Truthsaying: The need for honesty from patients & doctors: session # 5

With themes of truth & hope underpinning the session, it being International Men’s Day, we read texts mostly by women about pregnancy, labour, babies and girls!

We started, though, with a run through Yeats’ ‘Paudeen’. They’re getting there. We had a recap on last week, and a summary of Maeve Binchy’s ‘Anna’s Abortion’.

From that we read and analysed an extract from Emilie Pine‘s ‘From the Baby Years’ section of Notes to Self. The extract dealt with the loss of her one and only pregnancy. We discussed how particularly invested Pine was in the pregnancy (“I see that I’m shaking”) and how that comes through in her hope & wishful thinking in the face of contrary information/evidence > “Maybe I am wrong. / Maybe the date is wrong.”

We discussed how despite our ideals of professionalism and standardisation, we nonetheless often sense and operate by other, more human realities >

“I have a moment of hoping this coincidence [of going to the same university as the doctor] will make her well-disposed towards me”.

We mentioned how bizarre it is how we often act contrary to our truths, pretending because of not wanting to reveal our uncertainties or to risk appearing not in control > “I pretend like I’ve done this before”.

I emphasised how honestly Pine was recounting all of this now as the narrator. We discussed the contrast between how Pine is aware of the constraints on the staff when it comes to pronouncing the still growing foetus dead, and her actual anger >

“I am furious. At the situation and, specifically, at them. I am a woman, in grief, and these women will not look me in the eye as a fellow woman and tell me that I’m not going to be a mother.”

We discussed the possibility that shame felt by the midwives was behind their failure here. We discussed the blunt honesty of Pine’s admission of how she felt observing the pregnant women outside the National Maternity Hospital > “I would be a better mother. I deserve it more.”

I emphasised how honest a writer she is in her retrospective analysis of her actions and thoughts >

“I am so deep into this that I don’t even see the problem with comparing not being pregnant to a serious illness.” And I therefore suggested she was a welcome/useful voice to hear in the context of how complex the doctor-patient relationship can get, with two flawed “entities” contributing to it. (It is too often presented over-simplistically as rude doctor failing innocent patient.)

~

We moved on to Maggie O Farrell‘s I Am, I Am, I Am, specifically an extract from the chapter called ‘Abdomen 2003’ that recounts the birth-plan for and delivery of her child. (I used the adapted version published by Time magazine.) We discussed how incredibly rude (almost literally: not credible) the consultant, Mr C, was. I paused on and parsed the sentence: “I wish now I’d left there and then, but at the time I was so astonished I complied.” I asked whether or not O Farrell was being as retrospectively honest as Pine here. Was it just astonishment?

[I diverted for a moment to read this important passage from Pine’s last chapter:

The stinging irony, of course, was that my entire talk was about ways that women are intimidated into silence. And here I was, with a platform to speak [having just given a lecture on the silencing of women about rape], finding myself with the same difficulty. The Faculty Chair’s comment [“I find it hard to reconcile how you look and your manner with your subject matter. I mean you look … I don’t want to use the word ‘cute’ but …”] implied that I shouldn’t be talking about rape. It is more than just tedious, this women-should-be-seen-but-not-heard attitude. It is a way of telling women to back to where they belong, back to being silent. I am gobsmacked that I still encounter this attitude in the university. And I am, most of all, weary of having to come up with something in response. I should have called him on his misogyny. But in the moment that he said it, I did not even allow myself to think about the implications of his comment. I wanted to look professional. I wanted to seem strong. I wanted to move on. As so I side-stepped. Which is, of course, a kind of silence.

I suggested Pine’s analysis was possibly true for the O Farrell situation too.]

The reappearance later in the episode of Mr C as O Farrell’s “saviour” was useful in setting up the idea that sometimes the rude doctor is all we’ve got, and maybe we just have to learn as patients how to deal with it, how to communicate with them to protect ourselves.

We contrasted, as O Farrell clearly intends, Mr C with the stranger in beige scrubs who comes to her emotional rescue while “a room full of people … are frantically working to save [her] life.” > “He stepped towards me, away from his wall, and took my raised hand. He enfolded it in both of his. I gazed up at him mutely. His touch was infinitely gentle but firm and sure. He stayed with me while they stitched and stapled me together again; he took the weight of my head and shoulders as they lifted me from the operating table onto a gurney.” [Italics added.]

~

We then read & analysed a story written by a man, Yay! (albeit a Michael Longley type of man > “I’m finely attuned … to the feminine side of the men I like. I really don’t like men who are pumped full of testosterone. I like my men to have a large dose of the feminine virtues.”) ‘The Girl with a Pimply Face’ by William Carlos Williams is one of my favourite texts to discuss with medical students because at first the male doctor’s sexualised descriptions of the teenager he meets on a house visit (“She had breasts you
knew would be like small stones to the hand”) make him seem just “creepy” (as was said today). We analysed the story in considerable detail and discussed too many things to summarise here, but with similar themes as above, of honesty, truth telling, self-awareness … and the sources of hope amidst all the negativity and human failure.

The girl with acne acts like Pine & O Farrell wish, with hindsight or in the very moment, they had acted.

The Williams story is set in a poor, immigrant neighbourhood where people from socially disadvantaged situations do what they have to and can to survive. The doctor too. He (like Sassall in Berger’s A Fortunate Man) in the identifies more with them than he does his colleagues, and he sees in the teenager a sign of something that offers hope. (“She was just a child but nobody was putting anything over on her if she knew it, yet the real thing about her was the complete lack of the rotten smell of a liar.”)

~

To emphasise the socioeconomic angle of this (and of the Berger text from last week), I read the only poem of the week, Julia Donaldson’s brilliant version ofThe Magic Paintbrush (with equally brilliant and clever illustrations by Joel Stewart, which I showed them as I read):

"He slips the brush into her hand
And tells her to be sure
Never to paint for wealthy folk
But only for the poor."

I say straight up to them, emulating as best I can the girl with pimples: what if the paintbrush is your medical qualification and what if we told you only to treat poor people. That stirs things up a good bit. I tell them class is over.

Student notes on William Carlos Williams’ Doctor Stories

(by brennc26@tcd.ie)

The Girl With the Pimply Face:

The Girl with the Pimply Face is a short story unlike any other extracts we have read this semester. In my opinion, the main themes presented to us in this story are the themes of compassion and discrimination.

From the very outset we are presented with the theme of discrimination through the druggist’s discriminatory remark ”But they’re foreigners and you know how they are.”  This remark serves to marginalise the sick baby from the very outset. The narrator of this story serves to refute this discrimination however as he personifies the theme of compassion. Although he was “just sitting down to lunch”, he still succeeds in reaching the patient’s house by two-thirty and expresses no anger on discovery that no one is home. What I found interesting about this narrator was his non-judgemental character. Unlike the druggist who seemed rather dismissive, the narrator reserves all judgement regarding the foreign immigrants. He does not look upon the fifteen year old girl with disgust or scepticism but instead retains a high degree of respect for her. “Boy, she was tough and no kidding. I fell for her immediately”.  His sense of compassion is inherent in his ability to recognise her “excellence”- a complete contrast to his wife who later regards her as a “Pimply faced little bitch”. Throughout the story, “The Girl with a Pimply Face” is extremely unhelpful as she seems “indifferent as though it had been no relative of hers instead of her sister” and yet the doctor expresses no frustration and his adulation shines through as he describes her as “A tough little nut finding her own way in the world.” He seems to perfectly encapsulate “the Art of Medicine” as not only does he wish to help the baby, but also expresses concern regarding the young girl’s leg.

Although the doctor seems compassionate and intent on helping his patients, he still harbours pre-conceived notions regarding the immigrant family. This is thrown into relief as he assumes that this baby has been somewhat neglected”No doubt it had been in a bad way before that, improper feeding etc,etc.”.  He is also somewhat short regarding the mother and makes little attempt to comfort her or to even fully explain the situation.

The theme of discrimination is encapsulated in the wife’s reaction upon hearing the narrator’s story. She seems strongly opposed to such “charity work” and is immediately sceptical “Did they pay you.” She seems intent on demonizing the immigrant family as she retells Kate’s story. I feel that this character serves to reflect the discrimination inherent in society. This sense of prejudice is later emphasized as a fellow doctor expresses outright disdain for these Russian immigrants. I feel the author sets up a parallel between the narrator and his more sceptical colleague in an attempt to highlight the narrator’s compassion. The narrator’s compassion is in complete contrast with his colleague’s caustic criticism as he describes the immigrant mother as a “bugger” and the daughter as a “pimply-faced bitch”. The narrator even defends the mother’s actions by describing them as “Natural maternal instinct” to which his colleague replies “Whisky appetite, if you should ask me.”

The story ends with a final visit to the immigrant family. The narrator’s sense compassion is clearly unblemished by his wife’s and colleague’s advice. This is apparent in his unbridled admiration for the fifteen year-old “ A powerful little beast”.  It is obvious that the narrator does not seek monatory reward but is instead content with the sense of satisfaction which comes from helping others”God it is I said. And it was much better.” The story then ends with a sense of hope for the young girl as she returns to school. I feel that this ending seeks to highlight the importance of compassion, especially in healthcare.

The Use of Force

“The use of Force” is somewhat different to “ The Girl with The Pimply Face.” “The Use of Force” by William Carlos Williams addresses the exertion of physical superiority over others, asking the fundamental question: is it ethical to hurt someone for his own good? While “The Girl with the Pimply Face” displays a straightforward kind of compassion, “The Use of Force” shows us that compassion is not always straightforward. From the outset, the doctor displays patience as he tries to coax the young girl to open her mouth. When he realizes the futility of his approach, he gives the child an ultimatum “Will you open it now by yourself or shall we have to open it for you?” Williams’ choice to use interior monologue as a “stream-of-consciousness” tool reflects the narrator’s experience of dialogue and gives insight into the character and his appraisal of the situations he encounters. It is through this “stream-of-consciousness” that we come to realize the assertive nature of this doctor’s actions. This is seen as he steels himself for a battle “I had to do it. I had to have a throat culture for her own protection.” It is obvious then, that this doctor is committed to helping this child and his determination of purpose is untainted by a fear of hurting her. This is in contrast to the child’s father whose fear of hurting her impedes his ability to truly help her. The child’s mother is equally inept at helping her child as she cannot restrain her for fear of hurting her daughter. I feel this is highlighting the doctor’s strength of character, unlike the child’s parents. Williams creates the typical setting of tentative and indulgent parents contrasted by the assertive actions of the doctor and so we realize that doing what is best for someone is not synonymous to what is kindest. As the situation demands the story is told with wit and wry humour: ‘the damned little brat must be protected against her own idiocy, one says to ones self at such times’. The awkwardness of the situation is diffused using this humour: I could have torn the child apart…it was a pleasure to attack her…’. Here Williams presents the theme of the varied life of the doctor; in this case attempting to get a throat swab and having to battle wryly against the odds. It is a wonderful snapshot of a minor incident in the life of a doctor and outlines in a very humorous way the all too human thoughts of the doctor. The story also presents enjoyable cameos of human nature: the uselessness of the indulgent parents, the frustrations of the doctor  who is all too aware of human nature and above all the utter determination of the young girl who stubbornly refuses to co-operate. Embedded in the story is the theme of the life of the doctor entails-for all his glory and knowledge, he is still a mere human and is not immune to human fallibility.

Despite his all too human faults, I feel the story serves to highlight the heroism of this doctor as he understands that what is best is not always what is nicest.

 

JEAN BEICKE

This story is set in the USA during the Depression years in a children’s hospital where children who are the victims of poverty or unfortunate circumstances are nursed. The themes addressed are the issues of poverty, hopelessness and social decay, alongside the plight of a doctor who becomes outwardly cynical and disrespectful while at the same time managing to maintain a sense of duty and determination. The narrator doctor presents themes of poverty and social breakdown alongside the theme of his own personal battle against cynicism and fatalism balanced against his innate professional sense of duty and determination.

The narrator of the story is a battle-worn doctor who sounds overcome by a hopelessness that borders on outright cynicism.( I was taken aback) There are times in the story when the language used by this doctor makes the reader want to cry out at the wanton callousness of his observations. He refers to his child patients as ‘brats’ and observes that one child might grow up to become ‘a cheap prostitute…your country needs you, brat’. The story is masterful however in that beneath this exterior disregard for the dignity of the children under his care this doctor reveals an inner conscience and a determination that shines some light of hope on his desperate and fatalistic pronouncements. This doctor character is used to convey the desperation of the times and the strains that such social breakdown places on the doctor as a professional.

He paints a picture of a society in freefall. Many of the unwanted children in his care come from poverty in minority families – Hungarian gypsies and the Irish are cited. Yet for all the desperation and disregard portrayed through the eyes of the narrator we also glimpse themes of real hope and humanity. The care of the nurses’ shines strong – they care for the children as if they are their own children. One nurse cannot witness the post mortem of a child she has cared for. And despite himself the narrator doctor takes pleasure in the progress baby Jean Beicke makes as she gains weight and sleeps and feeds. He describes her blue eyes and shows real determination in caring for the child. He pesters the ‘ear man’ to inspect the child’s ears and he agonises over the failure to make a clear diagnosis. When all is lost and it becomes clear the child will die he cares enough to organise a post mortem to establish the cause of death and to learn for the future. He is scrupulous enough to call the ‘ear man’ in for the autopsy so that he too can benefit by discovering the real reason of death. In the words of the ‘ear man’ it was ‘a clear miss’. Perhaps the determination of the outwardly cynical narrator may save another child from a similar end.

There is also another theme that saves the narrator doctor from his own outward cynicism – that is his determination to reveal and highlight the social conditions in which people are living. When it becomes clear that baby Jean will die he makes sure to get permission from the child’s aunt to have an autopsy carried out and this is done in a discreet and sensitive way. Furthermore, the narrator of the story is careful to use the character of the aunt to tell the story of the desperation of baby Jean’s mother who is abandoned by her husband. In taking care to tell the full story of people caught in desperate circumstances he informs the reader of the real story of the Depression era and does not simply present a sentimental or judgemental presentation of the themes and issues. Behind the dreadful battle-worn pronouncements of this doctor lies a social conscience – could it be that the fatalistic and disrespectful language this doctor uses is a product of a social conscience that has left him burned-out and mentally bloodied? Bloodied but unbeaten in that he maintains a professional concern and determination to achieve some good and he possesses the humanity to appreciate the loving care of the nurses who he works with and to take real pleasure in a patient’s progress.

This is a masterful and fascinating story in that the language this doctor uses is shocking, downright disrespectful and unacceptable – yet it is this very shock value that conveys the desperation of the social conditions people live in and in this way our narrator doctor goads us into having a social conscience too. ‘Vote the straight Communist ticket’ he announces wryly and sarcastically at the end as if to say when all else fails we can always turn to the Communism! William Carlos Williams is determined in this story to present his themes of social and personal desperation and breakdown in a way that will shock and stir us into empathy, and hopefully action.