One should not identify with the patient's despair, but with the life there is in him, with his profound desire-even if it is mutilated, deformed, or hidden by distress-to get better and live. He must understand that I take his pain and his bad feeling seriously, but also that I am "armed" to struggle with him. (Even in the care given to comatose patients it seems that communication via talking and touching can have positive effects). I insist on this "with him" because I have often heard very competent doctors refuse to explain anything to a person burdened with uncertainty and anxiety, to rebuff him if he insists on "meddling with 'his problem.'" "Let me do my job. I know what I have to do." I admit that there are some personalities, if not at death's door, anxiety makes difficult to hear. However, with a bit of patience[horizontal ellipsis]but one must find this patience and exercise it.

For each time I fail to return to the vitality of a particular life, I lose a friend. Someone who believed in my power and competence which consists of an assortment of provisional knowledge, practical experience, and intuition. Between us on this decisive path that we walk together we established a closeness which has indelibly inscribed itself in the web of my life. I forget the names, but the faces, looks, and the expression of a desire to live come back to me.1^(p170)

In his Hospital Notes, Lorand Gaspar, noted French poet and surgeon, shares with us his philosophy of practice. In his medical practice as a physician and surgeon in Tunisia, he witnessed the disease of poverty, war-related injuries, and the ravages of infectious disease epidemics. Here, in his own words, we come to realize how it is that he prevailed in the midst of such sorrow and suffering. He has found through desire and will each individual human beings wish to "live and get better." He has seen his association with each person as a partner in the person's struggle to live and that he and the other are on a journey together. He chides healthcare practitioners who cannot or will not listen to the patient, most especially those who are laden with anxiety and fear. He deplores the fact that there are clinicians who essentially say to patients "Let me do my job," as though the information and knowledge coming from the patient has no importance in the design of therapeutic care. Gaspar reveals the implications to our personal and professional lives if we as nurses or doctors resort to this perfunctory practice that ignores the humanity of the other. We then do not experience the vitality of a particular life. Those who seek our care and concern depend on our "provisional knowledge, practical experiences, and intuition."

Those of us who have had the misfortune to become or be ill have not escaped the healthcare practitioner who does not have the capacity to acknowledge our humanity and who views individuals as poor unknowing people in need of advice and direct orders for proper health behavior. There is "no man to man talk. You are no longer a man, a familiar. You are under the force of a decree that took away your identity, like customs agents taking away all your papers."2^(p171)

In this situation, one's fears and mistrust are heightened; the mind is numbed. Accurate information on symptoms and personal knowledge about past and present health cannot be retrieved. It would not be remiss to say that this leads to second rate care, which is costly in terms of human emotion, time, and money, for medical mistakes will surely be made and its consequences must then be endured. The lack of accurate information may lead to inappropriate prescribing of pharmacological agents, which may lead to a new set of symptoms, which then must be treated.

Instead, let us ponder what calm discussion provides. The afflicted and the ill are given the opportunity to respond fully, sharing their point of view, their values, and their sense of what happened, what is happening, and what it means to them. In this honest and open atmosphere, they, then, are able to exchange valuable thought with the nurse or doctor and both can understand and learn from one another. This open exchange thus leads to both more humane and more practical results.

References