"You Should Have Met Me Before..."

I'd been hearing great things about a certain patient, a young woman, but my previous attempts to meet her had fallen on bad timing.

I always get a little nervous approaching a patient for the first time... I never know who I'll be meeting, what state she'll be in, especially at the early stages of diagnosis.  Overwhelming emotional storm?  Breakdown?  Confusion?  Denial?  Contradictory, shifting affect?  All of the above? Will she even register our introduction, or -- often as not at this early stage -- will she mistake me for a physician or nurse, and set forth a litany of disjointed questions about medicines, central catheters, fevers? 

But yesterday morning, there was G, smiling, inviting me into her little corner of the outpatient clinic.  Is this a good time? I ask.  Of course!  Why not? is her immediate answer.   She is already succumbing to the soporific effects of the meds she's received, but with little encouragement she gushes into a brief description of herself.   She has this job and that hobby. She is involved, engaged, active.  

You should have met me before.  I was the athletic type.  I used to run, do aerobics all the time. I was a teacher, I had a whole class of kids, ran a whole educational program.  I love art, love to write.  

I'm trying to keep up, listening at 100 km/hr.  I tell her we can offer her art therapy, bibliotherapy.  Meanwhile I'm noting all the was's and used to's.  That part has me a little worried;  she's only just begun treatment, and she's already left central parts of her identity behind.  She is clearly a doing person -- and for now, she is not doing, therefore she does not feel fully herself.  I can relate, all too well.   

I weigh my options.   Do I remark on the used to's, thus beginning the teeniest intervention without having had the time to really meet her, or do I let it go and make a note for later?  

Her oncologist steps in to inquire about her general welfare, and I gain a few more minutes to think, listen and decide.   I am impressed with how readily and directly she describes the recent state of her digestive system.  After all, he may be a physician, but he's a guy, and she's a young woman... who seems to understand the value of accurately reporting her physical state.

He goes, and we resume our conversation.  Meanwhile, I've made a decision.  You're still a teacher, you know.  You're on a break from teaching, but you're still a teacher.  And it really shows that you're an energetic, athletic person, despite all these tiring treatments.  We move into a brief discussion of what it means for her to be forced into this unwanted break from her active life.  At this first glance, she seems to know exactly what her limitations are, and what she still can do.  She is eager to move forward while she can.

I want to learn some art techniques, and I want to meet the bibliotherapist.  We should get started, right away.   But for now you'll have to excuse me, I'm a little stoned from all these drugs, I think I'm falling asleep...

I tell her it's been a real pleasure meeting her and excuse myself.   Her enthusiasm and optimism are contagious, and I find myself smiling as I exit the room.  I'm so happy to finally meet her,  I mention as I pass her oncologist. What a fantastic person. 

He looks up.  Don't get too attached.  Looks back down at his paperwork.

A sudden rush of air, and all that contagious enthusiasm has collapsed.

He means well.  Maybe he was just trying to look out for me, or for himself.  And yes, I am aware of the dangers of her illness.  But getting attached is part of the work.  I can't do my job without it.

Anyway, it's too late.

Keep the balance,

ALN

"Maybe I Should Write About It..."

I know, we're not supposed to have favorites.  Or at least, we're not supposed to show them.

But I won't lie to myself, or to you.  I have favorite patients.   And they're not necessarily the sweetest ones, or the friendliest ones, or the ones that always draw a crowd of staff members and volunteers, because they're so darn cute.

OK, I like those patients, too.  I love them, really.  But they aren't my favorites.

My favorite patients are the ones who tell their stories, share their lives, plunge the depths, with an authenticity that astounds.  It expresses itself, often as not, through a mighty silence, a reclaiming of their lives via quiet refusal, or restrained acknowledgement.

T is nineteen years old.  He was meant to have graduated high school last year with a diploma and a qualifying certificate in electronics, but he didn't make it back to school to finish his senior year.  

Meanwhile his hair has grown back, springy dark corkscrews that he still feels a need to hide under a baseball cap.   During last week's visit he was short on patience, fasting before a procedure, so our conversation was brief and centered around Spanish football teams.

This morning, though, T is feeling much better, sitting in Outpatient waiting for his regular check-up, and --surprise -- he wants to talk.   I ask him about the Sidge festival two weeks ago, a holy day for Ethiopian Jews, during which they celebrate aliyah and gather to pray for all Jews to return to the Holy Land.   T claims not to know too much about it, then changes his approach.  

What kind of respect do you think olim deserve? he asks me.  Point blank.  Immigrant to immigrant.   No beating around the bush, and no whitewashing.  

I think immigrants like me, from the United States, get a lot more respect than immigrants like you, from Ethiopia.  

He responds by giving me one of his fantastic smiles that announces:  At last, the truth comes out!  We discuss the discrepancies, the race-based unfairnesses.  We don't get into too much detail, since T is the type that likes to hint at things before laying his trust on the line.  With him, you gotta earn it, over and over.

You know, when we get here, they don't even recognize our university degrees.   No, I did not know that.  I also had no idea that T attended school for the first time only after moving, at age twelve, from his rural village to the far away city of Gondar.  He's telling me this, and I'm imagining a preteen, illiterate village boy falling like Dorothy into a foreign world whose very name sounds nearly Tolkien.  In Gondar T studied math and learned to speak a few basic words of English, though this barely helped him two months later when he arrived in Israel.  My mouth was already too old to learn to speak right, he explains, sticking his tongue out and demonstrating the difficulties he had, shaping that adolescent mouth into the words of yet another set of foreign sounds.

How many times can one kids move?  Multiple times, it turns out.  Once in Israel, he moved from an absorption center in the South to a development town in the Center, to a dormitory trade school along the West Coast, and then... leukemia.  Back down south for treatments. Recovery, and back to school.

Relapse.  

New hospital, new people, new living situation.  T recounts each step but leaves the details behind.

I'm sitting there, trying to follow all of this while keeping track of the number of times he moved in a span of six years.  So far I've counted seven.

Eight, he corrects me, and hints that there were more, prior to his family's move to Gondar. He pauses.  I've been thinking, maybe I should write a book, about all those moves.  

Pretty impressive idea for such a private person.  You'd be good at that, I tell him. Especially since you've been through things no one else has.  He faces me with that intense glance of his. What do you mean?   

He's not looking for me to tell him something new, of course.  He's testing me.  Not as a rebellious teenager, but as someone who has been through so much, he's almost given up believing that anyone else could get it. Especially a Western immigrant like me, with my light skin and state-recognized diplomas.

Well, you're different from most of the other people around here, I continue.  For one thing, you come from a different place, and you can't hide that.  Everyone sees it, right away.  

Now T is staring. What else? he says, waiting, so I continue.  

Beyond that, you've been through all of this.  You know what to expect -- the treatments, the tests, the pain, the complications.   You understand the threat hanging over your head, better than you ever did before.   I pause.  But there's one more thing, the most important thing of all.

He looks astounded, transfixed.  

You're different from other people.  Your personality is different.  You see the people around you;  you see a lot and you notice things.  But you don't jump to open your mouth and talk about it.  You keep your observations to yourself, until you know you can trust someone, and then --  maybe -- you share your thoughts with that person.

His expression says it all:  This revelation, this conversation, is the real thing.  This person might just get it, just a little... so maybe sharing one's inner thoughts and feelings is worth the occasional risk.  

(It's a risk for me, too, not having a direct way of understanding T's thought patterns until he --  or I -- voice them.  A serious misreading of his emotional and cognitive process would only have further isolated him by enforcing his belief that others cannot understand him).

Later on, I offer to help T start the writing process by typing into the computer as he narrate. He hesitates.  As with everything else, he wants to think about it first, on his own, and get back to me. 

We agree to discuss the option the next time we meet.  

Keep the balance,

ALN