Does it hurt?

I’ve been reading Liz O’Riordan’s blog. Wow – it’s powerful, awesome (in the basic meaning of the word), compulsive reading. We get to see breast cancer up close and personal, though the eyes of a person knowing it and fighting it. But I am also reading it as someone interested in medicine, writing about illness experience and medical practices. In a way, I think this blog should be compulsory reading for students of medicine and psychology. What I will say below is (partly), why I think that.

It was already in the second post that something struck me, and so I decided to write this (I’ve been writing this for quite some time, as I wanted it to be what I want to say). I might write more, I don’t know. Incidentally, I would like to note that because of the very personal nature of the blog, I contacted Dr O’Riordan asking for her permission to write about her blog. She was very kind to grant it – thank you again.

Before I start, I’d like to tell you about one of the interviews I carried out, when I was collecting data for my book on Men’s Discourses of Depression.  At the time, the man I interviewed, was in a closed psychiatric ward, diagnosed with the depressive episode (recurring) and after a suicide attempt. As he later told me, he agreed to talk to me, because there was nothing else to do.

So, I was sitting in a doctor’s room, when the door opened and I saw a man in his pyjamas. It was his own pyjamas, not standard issue, and they were of good quality. But there was a problem – although not transparent, the thinness of the cotton made his genitals quite visible. I am not certain, my interviewee was embarrassed – I think, he really was beyond caring (it was the second time he tried to kill himself, after his only child had been killed by a car).  Yet, I was quite embarrassed, as I immediately started to think of  situations, I would show myself to a stranger in my pyjamas. I could not come up with any. And yet, this man had to, as the consultant in charge of the ward decided that depression was an illness like any other (you know, chemistry in the brain), ill people are in bed, in bed you are in your pyjamas…. I won’t comment.

This encounter with a man in pyjamas made quite an impression on me. And ever since then, I have been saying at every appropriate opportunity that trainee clinicians (whether doctors, psychologists, or nurses), should spend at least a week a year coming to university in their pyjamas. The staff would be fully clothed, of course. And I talk about trainees, because those already trained would not even consider it.

Now, let me come back to Liz O’Riordan’s blog. As I was reading the second post (I am well beyond that now), one of the things she wrote, struck me, like, wow! She wrote:

I need a biopsy – I tell patients it doesn’t hurt, but does it?

This is the previous two paragraphs summarised in half a line. But this is also half a line which, really, shows what is I think a crucial tension not only in the blog, but also, possibly, in medicine. It boils down to the following question: How do you, as a doctor, look at the world through my, your patient’s, eyes? Do you actually know, how it hurts? Do you know, what it means to be ill? For me, not for her, him, them, or even for you, but for me!! Do you? (Imagine me saying that like Clint Eastwood in Dirty Harry)

In a later post, Dr O’Riordan writes:

I was still thinking how I would advise myself if I saw me in a clinic, and how I would treat me surgically, instead of thinking about what I actually wanted.

Once again, in a sentence (longish, admittedly), O’Riordan shows the tension, I am trying to render here. She inhabits two identities which you can see through what she says – she is both a doctor, and a patient, though the patient is only just being constructed. Separate now the doctor and the patient, see them as two different persons, and you will see the problem.

For linguists interested in medical stuff, the problem was described by Elliot Mishler. He described the medical interview as a clash of two languages – language of the lifewold (patients) and language of medicine (doctor). The doctor is tasked with translating the former into the latter. But Liz O’Riordan’s blog shows the tension as going way beyond issues of language. Her blog, I think, shows really ….impossibility of medicine. As you cannot look at the world through my eyes, through my pain, suffering, what is our relationship going to be based on?

Of course, I have no answer to such a question (there is the narrative spiel, I could give here, but it’s too obvious to write about), I really wanted to make the point of how difficult it is to be a patient, but also how difficult it is to be a doctor. Because to a considerable extent we are sitting on two sides of a window pane and try to communicate through it. And as I try to make you understand and you try to understand me, our efforts are at least partly doomed.

If you read this, you might understand how infuriating it is to hear the blasted ‘outcomes’, the NHS and all else seem to be interested in! How do you talk about ‘outcomes’, if you can’t even understand, how I feel!

A couple of months ago, I had an appointment with my GP. He was running very late, I could see the patients in the waiting room getting more and more irritated. To be honest, so was I – I was pressed for time. Finally, about 50 minutes past the time of my appointment, my name appeared on the screen (to inevitable reactions of some patients – I must be the migrant scrounger breaking the NHS), and I went to see the doctor. I could see, he was preparing for another patient who would tell him how unacceptable…. He tried to pre-empt it by telling me that he had had to spend the time with a patient who needed it. To his  astonishment, I said something like: “No problem, I understand completely. I hope you will also do it, when I need it”. In his bewilderment, he said I was very likely to be the only patient with this attitude.

So, there you are. If I can do it, perhaps you will consider wearing your pyjamas during your training for a while. So you can look at the world also through my eyes. At least a little.


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