Dr Arianna dell’Anna is a specialist in Gynaecology and Obstetrics. She also obtained a Master’s degree in PNEI and a Master’s degree in Narrative Medicine.
“Being a doctor is not a profession….
and what is it?
I don’t know…
Some kind of curse.”
Two doctors tell each other their disappointments, smoking a cigarette, on a terrace of a French hospital, in Hippocrates, a 2014 film directed by Thomas Lilti.
In order to write about trust, I had to rethink my story, the last 20 years of medical practice, I looked for films that could evoke images and memories and in Hippocrates I found my hook.
Being a doctor is “a curse”, as the film’s co-star provocatively says. The pain of listening to the other person, at times, seems like a condemnation, a burden, forcing one to make choices that are not always understandable, objectifiable, scientifically reproducible. Being a doctor means being a doctor, and to be a doctor you have to lose yourself: you have to tattoo your scrubs on your skin and sleep with them, you have to trust yourself and others, you have to bear the difficulty of not being “able”, the feeling of impotence that pervades each of us when we are unable to understand or advise those in front of us in a course of treatment.
To be a doctor, one must betray, that is, have the ability to advise and choose for the good of others, to the detriment of our own knowledge, beliefs and prejudices.
One has to betray oneself countless times to understand who one is dealing with, to establish a relationship of trust with the patient and/or his family.
When you start working as a doctor, the patient is something else, there is an enormous distance that protects, saves, prevents the young mind of a resident from crumbling. The younger one is, the more one is convinced of being able to frame the patient in rigid and fixed schemes, and that it is all in all easy to follow the guidelines. There is only one track and one train. One almost never betrays oneself, one trusts oneself, the books, the professor, pubmed. Being a doctor is a profession.
But then suddenly something happens, doubt creeps in, the ivory tower of Medicine begins to crumble, a mistake is made, the distance with the patient decreases. In this phase the confidence in oneself and one’s own abilities starts to waver, one can look at the other as an enemy, who pins us down in front of a film we do not want to see, who makes us feel inadequate. There is no longer a single track, but several paths, there are smells, tastes, screams, voices, cries, sighs, rain and sun. The landscape changes, we change and our relationship with others changes.
In order to regain confidence in ourselves, we have to accept the impotence, the sleep, the extreme fatigue of relating to those who are not like us, those who have studied less or more, those who live on the fringes or those at the top, we have to look at the world of the other and make an alliance. Finding a meeting point with the other requires observation, it requires time. It is necessary to have colleagues or staff around to give food for thought or build bridges.
The health care team that is created is the fundamental prerequisite for healing and listening; alone it is more difficult to observe the many facets of the person in front of you.
Treating is a creative act, which depends on study and the luck of meeting good teachers, but also on personal talent and the unity of the treating team.
The smell is where we start. The other person’s smell and our own generate the first dialogue, silent, subtle, violent. What do we smell of in our gowns or overalls, of betadine? Of chlorhexidine? Of starch? And the patient, does he smell? Has he washed himself thoroughly? Does he care? Or does he let go, he stinks. We can smell it if we get close. Yes, but how close can we get?
The look. The gaze, it seems to enlighten us, we see our patient and he looks at us, our mind elaborates that information and makes us immediately put who we have in front of us in a category that guides us in the diagnostic process (Stigma, the denied identity.1963. Erving Goffman). How much can we trust the gaze? How much does it betray us? How much does it influence us? What does the patient see in us? Do we look trustworthy if we have a trimmed beard or proper nails, or will he trust us more if we look unkempt because it means we study a lot? What does our hair – close-cropped, long, short – say about us?
The voice, warm, cold, sharp, imperative, desperate, we manage to modulate it, we manage to catch the vibrations of the other’s voice, we manage to be reassuring, convincing, and the patient manages to explain his symptoms, manages to modulate his voice and what does he tell us?
Touch, we touch other bodies and other bodies touch us, we caress ourselves sometimes, other times we hit our belly, chest, kidneys. We are gripped by a hand that restrains us, that tells us that it hurts, that this is not right, or that our touch is delicate, that it is OK.
Each time we start again, each time we lose and find ourselves, each time we meet and clash and change.
In the process of being a doctor, the tower of medicine, with its guidelines and evidence-based medicine, becomes a reliable refuge, to catch one’s breath and re-immerse oneself in an entropic reality.
In this we trust, challenge and rely on each other.
I’m in hospital, like many afternoons in my life, I’m on call and I don’t really want to work.
Afternoons spent locked up in hospital weigh on me immensely, it seems to me that I am wasting my time, the world outside is going on, running, I am locked up within the usual walls, in these old, badly furnished, badly tempered rooms. I am listless, I rest a little, I am tired even of resting, I look out the window, the sun is shining.
At this time in spring many people are at the seaside, others are resting, others are still eating.
I am here, on call, in this hospital where nothing new can be breathed in.
They work little, they work badly, they are all old, dull, I feel bored.
Few things manage to excite me, very few things excite me.
That’s how medicine is, it’s all a question of the team, if you play in Serie “E” you struggle more than if you play in Serie “A”. I continue to play, I keep myself informed, I try to talk about science with colleagues, with patients, but almost always everything falls on deaf ears, never a relaunch, never something new. My dreams were something else, in my dreams people fought for Life, people joined groups and helped others, I didn’t know the “who makes you do it, this bitch, the golden asses”, in my “Candy Candy” dreams the patients were all the same.
So much the same that they no longer had an identity, just patients, then with time I understood, I felt that they were people, like me. I oscillate between being a patient and a sick person, I oscillate continuously, in and out of giving an answer and receiving one, doctor-patient, doctor-doctor, patient-patient. A schizophrenic circle, I feel the pain of others, I see it from afar, it stinks, I plug my nose, I squeeze hard, I already have mine, I can’t avoid it, it pushes from inside, it still screams sometimes, I hate it when patients complain about bullshit. I hate the fearful tears, come on lady it’s nothing, let’s do the therapy and it will pass, come on.
Real pain is silent, doesn’t say anything. I have never said anything.
I always ask myself why people want to heal if they don’t want to live.
I have never prayed for healing, but I want to live.
Doctor, a first aid consultation – whispers the nurse on the phone. I get fed up, I’m already seeing other women, she interrupts me. Come in ma’am, have a seat, what’s going on – I have some pain and some bleeding – I quickly read the request for advice on the monitor, I read 6. I think what do you want it to be – ma’am get changed, nurse takes ma’am to undress, back there, take off your trousers and panties. I have said this phrase too many times, take off your trousers and panties, push out your panties, how boring to repeat it, how boring, even the panties???? Yes ma’am, I’m not an eye doctor, you have to take off your panties.
You ready? Yes, Doctor, she’s ready. Ma’am, you’ve had more tests, haven’t you? Have you? NO! She’s probably the usual freeloader who comes to the hospital to diagnose a pregnancy, but what kind of manners are they, always like this. Ignorant and pregnant. I tense up, my face souring, preparing to lecture her about using the emergency room. There’s covid, you don’t come to the hospital without a valid reason. It bothers me to wear all that protection, not at all, I would kick her out of the room screaming loudly.
You have to lie down on the couch, open your legs, your feet, I said your feet in the stirrups, your feet, not your legs!!! Oh, my God, she’s so fat, my God, how do you do it.
Can you tell me when was your last period, madam? November? November?! It is the sixth month not sixth week of pregnancy then, how is it possible that you haven’t had any check-ups during these months, are you crazy? Are you unconscious? Madam, will you answer me?
I don’t know, doctor. There was covid.
I understand, but… God… how can we now understand the course, but this is the first pregnancy?
My third.
What do you mean, my third? So you know you need to be tested?
Yes
And how did the others go?
The last one died.
What do you mean, died? When?
He got tangled up in the cord.
But when.
I don’t know, a while ago.
When
Don’t know
Madam, look at me, will you answer me?
Nothing, she doesn’t say anything, she looks at the ceiling of the room, nothing, I didn’t understand anything, I’m scared, I didn’t understand, I look at her, she looks elsewhere, I look at her, she’s not there, so I look at her labia, I look for the hole where to slide the probe, she doesn’t resist, I go in and I see, there’s nothing, there’s nothing, no embryo, no fetus, nothing will be born.
I sweat, I check again, I sweat.
Madam have you ever had any bleeding, any bleeding?
NO
Have you had any pains?
YES
Did you feel the baby moving?
YES
Are you sure?
YES
Listen, madam, what is your name?
Chiara
I change my voice, it breaks, I try to switch to another register, I didn’t understand, I didn’t feel that pain, I was numb from my own, from boredom, from fear. I am a doctor, I am a doctor, I change my tone, my voice is now soft, the nurse looks at me, she recognises me, she smiles, she knows I can do this job, I am just tired. Chiara keeps looking at the dirty white ceiling, she doesn’t look at the monitor. I look, I look for a baby between the intestinal loops, behind the bladder, behind the small ovaries, there is nothing.
She has a beautiful name Chiara, when she was lost, why. The other baby because it’s dead, tangled, that’s what she said, that means. I smell the stench, I smell the stench of pain, I open my nostrils, I breathe it in, I inhale hard, it is my punishment to feel that terrible stench, I would like to touch her, I would like to whisper in her ear, I would like to find a baby, or at least an embryo in that huge belly.
Your belly, Chiara? Has it grown?
Yes
A lot?
Yes
I look at it, it’s a pregnant woman’s belly, it’s got a peculiar shape, how is it possible.
Are you alone? Chiara? Are you alone? When did the other child Chiara die? The other children how old are they, Chiara?
I keep repeating her name, it is the only thing I can do to get closer, but everything moves us away, the gloves, the uniform, the gown, the mask, the bonnet, everything except her name, not even the eyes link us, she does not look, she is not there.
I am sorry, but it is not there. In your womb there is no baby, I don’t know if there ever was, but now there isn’t. Did you know that?
( )
Who is with you? Chiara? Are you alone?
There is my fake mother and my partner.
What do they know?
That I’m giving birth today.
Can I talk to your fake mother?
YES
Dress up.
YES
Nurse, call this lady, call her, let her in, I know you can’t because of the covid, but fuck it, call her and let her in, fuck the covid, fuck nothing, fuck boredom, call this pseudo-mother, call someone to explain to me, because today a baby was supposed to be born that isn’t there, because there’s nothing in this womb.
Madam, good evening, I’m the doctor on call, I’ve examined Chiara, and nothing, she’s not pregnant.
She is 6 months pregnant, her husband is out, waiting to see the baby.
Ma’am, she hasn’t been checked.
There’s covid, I told her to get checked out, but nothing.
Ma’am, there is no baby.
Chiara? Did you know about this?
SI
We’ll have to tell your husband. We’ll have to talk to him.
SI
We wait… I look at Chiara, we all look at her, me, the nurse, the fake mother, the walls, the scanty and worn-out objects of this big room. It had never happened in that room that someone came to give birth to a baby that is not there. We had never seen a belly full of nothing. A nausea due to nothing, contractions mixed with nothing.
Shall I call the psychiatrist, Chiara? Do you want help?
Yes
Get your husband on the phone.
Doctor, the Covid…
Fuck the covid!
Good evening. I’m the doctor on duty. I wanted to tell you that I did an ultrasound on your wife.
When it is going to born?
Wait, don’t look at me like that, with those eyes, but where were you, didn’t you hear Chiara screaming, didn’t you feel the stink, how could you sleep next to her, what did you touch, did you feel the baby’s kicks too? Did you help her with nausea, did you paint the room? Where were you, who were you with? It makes me angry, her smug look of the child that will arrive, it makes me angry. Who is Chiara? Who is she to this man, ugly, old, dirty, who is she… why does he keep looking at me, fuck, lower your gaze, where the fuck were you, where were you, working? Absent men always work, a lot, tirelessly, tirelessly absent, they deserve dinner, they deserve a child, they deserve care, they deserve love. They work.
You haven’t had a check-up in these months?
No, for the covid, then pregnancy is a natural thing.
It is natural, pregnancy is a natural event, he keeps looking me in the eyes, he challenges me, he shouts at me that I have not found his son, that he must be there among the loops and the fat of that belly grown without anything inside. Without a future, a perspective. She looks me straight in the eyes, lower that gaze, lower that her gaze, it’s not my fault, I’m a doctor, I’m a woman, I work too, I too didn’t smell the stench, I didn’t feel the pain. We are the same, my eyes burn.
Yes, but there is no baby.
She hasn’t had her period the whole time
Yes
But there is no baby.
But she felt it move.
Nothing in there. It’s not there, I’m sorry, it looks like menopause.
Smiles Sweat
Smiles Breathing
Smile Breathlessness
What are you talking about? My ex-wife at the same age as Chiara gave me a son!