Her father’s pancreatic cancer came as a shock, but an outside observer would never know there was a difference in him. As always, the TV remained on practically day and night, although it was unclear how much he understood (at 82-years old, his hearing wasn’t like it used to be). He continued to eat dinner every night at 6 o’clock, and everyone knew not to sit in “his chair” in the family room, even when he went to his computer to surf the net. But things weren’t the same, despite outward appearances.
Jill had never really known her father. A taciturn workaholic from as far back as she could remember, her dad had almost always seemed too busy for the family. As a salesman, he was on the road most of the time, and when he wasn’t traveling, he would routinely collapse on his chair with a couple of six-packs and watch whatever happened to be on TV. “I work hard” was his loudly pronounced justification.
Now in her mid-fifties, Jill, too, had fallen into the pattern of overworking and abusing alcohol, with the justification that she was made of “good stock” and could withstand the necessary stresses of a high-pressured sales job. Thankfully, she had enjoyed perfect health. However, six years ago, she was diagnosed with “idiopathic hearing loss.” But, true to form, she didn’t let it consume her. She recollected that, “I had no hearing in my left ear and 20% in my right, but I could live with it, and I got used to quiet.” She hadn’t considered hearing aids, even though her family and friends told her that they would improve the quality of her life. Her definitive verdict was “Hearing aids are too much trouble and too much money!”
But she wasn’t definitive about how to react to her father’s terminal diagnosis. Initially she did nothing, sometimes even pretending that it never happened—so-called denial. But after several phone conversations with her father, she found herself vacillating between feeling content to accept his recollection of what the doctor said—“I need more tests” or “It doesn’t look good, but who knows?” —and feverishly downloading information on carcinoma from the Internet. Finally after more vague and contradictory reports, she insisted on accompanying him to his next medical appointment.
It was after the first of what would be several doctor’s appointments that Jill decided to get herself hearing aids. When the dispensing professional asked her the “Why now?” question, her response was short and to the point: “I want to be sure to understand everything my dad’s oncologist says.”
Having been in practice as a dispensing professional for 25 years, the starkness of Jill’s statement was a first for Robert. He was taken aback and initially didn’t respond. Then he slowly nodded his head and looked at Jill compassionately, allowing time and space for both of them to acknowledge the implications of what she had just said.
His nonverbal response beckoned her to say more. “I don’t think he’s doing well. We’ve never been close, but I want to try to change that.”
“It’s never too late.” Robert said.
Jill nodded her head, and they got to work on testing her hearing.
Nothing in Robert’s training taught him to say those simple, comforting words of wisdom. It came naturally to him; he didn’t think about it, as it was just a casual comment — seemingly insignificant, inconsequential. In fact, after the appointment with Jill, he forgot what he had said.
But Jill didn’t forget. Robert’s words, “It’s never too late,” would echo in her mind as she would begin making regular visits to her dying father.
A couple of weeks later, Jill was fitted with two top-of-the line digital hearing aids. Per standard practice, Robert succinctly explained the operating and maintenance instructions, clarified realistic expectations, and answered her questions. But he didn’t stop there. Toward the end of their appointment, Robert asked how her dad was doing. He had recorded in his charting notes, “Pt wants HA to ¤ communication with dad’s cancer doc.” In one respect, that note wasn’t necessary to jog his memory, as he was not about to forget the impact of Jill’s statement. He had only forgotten his response, falsely deeming it as insignificant.
“His appointment’s in three days,” she responded.
“I hope it goes well.”
Robert took care to establish a personal rapport with his patients, but he properly understood that his role did not include being a therapist. Accordingly, he would have been surprised to learn that his earlier comment, “It’s never too late,” had become a guiding mantra for Jill to help repair her relationship with her father. Similarly, he was shocked at Jill’s outpouring of tears that immediately came forth after his simple, supportive statement. Unbeknownst to Robert, he had provided a sanctuary, a safe place, for Jill to release the torrent of pain that she had carried within her. For several moments, she let out heart-wrenching sobs.
Robert simply sat there. No words were needed; he needed only to listen.
Although his personal “therapeutic” feedback to Jill was incidental to the task of diagnosing and treating her hearing loss (for which he was well trained), it was not incidental to his serving as a catalyst for her psychological growth, a role for which he had no formal training. He had left a healing imprint that would be forever etched in Jill’s consciousness. Indeed, as described in earlier publications1, the interpersonal context of a hearing evaluation often sets the stage for this kind of profound psychological transformation of a patient(s).
Jill forgot the operating and maintenance instructions for her new hearing aids and, in fact, had forgotten most of what Robert had said during their almost one-hour appointment. (Thankfully, he had given her written instructions and had made a follow-up appointment.) Instead, she clearly remembered his kind presence, his compassion, and his acceptance of the emotionally-laded dynamics surrounding her decision to get hearing aids.
Jill picked up her father for his oncology appointment on a cold, rainy day —appropriate scenery, she thought. “It’s impossible to be precise,” the physician told Bill, “but your cancer has spread, your white cell count is…and you have 6 months or so left.” He recommended that Bill put his affairs in order. The doctor also recommended that he see a therapist, as well as Jill who took in every word of the meeting and whose face had become ghost white.
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Several days later, Jill telephoned me for an appointment. “My father has cancer and will die soon. He’s depressed. I’d like some advice on how to best help him. I’d like to come by myself, as I don’t want to upset him.”
No kidding, he’s depressed, I thought. Frankly I was relieved that she didn’t want to bring her father. I don’t like to see dying patients. I don’t “do” death well; frankly, it scares me. I often muse about posting a rule in my office that patients who die will be penalized a percentage of the treatment fee. But it would be unethical, and besides, how would I enforce it?
Our meeting went well. Jill was grieving the eventual loss of her father, the man whom she had hardly known for over 50 years, but for whom she had so many questions and things she wanted to say before it was too late. I coached her on ways to approach her dad. Toward the end of our meeting, I changed the subject and asked about what had changed for her since being fitted with hearing aids. Her affect suddenly brightened and she recounted what she later would half-jokingly describe as a “sublime experience getting the newspaper”:
“One morning,” she said, “as I was making my usual trek to the foot of my driveway for the newspaper, I heard birds chirping — beautiful ‘songs from heaven’ that I hadn’t heard for several years. I stopped and listened, oblivious that I would be late for work and that a few neighbors were staring at me. ‘Why hadn’t I improved my hearing much earlier?’ I thought. ‘Why didn’t my doctor and friends recommend hearing aids long ago?’ But then I recalled that they did.”
I told Jill how happy I was that her auditory world had opened up for her. Indeed she looked exuberant. Then, as she prepared to leave, she asked me if she could bring her father for a meeting. I dutifully replied, “Of course.”
Bill looked as I had expected — quite old and sickly, with labored breathing. He spoke slowly and deliberately, as if he knew he had a limited amount of energy to expend and didn’t want to carelessly waste what was left. He was neatly and stylishly dressed, seemed to have a sense of humor, at times even appearing jovial.
What do you say to someone who’s dying? After some introductions and pleasantries, I asked Bill, “What would you like to say to your daughter, before you die?” and asked Jill “What would you like to say to your father?” Perhaps a bit too abrupt, and definitely sloppy, but I wanted to get the albatross on the table. And admittedly, I was anxious.
They began by acknowledging that, although they hadn’t spent much time together in the last several years, they were “two peas in a pod”: both were racing through life to finish whatever had to be done in the most efficient manner and shortest time possible. In the last decade, both of them had updated their personal computers roughly every 6 months for new models with even slightly faster processors. Weeks before Bill’s cancer was diagnosed, both he and Jill had bought new Pentium IV computers, by coincidence on the same day.
But there was a marked difference between them as they sat in my office. In contrast to Bill’s soft voice, Jill’s voice was loud and had an anxious, pressured edge to it. She was in a frenzy to help her father: “I want you and mom to go traveling; you should let me take you to the art museum that you like so much; there’s a holistic health center not too far away that we can go to. And there’s a lot of information on-line. You can’t waste time, dad. We gotta…” Her attempts to be helpful to her dad barely gave him enough time to respond. I needed to help her slow down.
“Excuse me, how long did it take you to get your newspaper in your driveway before you got hearing aids?”
A pause. She was surprised by my apparent non sequitor. “I don’t know, maybe a minute or so.”
“And how long, post-hearing aids, do you typically spend listening to the birds singing?”
“I dunno, maybe 5 seconds.” She nodded her head with mild amusement and irritation. I think she knew where I was going.
“So let me see [I got out my calculator]. It used to take you 60 seconds x 365 days = 21,900 seconds per year to get the paper, but since you started listening to birds, it has taken you 65 x 365 = 23,725 seconds – 1,825 seconds more! Over a 2 year period, that’ll be…”
“It’s okay, I get your point,“ she interrupted. “But it wasn’t wasting time.”
“I certainly agree. Would you please tell your father why it wasn’t a waste of time?”
After a bit of coaxing, Jill took a slow breath, looked at her father, and began:
“Because there’s so much beauty in the world to see, to hear, if only you take time to notice. Not hearing the birds, not hearing the sounds around me was okay until I realized that there could be something more, that I was really missing something: beautiful sounds that make life worth living. I know it’s a cliché, dad, but I really want you to enjoy the rest of your life, too. Maybe you could visit…”
After having allowed herself a brief respite, Jill began to revert back to her frenetic state.
I turned to Bill and asked, “Are there advantages to downgrading your Pentium IV?” On the surface, it was a ridiculous question, and on a symbolic level, represented my own worst fear.
Bill let out a laugh and said, “I wouldn’t go that far. I couldn’t go on-line, I couldn’t do graphics, I hated Windows 3.1… Would you do that?” he asked, somewhat incredulously.
“Of course not,” I quickly responded. “Why, just the other day, I saw a system with an AMD XP 2400+ processor, 512 MB RAM, an 80 GB hard drive, 16x DVD ROM drive with a 266 MHz frontsie bus…” Bill grinned from ear to ear as we enjoyed several moments of fun respite, derided Windows 3.1, and threw out computer specs at a pace that would rival the pace of Wall Street. Jill looked stupefied.
“But sometimes we don’t have a choice and we may have to reap the advantages of a slower processor,” I interjected, effectively ending our play break. “So what advantages might there be to downgrading from a Pentium IV?“
Bill’s next response showed me that he understood the metaphor, although he was uncomfortable with it. “My body has slowed down; I can’t handle as many bits of information that I could years ago; I can’t do a million things at once like I used to, and my thoughts are slower.” Then he cut to the bottom line: “And I’m going to die in about 6 months. You call these things advantages?” His anger became visible.
“If either Jill or I had the power to change it, we would in a heartbeat,” I immediately responded. “But I’m still wondering if important things can happen — important dialogue between you two as father and daughter —if you don’t rush around so much, if you lower your megahertz a bit.” There’s very special magic between fathers and daughters, only their magic had been buried underneath computer chips and hard drives.
Both of them fell silent, but it felt like a peaceful respite, almost a meditation. It was Jill who broke the silence. “Dad, do you remember when I was a child and bumped my knee; and I couldn’t go to sleep because it hurt so much? You brought me up a bowl of ice cream to my room?” It was her turn for a non sequitor.
“Yeah, I remember that,” he chuckled. “I felt so sorry for you.”
Jill smiled, made solid eye contact with the man with whom she had been estranged for so many years and took the next step: “But dad, I never thanked you for what you did. You have no idea how much that meant to me. Even to this day, when I have ice cream, I think of you.”
“It was no big deal, really.”
Although her dad had probably forgotten about that incident, it was very much a big deal to Jill. “You knew how much pain I was in,” she responded.
I found myself thinking of Robert, Jill’s hearing aid dispenser, who, decades later and in a very different context, also demonstrated that he knew how much pain she was in. In fact, Jill had just sent him a thank-you note, not so much for the hearing aids, but for his compassion. In a psychological sense, she had experienced Robert as a parental figure —as an expert, a nurturing authority, as one who had the power to make her feel whole and worthy as a person. Symbolically, Robert, too, had given Jill a bowl of ice cream.
************
We all have people in our past or present to whom we owe thanks. At workshops, I often invite participants to recall a significant person in their past; one who was very helpful to them, but one with whom they had never shared these feelings; a person who to this day has no idea how significant he or she was to them. I then ask, “What would you thank that person for?” Many participants thank cherished people who have long been deceased. Reminiscent of Jill sending the note to Robert, Jill wanted to thank her dad for the ice cream, and other cherished moments, while he was still alive.
We tend to experience time moving increasingly more rapidly as years pass. Mounting obligations, challenges, and new modes of entertainment all make time seem to go faster. The busier with change we are, the quicker time seems to slip past and vanish.2 Being confronted with one’s imminent death abruptly slows down this acceleration of time; it has a way of helping us to be more self-conscious and more deliberate about the process of living and of choosing how to spend time. Of course, as I said to Bill, I would never choose to exchange my Pentium IV for a slower processor. But if I had to, my life would be enriched in some ways.
“You were the catalyst for Jill to gain access to the auditory world,” I said to Bill. “Hearing aids slowed down her life enough so that she could appreciate its beauty. It helped her ‘smell the flowers’ via her ears.” When I first heard that Bill’s imminent death propelled Jill to enrich her life via hearing amplification, it seemed an odd, even cruel, justification. (Did he have to be sacrificed?) But it is an unfortunate truism that it often takes a crisis to catalyze one’s long overdue personal and relational growth. But, as Robert cogently said, it’s never too late.
Bill nodded and looked longingly at his previously estranged daughter, who now and for the few remaining months would have her father back. He outstretched his hands and she held on to them tightly.
“I haven’t been able to hear birds in a long time,” Bill blurted out. His face revealed his sadness. Like 6 years of Jill’s life, and 80% (21 million) of the hearing-impaired population, Bill had never reaped the benefits of hearing aids.3
“If you want, I’ll make bird sounds for you,” Jill joked.
Bill smiled, shook his head and said, “No, that’s all right.”
But I decided to take her offer at face value and asked her to imitate some bird songs for her dad — perhaps the sound of a humming bird, a lark, a blackbird. Jill let out a melody of shrills while we broke up into hysterics. Several moments passed. Then, as they faced each other, their laughter gave way to silence. Tears came to their eyes, and to mine.
The two people in my office had come to realize an essential truth: that sometimes the routine and busy-ness of our lives become so rigidified —eg, Bill being glued to the TV, eating dinner at 6 o’clock, sitting in his designated chair —that any change, positive or negative, is resisted at all costs. Safer to remain busy and numb than to risk any uncertainty, whether it be resurrecting a cherished relationship or hearing birds sing. In retrospect, it all seems so clear.
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References
1. Harvey MA. The transformative power of an audiology visit. Hear Jour. 2000; 53(2), 43-47.
2. St. Clair M. The psychologist and time: going, going, gone. Massachusetts Psychol Assoc Quarterly. 2002;46(3), 20-21.
3. Taylor B, Hansen V. To change the industry, we must change, Part 1. Hearing Review. 2002;9(12):28-33,56.
Correspondence can be addressed to HR or Michael A. Harvey, PhD, 14 Vernon Street, Ste. 304, Framingham, MA 01701; email: [email protected].
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