Words are not enough…..

BMJ 23 October 1999    Cite this as: BMJ 1999;319:1143

 When you English first came to Ireland you stole our land, despoiled our relics, cut down all our ancient trees, drank our whiskey, opened branches of Marks and Spencer, introduced grey squirrels, bribed our planning officials, pillaged our women (especially the better-looking ones), and made rude noises at our menfolk. But we got the better of you; we loved every second of it, it gave us centuries-long grudges to nestle close to our bosoms, and as a bonus we got the English language, the heritage of Shakespeare and Milton, with all its capacity for bombast and subtlety, pageantry, and nuance, a star crossed marriage of a people gifted with a wild imagination with a vehicle sufficiently complex and idiosyncratic to allow them expression.

Even so, the vagaries of general practice can yet leave us lost for words; the skill of extemporaneous dissembling is not taught in the textbooks.

“Don’t worry, man,” I said, faking a heavy Jamaican accent in a despairing attempt at humour, caught as I was between the Scylla and Charybdis of trying to reassure him without actually telling him lies;  anyway, to paraphrase John Belushi in The Blues Brothers, it’s not really lies, it’s just … bullshit. “The fluid tablets will help your breathing and the antibiotics will take care of the chest infection; you’ll feel much better in the morning, and I’ll see you then.”

I went outside to find the whole family assembled.

“How is he, Doctor?” asked his wife anxiously.

I paused, aware that they were hanging on my every word. I was also aware that words were inadequate here. “Feck it, it’ll be grand,” the Irish prognosis which usually covers every eventuality, was for once not good enough. Even the English language in all its meandering glory and richness of texture cannot quite seem to convey that there is a sick old man in there. I’m sure he’s dying, body falling apart, all systems are failing, heart, lung, kidneys, brain, you name it.

Although I’m doing my best to keep him comfortable I don’t really know what’s going on, perhaps only that doing nothing heroic is the right thing; don’t really know what’s wrong with him; pay no attention to what I write on the death certificate, only guessing; and most of all I don’t know how to explain my sense of uncertainty and inadequacy to you because I know it’s not what you want to hear right now. You want someone strong and certain and positive, someone who knows what is happening, someone in control.

So: “Mary,” I said gravely, placing a firm, supportive hand on her shoulder, in the hope that my body language might help disguise the poverty of my words, “I’m afraid he’s bucked.”

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