Molly, who ‘was born severely deaf and learned to lip read. But, at the age of 12, she was diagnosed with Usher syndrome, a degenerative disease which causes sight and hearing loss. Now aged 22 she has just 5% of sight left in one eye.’ The eye condition is called retinitis pigmentosa which progressively affects peripheral vision and results in night blindness as well.

And, as if deafness and blindness were not enough, she was also a teenager struggling like every other teen, to negotiate the serpentine interstices of social life. She did receive speech therapy, so communication was possible, but as she admits, ‘”I have to strategise everything I do. I am night-blind and so when I go out I would often ask to hang onto a friend. I will only go out with the close friends who do not make me feel a burden.”’

There are also mental health issues with Usher syndrome, not surprisingly, and Molly has a bipolar disease which can complicate her ability to cope with her disabilities at times. Also, ‘Her experiences are often dictated by the support she receives. While she says college restored her faith in humanity, she left university early due to a lack of assistance. “Lecturers didn’t have the time to understand my condition. Training and awareness sessions were set up for staff and nobody turned up. I just needed materials to be made accessible – large text, for lecturers to wear a radio aid that connected to my hearing aids – it’s as simple as that.”’

Some people are truly special, aren’t they? I suspect I would have sunk into an irremediable depression and yet ‘Molly has set up her own charity – The Molly Watt Trust – to support others with Usher and has spoken at prestigious institutions including Harvard University and the House of Commons [UK] outlining how capable people with Usher are.’

But perhaps the spirit soars, even in captivity –or maybe especially in captivity. I’m reminded of Victor Frankl’s book Man’s Search for Meaning and his thesis of ‘tragic optimism’: ‘How […] can life retain its potential meaning in spite of its tragic aspects? After all, “saying yes to life in spite of everything […] presupposes that life is potentially meaningful under any conditions, even those which are most miserable. And this in turn presupposes the human capacity to creatively turn life’s negative aspects into something positive or constructive. In other words, what matters is to make the best of any given situation. […]an optimism in the face of tragedy and in view of the human potential which at its best always allows for: turning suffering into a human achievement and accomplishment […] and deriving from life’s transitoriness an incentive to take responsible action.’

I suppose that it is difficult to judge a response like Molly’s from the outside, though; I suspect that true empathy –experiencing something through another’s mind- is nigh on impossible for most of us in her case. After all, it would require relinquishing all of that which we have come to accept as normal –sight for as many years as we have lived, and the sounds that have accompanied us through the years… An existence unimpeded -until now, perhaps- by significant impairment. The contrast between then and now would be overwhelming, I think.

And yet, as Helena says in Shakespeare’s All’s Well That Ends Well, ‘”Oft expectation fails, and most oft there where most it promises; and oft it hits where hope is coldest, and despair most fits.”’

Thank you Molly!

 

 

Methought I heard a voice cry Sleep No More.

 

I have always had a healthy respect for fire. I suppose this is not unusual, although nowadays fire is not a regular component of our daily lives, so its presence awakens something that alternates between fascination and fear. Something atavistic. Fire –especially unexpected fire- can produce panic; smoke –also if unexpected, or inexplicable- can have the same effect. Both are worthy of our attention, both should command our respect, our search for the source.

That’s why smoke detectors are so valuable. The two commonest detection systems would seem to be either ionization and/or photoelectric –the former, ionization, grew from an attempt in the late 1930ies to detect poison gas, but the advance of the technology did not make it widely available –or affordable- until the 1970ies. The optical variety matured around the same time.

The purpose of both smoke and heat detectors, as we all know, is to alert us to the presence of the potential danger by activating some form of alarm –something that either by sheer volume or unpleasant pitch will demand action. It should arouse us if we are asleep, or get us out of our chairs if we are not. It should be audible over whatever other sounds are present in the environment, and sufficiently different from them to concern us. Usually, smoke alarms have a frequency of around 3000-3200 Hz and need to reach 85 decibels at 3 metres.

Anybody who has ever heard their smoke alarm sounding when the toast burns in the kitchen can attest to the discomfort this incites. It is piercing and –at least for the hearing population- impossible to ignore. Enough to wake the dead, as my mother used to say -but apparently not the child: http://www.bbc.com/news/health-38918056  As the BBC article reports, ‘Researchers at Dundee say there are several theories they were exploring as to why standard smoke alarms may not wake children.’ One, however, has led to an interesting innovation. ‘Rodney Mountain, from the University’s School of Medicine, said: “Children’s hearing ability, brain function, sleep patterns and stage of brain development is very different to adults. We are programmed to respond to human voices warning of danger, such as a mother’s voice shouting to warn a child. Children are not born pre-programmed for our modern world of danger warning sounds from digital beeps and sirens -they have to learn, recognise and interpret these sounds.”’

So, the researchers wondered whether the sound of a woman’s voice –a mother surrogate, essentially- might trigger a child’s arousal more effectively. ‘Research by Dundee University and Derbyshire Fire and Rescue found that of 34 children tested, 27 repeatedly slept through smoke detector alarms. They have developed an alarm with a lower pitch and a woman’s voice, which issues a warning: “Wake up, the house is on fire.”’ And, instead of the terrifyingly strident, ear-piercing pitch, ‘the prototype has a lower pitch of 520Hz, to which young children are more likely to respond.’

Of course, this approach is still in its experimental phase and ‘The researchers said it was important the study did not undermine the need for every home to be fitted with smoke alarms, as these will wake adults and had a proven record in saving lives.’

Several weeks after reading this article, I happened to be over for dinner at the house of an old friend. We were sitting in the living room enjoying a glass of wine before eating when the smoke alarm suddenly activated. Apparently some grease on the stove had started to smoke.

“Well, the alarm did its job, didn’t it?” she said, laughing and filling up my glass again when she returned. “It’s amazing how annoying they are. You can’t ignore the alarm –you just can’t!”

I chuckled and told her about the BBC article I’d read about the alarm failing to rouse children.

The smile never left her face even when she had another a sip of her wine, but I could tell she was still thinking about what I’d said. “You know, that reminds me of something that happened when my son Jeremy was still around two years old…” She closed her eyes for a moment, savouring the memory. “We were over at my father’s cabin at the lake. Jeremy loved it there…” Her smile grew even larger and transformed her face. “It was so different from the city where we lived. Everything was new to him –the birds, the trees, the lake with Grampa’s little wooden rowing boat… He was usually so tired, it was no trouble getting him to go to bed at night. He slept in a little crib in my room, and rarely stirred even when I eventually came in to go to bed at night.

“Anyway one morning dad and I were sitting in the kitchen enjoying a cup of coffee while Jeremy was still asleep. He’d just installed a new smoke alarm because he used the fireplace a lot at night and I told him I was worried about the dangers of fire in a wooden cabin. I suppose he’d put it too close to the counter, or something, because when our toast began to burn, suddenly the alarm went off. The noise was so loud and high pitched it was painful and I had to cover my ears. I remember my heart started pounding and I actually felt faint.

“’The man at the store told me it’d wake me from a coma,’ dad said once he’d turned it off. ‘I’m surprised Jeremy isn’t crying.’

“Or out here,” I said. “Your crib is so low to the ground, I took the side off it so he could get out if he wanted.

“I went in to check on him right away; I’d left the bedroom door partially open when I’d gone into the kitchen, but he was still lying motionless in the crib like he does when he’s really asleep. I even remember standing at the door and watching him for a while –he was so adorable when he was sleeping…” She sighed and had another sip of her wine.

“I could see the gentle rising of his chest as he slept, so I knew he was okay. Dad started calling me from the kitchen to tell me my burnt toast was getting cold, and I can recall speaking Jeremy’s name in a normal tone of voice, telling him to wake up. Suddenly his eyes flickered then opened and a big warm smile filled his face…”

Martha turned her head to look at me, her eyes little sparrows flitting from cheek to nose and hovering over my face trying to decide where to land. “Do you think that’s what they were describing in the article?”

I smiled and added a tiny shrug. “A mother’s voice is so important, isn’t it?” I said, but realized as soon as the words emerged that it wasn’t a particularly profound observation.

She nodded her head and laughed. “Curious how my voice could wake him as a child but not as a teenager.”

“Who starves the ears she feeds and makes them hungry, the more she gives them speech…”

“Pardon me?” she said, giggling with the wine.

I enlarged the shrug. “Just a fragment of Shakespeare,” I said. “It means that noise isn’t as valuable as words… I’ve always wanted to use that quote.” I glanced at my own wine and smiled.

 

 

 

Let No One Put Asunder

At my age, I suppose I should have learned to expect the unexpected, to revel in the entrepreneurism of a new and alien generation, and to wonder at its ability to see opportunity in the predicaments of others. But then again, why not? Isn’t that what lawyers are all about? And doctors…? Where would we be without predicaments?

Alright, I accept that the approach may seem cheeky, or even downright calculating, but I have to say I sometimes admire the attempt –a Swedish hotel chain is ‘offering a refund to couples who get divorced within a year of staying at one of its places.’ http://www.bbc.com/news/blogs-news-from-elsewhere-39382059 The idea being, apparently, ‘to encourage spouses to spend time together and work on their relationship’. And so, ‘It’s offering a “relationship guarantee” on mini-breaks at its hotels, so if things subsequently don’t work out and the marriage ends within a year, then the chain says it will reimburse the cost of a two-night stay’.

Of course, they’re not fools; nobody wants to be taken to the cleaners -they’re out to make a profit and, perhaps naively, figure that those who decide to vacation together for a while might not be that close to the brink. And, naturally, ‘There is some fine print: couples must be already married, stay in the same room and reference the relationship guarantee when booking. If they subsequently divorce and want to claim a refund, they have to submit court documents as evidence’.

I don’t know… At first glance, it might seem that they’re either very naïve, or really convinced they have an effective therapy -I mean, the divorce to marriage ratio in Sweden (2010, at least) was 47%. On second glance, however, the marriage rate in Sweden according to Eurostat Demographic Statistics –OECD Family Database (2014)- was only around 6 per 1000. So who, exactly, is sufficiently wide-eyed not to notice they may be on to something? I’m reminded of most private insurance agencies who offer great deals as long as you are low risk and have no major ongoing disabilities.

But it speaks to something larger, I think: the institute of marriage itself. Marriage is something which is incredibly difficult to define. In its simplest form, it is an officially sanctioned union between two people that affords legitimacy to any offspring and entails certain rights and responsibilities -and these vary from one society to another. In Western cultures it has been the religious –or secular (usually governmental)- authorities that are required to sanction and guarantee those issues. But in other societies, families, traditions, and deeply held beliefs often prescribe the boundaries, duties, and also the rights of each person in the relationship. Hence the cross-cultural misunderstandings and misgivings. We tend to ascribe the most legitimacy to that of the society in which we were raised.

Guilt, is not imposed, by and large, it is acquired -usually at a very early age- by deviating from the expectations of those we love and trust: our family, and immediate friends, bonds that link intimately with cultural and, often, religious beliefs. Sexual mores and intimacy are no exception -in fact, they are often the incentives offered by matrimony.

But marriage is becoming more popular recently, even in Sweden, with the ongoing influx of migrants from other cultures who were raised with different familial and religious obligations to which they feel they must adhere -obligations which may not be as easily dissolved, or as readily ignored as in the host country. After all, ‘Marriage is a matter of more worth than to be dealt in by attorneyship’ according to Shakespeare.

So is the hotel chain actually reading those trends, too? And are there other conditions –loopholes- that are not immediately apparent in their advertisements? Fine print? Exceptions? I don’t know, but I certainly wish them well. It’s a gamble on their part, to be sure… But I think I’d put my money in real estate, frankly.

Perhaps I’m just being far too cynical, though. Far too… divorced –there, I said it- but I’m willing to bet that they haven’t read the famous definition of how realistic are the expectations of marriage by none other than George Bernard Shaw in his preface to ‘Getting Married,’ 1908: ‘[W]hen two people are under the influence of the most violent, most insane, most delusive, and most transient of passions, they are required to swear that they will remain in that excited, abnormal, and exhausting condition until death do them part’.

Pick your side on divorce and marriage, but they do seem to follow each other around and around like a tail the dog. I have to say, part of me is tempted to quote Samuel Johnston’s sarcasm (out of context) on the hotel chain’s promise -that it’s ‘The triumph of hope over experience’. And yet, when I stop to think of it, why not credit them with the courage of their conviction? Why not Alexander Pope’s ‘Hope springs eternal in the human breast’…?  After all, that’s what they’re trying to accomplish in those couples who stay with them… And that’s what we all hope for, isn’t it?

 

 

The Stealing Steps of Age

Elderspeak. We’ve all heard it: baby-talk for seniors, an almost unconscious reaction to those we deem cognitively impaired, or hopelessly out of date. It’s a kind of pretend-communication with those who seem unreceptive, or beyond the pale of verbal comprehension.

Although the term is aptly descriptive and eerily evocative of rows of beds with wrinkled heads whose staring eyes peek out from where their bodies are tucked, I have to admit I had not heard the word before seeing an article in the CBC News. It described a study published in The Gerontologist about the way a group of nuns cared for their elderly colleagues from their convent: http://www.cbc.ca/news/health/nuns-elderly-1.4039508

‘The sisters caring for cognitively impaired elderly nuns in a Midwestern convent spoke to their care recipients in a way that sounded strikingly different to linguistic anthropologist Anna Corwin. The nuns rarely used “elderspeak” — a loud, slow, simple, patronizing and common form of baby talk for seniors. Instead, Corwin reports, they told jokes, stories and blessed the sick nuns, all the while speaking to them like they were completely capable, even though their ability to communicate was significantly diminished.’

‘The nuns in the infirmary suffered from dementia, Alzheimer’s disease, aphasia, stroke and neurological deterioration, and all had limited or impaired communication abilities. Sometimes the caregiver nuns held the sick nuns’ hands, and sometimes they massaged their legs, Corwin said.’

It all sounds so… sensible. So empathetic. And yet, so often we are frustrated by our apparent inability to effectively communicate that elderspeak becomes a sort of default –almost as if those to whom we are speaking are not really listening, or, depending on their condition, are minimally aware of our presence. And this can be especially prevalent among overworked care providers in geriatric wards.

‘Kristine Williams, a professor at the University of Kansas School of Nursing in Kansas City, trains nursing home providers to use less elderspeak. Her studies found that communication training can reduce the number of diminutives, terms of endearments and collective pronouns senior caregivers use.’ But training to do what?

The nuns offer an interesting option. ‘The caregiver nuns had long-established deep relationships with their elder charges, Williams noted. “They are in almost a family-like relationship, as opposed to someone who’s a nursing assistant in a home,” she said.’ And what they offered, was not condescension or inadvertent humiliation. Not patronage or mere toleration. ‘”They see these older adults, even when they’re lying in bed moaning and can’t move, as not being reduced by these chronic conditions but still as whole individuals.”’

The study was an interesting one, and yet its findings should not surprise us. ‘Beauty doth varnish age, as if newborn, and gives the crutch the cradle’s infancy’ as Shakespeare said. In other words, finding beauty in old age can transform it and make it bearable –in this case both for the aged as well as the caregiver.

Now that I think about it, I suspect I learned that years ago when I was a beginning medical student and visiting my aunt Shirley who was hospitalized after a stroke. She was stored –that’s the only word to describe it- in an older part of an already-old hospital on a ward –a large room, really- lined on both walls with beds like a dormitory. And for the most part, as I described above, all one could see looking down the rows were heads peeking out from neatly tucked bedsheets, white hair splayed across the pillows or stuck to the scalp with sweat. Some had eyes that moved, but mostly it was a room of mouths –none speaking, all busy with just the chore of breathing.

Shirley was one of the exceptions, propped as she was by a series of pillows and a cloth bib whose tethers kept her from tipping over the bed railings and onto the floor. Her voice was slurred and indistinct, so I had trouble hearing what she had to say, but I could tell she was getting better because she was complaining about the woman in the bed next to hers.

“There’s nothing there,” she kept saying, her eyes pointed at the head beside her that was staring, unblinking, at the ceiling. “They’ve put me in an empty room, dear, and I don’t like it.”

My aunt had always been gregarious, some might even say nosy, so to be confined to a room where she couldn’t extract vital gossip and life histories, was a type of exile for her. A punishment.

“You seem to have improved each time I come here,” I said, trying to cheer her up. For my part, the ward depressed me. “They’re obviously treating you well,” I added, quickly running out of small talk.

Part of her mouth smiled, but most of her face seemed still asleep. Not at all happy.

“Your aunt is improving, sir,” a soft voice said from behind me.

I turned and saw a short, smiling, grey-haired nurse dressed in white trousers and a white shirt buttoned up to his neck. His eyes were twinkling, and he was gazing at my aunt as if he, too, was proud of what she’d accomplished. There weren’t very many male nurses then, so I was surprised. “I expect they’ll be transferring you to another ward, soon, Shirl,” he added locking her eyes in his and ignoring me for a moment. “So quit complaining, eh?” He chuckled when he saw her smile broaden and the rest of her face follow suit. He reached out and squeezed her toe through the sheet and wandered off to check on the next bed. Shirley giggled, obviously pleased.

I could hear the nurse talking to that unresponsive woman in the next bed, although he spoke quietly. First, he tilted his head to stare at the ceiling above her bed. Then, he smiled. “You know, Liz, I figure you must have much better eyes than me…” He liberated a skeletal arm whose flesh hung from it like curtains on a window and held it tenderly. “…Because no matter how often I look, I still can’t see whatever it is that you find so interesting up there.” He gently squeezed her hand. “We’re gonna have to discuss this over a beer someday, eh?”

Her face didn’t change, but her breathing seemed a little less laboured. A little slower. More even. “Anyway, is there anything you need me to help you with today?” he said as he ever so gently massaged her arm then flexed and relaxed her fingers. When he’d finished with that arm, he tucked it under the sheets again and repeated the exercise on the other. “I’m going to come back and move you into a different position in a few minutes, Liz, so don’t get too comfortable like that, eh?” He loosened the sheets around her and raised the railings around the bed again that guarded her from falling. “And I’m going to make sure that physiotherapist you like comes with me to massage your legs.” He winked at her flirtatiously and gave her leg a squeeze through the sheet.

“He might as well be talking to the pillow,” Shirley whispered, as he busied himself with the railing. “All she does is stare at the ceiling. She doesn’t seem to notice when I talk to her…”

“So wait for me, Liz. I don’t want to have to go looking all over the ward for you again,” he said, laughing, and wandered off to yet another bed.

“I do like Bill,” Shirley said when he was out of earshot. “He treats us all like family –like we matter.” She was silent for a moment and then, just when I was about to leave, she managed to snag me with her good hand. “But I don’t know how he stays so cheerful here. I think half of the patients don’t even know he’s talking to them.” And her eyes wandered over to the woman in the next bed again. “It must be terribly discouraging for him, don’t you think?”

I glanced at the woman, and for a moment, I thought I saw her eyes flicker as if they were searching for something. Someone. And then, a tear? But maybe it was just a trick of the light, because, as her face relaxed a tiny bit, they closed and she began to snore. Not loudly, not as if she couldn’t breathe –but quietly, comfortably, and slipped from the waking dream, into yet another more peaceful one further inside.

 

 

 

 

 

 

 

The Primrose Path

Age is sometimes mysterious, isn’t it? Despite the experience and occasional brush with wisdom I have encountered, I am still a child in many ways. Naïve -not so much about things I have encountered in my drive through life, but more about those on streets I have not visited. Addresses in the shadows.

I suppose there will always be issues that will never spring to mind in our normal passage through the years and yet, in retrospect, one wonders how they were missed. Or why. What, for example, happens to different populations as they age? And who do we get to care for those who have chosen -or been forced- to walk the darker paths, then fallen neglected and forgotten by the wayside, too old to re-offend? Should we care for those who flout our laws and reject the duty to conform? Are we a family, or just a collection of intolerant strangers easily offended and quick to turn away?

Imponderables, to be sure, and yet, like it or not, there are needs that must be met… by someone anyway. I was intrigued by an article in the BBC News about aging prostitutes in Mexico City: http://www.bbc.com/news/magazine-38677679  One of their members opened a retirement facility for them.

I must admit, that the plight of aging sex workers had never really occurred to me. I’m not sure what I thought would happen as they got old, although, as a gynaecologist, I was certainly aware of their life style risks; their need for consultation in the Emergency Department was a regular and frequent occurrence whenever I was on call. For some reason, I’m reminded of that quote of Queen Katharine buried deep in Shakespeare’s Henry VIII: ‘Like the lily, that once was mistress of the field and flourish’d, I’ll hang my head and perish.’ Is that how they end their days…? I hope not.

But a retirement home –how perfect! The social safety net in Mexico is likely not as comprehensive as that in Canada, and yet even here, I’m not aware of any such facility. Indeed, the oldest profession has undergone other, more callous impediments as I noted in a 2014 blog on prostitution laws: https://musingsonwomenshealth.com/2014/06/12/prostitution-laws/  So perhaps it might be asking too much to wonder if such a facility might be in the offing -if not governmentally sponsored, then perhaps privately funded. Or better still, a legal adoption of  something like the New Zealand model might discourage exploitation and even offer salaries and, who knows, pensions…? Comfort for their end of days?

*

I do not ordinarily sit in malls; I do not ordinarily go to malls, for that matter, but sometimes circumstances foster unexpected opportunities. I was tired that day –tired of fighting through Friday crowds in search of things I probably didn’t need, or at least could likely find with a little effort somewhere else. I had just decided to look for a place to rest and collect my thoughts, when I saw a woman check her watch and stand to leave an uncomfortable-looking wooden seat near where the tide of people was sweeping me. I immediately swam over and moored before the woman right behind me could claim it for herself.

The seat was one of four that served as a kind of breakwater for the waves of people flowing down the shop-lined banks in confused eddies. Bolted to the floor, they were arranged in a little circle, presumably to facilitate conversation, but only two of the occupants seemed to know each other. They were deep in conversation so even an exchange of pleasantries seemed inappropriate, but just before I closed my eyes, I managed to catch their attention and smile at them. In the seat beside me was an old man who also smiled, but seemed more preoccupied with his watch than anything else.

The women were quite old and both looked as if they’d seen better days. Although their clothes were clean and obviously worn with an attempt at style, I could see fraying at the hems, and areas where the patterns were disrupted by attempts at repair. Both their faces were wrinkled, as much by life as age, I suspected, and the one directly across from where I sat, seemed hollow around her cheeks and gummed her words through sparsely distributed teeth. Short and gaunt, she sat proud and straight in her chair, however, her long, greying hair swept back in an elegant ponytail that danced each time she talked. She had dressed that day in a green, fading sweater and black jeans that seemed a bit too large, so the cuffs were carefully rolled to matching folds.

The other was a larger woman with short, ash-white hair that she had scrunched under a blue baseball cap that had some sort of a truck logo on its front. She was dressed in a red and white flower print dress which seemed to hang shapelessly below a tattered and faded nylon jacket that had probably once been totally black. At her feet was a big, stained cloth shopping bag that bulged oddly in places with items too irregular to be just clothes.

Friendly strangers, they both smiled back at me before resuming their conversation.

I closed my eyes and tried to relax into the wooden slats, but their words kept floating over to me during lulls in the storm of voices and accidental elbows hurrying past me. I could tell it was an unsafe anchorage at best.

“Haven’t seen you for a while. You still working, Ethel?” It must have been the pony-tailed woman, because her words seemed strangely distorted and her lips smacked together a little as she spoke.

A gaggle of children passed nearby so I missed some of the response. “… men anymore, Rita…”

“Yeah, I guess, eh?” But I didn’t think Rita sounded very sure. “You still on the…” A demonic laugh surfaced in the crowd for a moment then faded along with Rita’s words.

“Yeah,” Ethel replied. “Hard to get off though, eh?”

I opened my eyes to get a little more comfortable on my seat, and saw Rita nodding in agreement. “Hang out in the same place?”

Ethel shrugged as I closed my eyes again. “They know me there,” she answered.

I imagined Rita nodding in agreement. “Mmmh,” I heard.

School must have ended for lunch, because a group of noisy teenagers rambled past, joking and poking each other. “What shelter you going to nowadays?” Ethel’s words caught my attention, even amidst the confusion of teenage jests and I opened my eyes, pretending to adjust my position again.

I could see the indecision on Rita’s face, and her lips moved as she considered her answer. “Used to go to the one on Main…”

“Yeah, me too,” Ethel agreed, glancing at her. “Got assaulted there, though, so I sometimes try the Sally Ann…”

“Mmmh.”

“What about now, Rita?” She adjusted her baseball cap as she spoke. “Where you headed tonight…?” She sounded suspicious. They were clearly not good friends –just acquaintances, perhaps, who’d found themselves in adjoining seats to shelter from the weather for a while.

Rita stared at Ethel for a moment, obviously uncertain how to answer. Then she ordered her eyes to scan the passing crowd. “Found a new place. Some of the girls got together…” But it wasn’t the noise of passing voices that ended her words.

Ethel tried to find out more, but Rita suddenly stood and waved, as if she recognized someone in the crowd, and dived into a particularly noisy wave and disappeared.

Ethel sighed and then gathered up her things and melted into a similar eddy going another direction. Despite her weight, she seemed frail and aged. Her movements were no longer fluid, her gait was unbalanced and she hobbled with a decided limp. But as she disappeared, her eyes brushed mine -by mistake, I thought at first, but when I remembered it later, I wondered if it had just been habit. A desperate plea for another friend –however temporary.

 

 

 

 

Time Out, eh?

Time-outs to wring behavioural change from naughty children are all the rage nowadays. Everywhere you go there seem to be men sitting near their tantrum-laden little boys in the parking lots of stores, or women standing outside of cars fastidiously ignoring the screams of alternately pounding and pouting children confined within. Perhaps this has been going on for years, but only recently have I begun to notice the ritual. In fact, it seems so ubiquitous, that I am beginning to suspect a flaw in my own upbringing. I don’t remember being an easy child; maybe I just had easy parents. Or maybe the Encyclopedia Britannica of the age didn’t cover that aspect of childrearing.

It might be investigating the obvious, but I had to look it up at any rate. Time-outs are more acceptable attempts at behaviour modification than corporal punishment –spanking comes to mind- especially in public, where the difference between remonstration and child abuse is uncomfortably opaque. The idea of social exclusion was likely popularized in a paper by a Dr. Montrose Wolf at the University of Washington in the mid 60ies, drawing on the work by his mentor, Dr. Arthur Staats (who called it ‘time-out’).

But, unless you grew up in Winnipeg in the 1950ies, you might now regard time-outs as such an intuitively obvious way of treating both the child’s misbehaviour and the resultant parental frustration, that you would be forgiven for assuming it had been hard-wired in our DNA. Perhaps it was, but with variable penetrance, and probable mid-prairie epigenetic modification –anyway, there seem to be some issues with its application: http://www.cbc.ca/news/health/time-outs-study-parenting-1.3888166

By default, I suppose I’m an educationally impoverished repository of doctrinal wisdom when it comes to children. As an obstetrician, for years -until my own arrived, at least- my responsibilities ended with handing the freshly-liberated, and usually screaming newborn to the mother, tidying things up, and then congratulating the smiling, emotionally overcome parents before I left the room. I didn’t expect to be confronted with any of their subsequent behavioural peccadillos. But, as Shakespeare’s Cleopatra remarked, those were ‘my salad days, when I was green in judgment’.

Usually, I enjoy seeing children in the waiting room –they lend a kind of friendly family air to the office. Sometimes, however, there are things I need to discuss with the mother, procedures I need to perform, or even examinations that might alarm the child, so my enjoyment is often that of seeing the child stay in the waiting room. It’s not called that for nothing.

Clara was already a harried teenage mother of a two year old when I first met her several years ago, and I delivered three more for her in the following years. Now in her late twenties and recently divorced, she had been sent to see me for permanent birth control.

I heard the excited screaming even before I reached the front desk, and I have to admit that I hid behind a wall to assess the situation more fully before I ventured into the open. The first of the children I delivered -Edward, now around five- was stirring the pot by running around the room clutching a toy to his chest so the dauphin, despite the obvious entitlement of age, could not get it.

Clara’s long auburn hair, now partially liberated from whatever restraints she’d attempted at home, was hanging forlornly around her shoulders, while her eyes followed the action around the room like a hockey game. A large lady now, she sat uncomfortably on the edge of her seat, no doubt hoping to catch Edward and the toy if he was so unwise as to come anywhere near grabbing range. The youngest, still breast feeding, was the only one over whom she exercised even temporary dominion.

I glanced nervously around the room from the shelter of the alcove, hoping she had brought a friend or older family member with her, but Clara was the last patient of the day and the room was otherwise empty.

“Clara,” I said, face prepared, and hoping she hadn’t noticed me behind the wall. “Nice to see you again.”

The children immediately stopped running and flocked to my side to tug on my clothes. Jamie, the oldest, grabbed the toy from Edward, who was now too busy trying to reach my stethoscope to notice.

“I… I saw you… watching from the alcove, doctor,” Clara said, blushing a deep crimson because she almost said ‘hiding’. “I tried to get my sister to take care of the kids, but she had to work today…” She shrugged and reached out with lightning speed to grab Jamie’s arm before he could swat his brother. “You behave yourself, Jamie, or you’re gonna do a Time-out, eh?”

Jamie immediately akimboed his arms and made a face at his brother. “He grabbed my car…!”

Clara glared at him and frowned, but from the defiant face with which Jamie greeted the threat, I could see the battle lines hardening.

I glanced at my secretary sitting behind the front desk, but she was on the phone and I realized that I was on my own. “Let’s go into my office,” I said, with a worried look at the boys, and the little girl, Janice, who by now had decided that the way to recapture some attention was to stick her tongue out at Jamie. Only the baby seemed compliant, but that was probably because Clara was still nursing her.

My office, unfortunately, was not designed for children –there are simply too many things that could tip over or break if handled indelicately. On the way down the hall to the office, I even thought of getting my secretary to fake a call from the hospital requiring my immediate assistance, but she was still on the phone and merely winked at me as I passed. I got the impression she was just holding the receiver for show.

As soon as the troupe entered the office they began to explore, and Jamie, who had probably never seen pennies before, made a quick exploratory lunge for the penny bowl that sat in front of a terra cotta statue of a begging lady precariously balanced on a little oak table. Edward, on the other hand, was reaching for the carved wooden statue of a woman holding a child that I had put behind a plant on my desk, and Janice was trying to extract the contents of the shelf where I keep my medical journals. It was a multi-pronged attack worthy of an Alexander.

“I’m not sure this is going to work, doctor,” Clara said, trying unsuccessfully to reposition the baby onto a breast while glaring at all three of her children now crawling along the floor scooping pennies into their pockets.

I called my receptionist to come in with us. “Laura,” I said as she opened the door a crack and peeked in. “Please put the phone on hold, or something…  I need your help.” Actually, I needed a time-out.

I could feel Laura’s eyes rolling behind the door. She was the mother of three young children, so she knew what I was going to ask.

“I want you to take the kids and… occupy them for a few minutes while I talk to Clara.”

She shrugged, but I could tell from her face that she thought it might be an interesting challenge as she gathered the tribe -minus the now sleeping baby- and led it out of the door. The office felt so peaceful suddenly that Clara and I just looked at each other for a moment. I managed to gather a more complete history and when I opened the door to lead her across the hall to the examining room I could only hear quiet giggles.

Finally, after Clara and I had discussed her needs, we both tiptoed down the corridor to the waiting room. But it, too, was quiet except for Laura’s voice telling a story as the children sat around her in a little circle on the floor.

Each of them had a plastic speculum with a sticker face stuck on the top and when Laura asked a question, one of the children would make the speculum talk. They were loving it and didn’t even look up when we crossed the rug. But Laura did, her eyes glistening from quiet laughter.

Clara just stared at them, unable to speak.

Laura chuckled and then shrugged. “I gave each of them a choice of those little funny face stickers we always give to the kids and showed them how to attach them to the top of the speculum.” A contented sigh escaped as she watched them all talking quietly to each other through the specula. “From then on, it was just role playing…”

“How did you ever think of that, Laura?” I asked when they’d all left.

She shrugged again. “The specula have always reminded me of quidnuncs… you know, snoops -those who insist on sticking their noses in other people’s business.”

I had to sigh in admiration -Laura has a name for everything. I just hope she doesn’t expect me to name the specula now… But I looked up quidnunc just in case.