Wednesday, February 27, 2008

We do not know

The Ways We Touch

Have compassion for everyone you meet,
even if they don't want it.
What appears bad manners, an ill temper or cynicism
is always a sign of things no ears have heard,
no eyes have seen.
You do not know what wars are going on down there where the spirit meets
the bone.

- Miller Williams


I was fifteen minutes late when I walked into the neurology clinic today. We had a guest lecture earlier in the morning and the speaker, an expert from a large university, had gone over time in her, and our, enthusiasm for her subject. The neurologist was sitting at the conference table going over some files and I was waiting for a silent reprimand, some subtle movement in the eyes, that would indicate his disapproval. Instead he smiled and handed me a little purple note.

"This is for you," he said. "Remember that girl we diagnosed last week?"

I looked at the note. It was from the mother of a girl we had seen in the clinic last week. Hannah Ascher (not her real name) had symptoms suggestive of a pervasive developmental disorder and, following our evaluation, we had diagnosed her with autism. Her mother had written to thank me for the care I had provided Hannah who, normally afraid of medical personnel, had taken very warmly to me because of the way I interacted with her. Mrs. Ascher also wrote that mothers of autistic children get very little credit for their stressful and exhausting work and that my encouragement had given her the strength to persevere through her child's difficult diagnosis.

Naturally, I was thrilled. It's a pleasure to be appreciated for work you do and all the more so when your teachers commend you for it. I spent the next few minutes gloating, glowing on the inside as I scanned in faux professionalism through the charts for the morning's cases. But the more I thought about it, the more convinced I grew that I had done nothing to deserve such praise. A diagnosis of autism is a devastating event for a lot of families, even with the knowledge and support available nowadays through public media. Hannah's mother had gone through a strenuous experience raising an autistic child, watching her separate away inscrutably into a private world difficult to explain or understand. If anyone needed to be commended, it was Mrs. Ascher, not me. All I did was be polite and maybe offer some small gesture of empathy. At the time, I had no idea of what she endured, of the struggles that went on daily as she took care of her daughter. It was only after understanding her note did the gravity of her commitment sink in.

It reminded me of somethingI read many years ago, when I was in medical school, about the need to practise a more humane standard of care. The quote was from a short play by Margaret Edson called Wit, later made into a stunning movie starring Emma Thompson, about a woman with metastic cancer undergoing experimental chemotherapy in an attempt to cure her disease. Although her treatment is exact and expedient by scientific standards, the woman slowly comes to despair the mechanization of her cure as doctors become increasingly absorbed with the minutiae of her case and relentlessly ignore her as a person. She later dies but not before reminding us that

"Now is not the time for verbal swordplay, for unlikely flights of imagination and wildly shifting perspectives, for metaphysical conceit, for wit . . . Now is a time for simplicity. Now is a time for, dare I say it, kindness."

Friday, February 15, 2008

Being Boring

If you ask me 'What's new?', I have nothing to say
Except that the garden is growing.
I had a slight cold but it's better today.
I'm content with the way things are going.
Yes, he is the same as he usually is,
Still eating and sleeping and snoring.
I get on with my work. He gets on with his.
I know this is all very boring.

There was drama enough in my turbulent past:
Tears and passion-I've used up a tankful.
No news is good news, and long may it last,
If nothing much happens, I'm thankful.
A happier cabbage you never did see,
My vegetable spirits are soaring.
If you're after excitement, steer well clear of me.
I want to go on being boring.

I don't go to parties. Well, what are they for,
If you don't need to find a new lover?
You drink and you listen and drink a bit more
And you take the next day to recover.
Someone to stay home with was all my desire
And, now that I've found a safe mooring,
I've just one ambition in life: I aspire
To go on and on being boring.

- Wendy Cope

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