One of my patients one morning was a young boy, maybe 10 or 11 years old, with DMD. His lungs were full of sputum and he was too weak to cough effectively. His dad was there, sitting beside him. My job was to handle his chest wall to help support him to cough, and breathe. I'd been taught all sorts of fancy positions to supposedly aid in this effort, and got busy.
I really got into my task, and promptly lost track of time. The story of my life. I worked and worked and worked with him, and the kid expelled a great deal of sputum. Success. His dad sat by his side, watching hopefully, remaining contained, a silent and steady support. I was barely out of being a kid myself (18 at the time), and I was glad he was there.
After what seemed like five minutes had passed, but in reality had been almost an hour probably, another PT student came in, looking for me.
PT student: "Why didn't you answer your page?"
Me: "What page? You were paging me? Why?"
PT student: "You were supposed to be back in the department by 10 AM so we could all go to coffee together."
Me: "Oh. Gee, sorry, I completely lost track of time, forgot, didn't hear the page. OK, I'll be there in a minute."PT student hurried off in order to enjoy her coffee and hang with the group.
This had been my first conscious experience of having immersed myself in free-falling interaction with another person's nervous system, then being rudely brought back to unwelcome social exigency, at the expense of the process that had begun to unfold and which I felt completely part of. I remember that I felt confused and resentful, all mixed together. Sort of the story of my whole life, actually, now that I think about it. There has always been that kind of grind in my gears.
I took another look at the task: the kid was breathing much easier now, and I was fairly pleased with the job I had done. The dad was pleased too, and tried to reward me. He said, "I want you to have this pen." (He had quickly fished around for a present and had found it in his shirt.)
We had just had a big lecture in the department about how it was wrong to accept any gifts or money from patients, to gracefully refuse. So I tried to. It felt awkward and uncomfortable. Here was a guy genuinely trying to compensate me, as part of a completion of a therapeutic ritual which had been (at least temporarily) successful; he was genuinely grateful, and could probably see that I was struggling to unfold into a good therapist, wanted to mark his attendance at this event somehow, so, had been moved to do this, make this gesture. It wasn't just empty gesture. Even I could sense this, and I'm not really great at telling the difference. So, I tried, but in the end, I accepted his gift of his own 29 cent ballpoint pen, as a symbol of his own completion of a psychosocial moment, and expression of his own gratitude. I did not think I had any right to refuse, on that level. I mean, here was a guy watching his own son die slowly - I knew full well I'd never in a million years ever have the strength or grace to do anything like it. I was embarrassed about my robust health and good fortune in life. If he wanted me to have a dumb pen, then he had the right to bestow it, because he had earned that right.
I went to rejoin the human primate social grooming squad I had signed up to travel with through this phase of my life and training, but always kept an eye open for some way not to have to be subject to group dynamics and behaviour if I didn't want to, as it always has seemed mostly annoying and interruptive, as opposed to welcome and distracting. Looking back I can see now that all the discomfort I felt led me out of hospital work and toward working with pure pain in patients, and independently, as a solo practitioner, in order to be able to lose myself in the interactive process with no interruption.