Ben Utter, one of the founders of Vital, reflects on how we–doctors, scholars, parents, everyone–can improve each other’s health by listening.
The lark sings loud and glad,
Yet I am not loth
That silence should take the song and the bird
And lose them both.
—D.H. Lawrence, “Listening”
The doorbell rang in my dream the other night, and I opened our front door to find a food deliveryman. Without a word, he handed me a cooler and walking back toward his car. Inside the Styrofoam container were several slices of fugu, the infamous, highly toxic pufferfish, the kind prepared only by highly-skilled Japanese chefs, lest a residual trace of poison kill a diner. In the dream, I handed these morsels to my young daughter and son and watched—unreflectingly but, as is often the case in dreams, with a suffocating sense of imminent danger—as they slurped them down. I awoke with a gasp, disoriented, still wondering whether or not this dangerous dinner was going to send my children into renal failure (turns out that on this count, at least, I needn’t have worried, since tetrodotoxin kills by paralyzing the lungs—an unsurprising error on the part of my mind’s dream production company, which had no more data to draw on than what I knew about fugu from watching that episode of The Simpsons).
I can’t say for sure why I was dreaming of blithely endangering the lives of my children, though I suspect it may have been a manifestation of parental anxiety over a small mass that had recently appeared in my daughter’s cheek. She had been complaining for several days of pain along her jaw. Probably just a blocked salivary duct, my wife and I assured each other. Surely not an abscess. And so we treated it with a hot water bottle, and told her to be tough, and hoped it would go away.
Listening can be hard, but what we ignore will often insist on being heard. Captive to paralyzing dread at 3 a.m., I’m forced to take notice, and listen, often uncomprehendingly, to the murmur of the weird language of dreams. Whether or not dreams are, as Freud claimed, the royal road to the unconscious, they are surely a service road to the dilapidated self-storage unit of things I’ve been semi-consciously ignoring.
The gentle tap tap tap I thought I heard overhead during a recent week of heavy rain . . . surely that was just water falling from the eves outside the window. Had I listened more closely to what I didn’t want to hear, I would have realized that the sound was coming from inside the house and caught the leak in our attic before it turned into a leak in our bedroom ceiling. As it is, I still have some drywall to repair.
The importance of listening is emerging as a dominant theme in a class I’m teaching this semester, a composition course required at my university for students majoring in the sciences—and not one they have traditionally been overjoyed to have to take. With their consternation in mind, I tried to design the course around a theme that might feel more connected to the health care work that most of them hope to do in the future. Drawing on the interdisciplinary field of the Medical Humanities, I named the course Narratives of Illness and (Sometimes) Healing.
In this class, as in every Composition class I’ve taught, we discuss philosopher Kenneth Burke’s well-known metaphor of scholarly dialogue as a cocktail party conversation. It’s a party to which the would-be writers have arrived late, and to which they must listen before advancing their own views. As it turns out, the same principle applies in medicine:
[m]edicine can benefit from learning that which literary scholars and psychologists and anthropologists and storytellers have known for some time—that is, what narratives are, how they are built, how they convey their knowledge about the world, what happens when stories are told and listened to, how narratives organize life, and how they let those who live life recognize what it means. (9)
For my students, reading accounts of illness is a kind of listening. That listening is central to the work of healing is one of the lessons of Dr. Paul Kalanithi’s posthumously-published memoir, When Breath Becomes Air, which my students have just finished reading, and which, I was gratified to hear, they found compelling and gorgeous as I do. They also found it heartbreaking. They might tell you that sometimes listening is no cocktail party. Sometimes it’s emotionally gutting.
Listening can be hard, but so too is not being listened to. My seven-year-old daughter discovered this when I finally took her to the pediatrician to check on that painful lump.
The visit didn’t go well. This was partly my fault. Champion dad that I am, I handed her a half-squished chocolate protein bar while we waited for her name to be called, and our surprisingly swift summons from the waiting area to the exam room meant that she arrived with her mouth absolutely stuffed with chocolate. This proved rather unhelpful to the task of examining her inner cheek. Our usual pediatrician wasn’t in, and the doctor who saw us was obviously being run ragged by cases of flu lined up before and after us. Taking one look at the chocolate dribbling down her chin, he sighed, and said, “I can’t see a thing in there.” A glass of water would have cleared the offending chocolate, but he didn’t give us time. “It doesn’t look swollen, so just keep some heat on it and come back in a few days if it hasn’t subsided.”
This turned out to be fine advice. Happily, the lump and the pain resolved themselves in a few days’ time—but his reassurances weren’t very reassuring. I left the clinic far from certain that we hadn’t wasted our time, and my daughter was frustrated that, yet again, she hadn’t been heard.
No, my dream of perilous sushi hadn’t revealed a lurking sepsis, but if I had listened sooner to my daughter’s account of her pain, our appointment might not have been such a rushed, last-minute affair. And if I had paid more attention while shooing her toward the car, I might not have forgotten about lunch before we left for the clinic, or at least secured a snack that wouldn’t make the front of her shirt look like the Deepwater Horizon spill. That I hadn’t done so owed something to the anxious tap tap tap my mind played in time with the rain water that had soaked through a patch of insulation and drywall and was now eroding my attention.
Listening can be hard, but it’s my job, and not just as a parent and homeowner. My wife is a physician, and the fact that we are both “Dr. Utter” prompted the young daughter of some friends of ours to ask what kind of doctors we are. Her father helped her understand the difference between my humanities PhD and my wife’s MD by explaining (with a wicked gleam in his eye) that my wife is “the kind of doctor who helps people.” Be that as it may, what I do share with medical doctors in my role as a professor is a position of authority that makes speaking much easier than listening. And yet, like a “real doctor,” listening to narratives of distress is part of my duty to those in my care.
For me, as for my students, listening can take the form of reading. I invite students to write me a “Dear Ben” letter during the first week of class, so that quieter students can introduce themselves more comfortably, and perhaps alert me to things they would hesitate to mention in person. As it turned out, they had a great deal to say. One wrote of her high school graduation day, on which her grandfather had suffered a fatal heart attack. She spends her weekends now visiting her grandmother, whose identity is ravaged by Alzheimer’s. Several students suffer from depression, and anxiety appears to be the rule rather than the exception. One young woman lost a parent to cancer only two weeks before the beginning of the semester.
The mind’s attic drips with invasive sadness and stress. Sometimes it floods.
Straining to hear above the noise isn’t easy, but I am grateful that this time, at least, I took practical steps to allow my students the chance to be heard, and perhaps hear themselves in the process. What we learned together helped us prepare for the emotional intensity of the narratives of illness we read together, so that the experience could be meaningful rather than merely traumatic.
Paul Kalanithi advises his fellow physicians, “When there’s no place for the scalpel, words are the surgeon’s only tool” (87). But for most of us, words are more than just a last resort. They can be a good front-line measure, too.
Listening–to other or even to ourselves–can be hard, though it is often far easier than what happens when we don’t.
Charon, Rita. Narrative Medicine: Honoring the Stories of Illness. Oxford University Press, 2006.
Kalanithi, Paul. When Breath Becomes Air. New York: Random House, 2016.