[Sidenote: Advising the sick.]
The sick man to his advisers.
"My advisers! Their name is legion. * * * Somehow or other, it seems a
provision of the universal destinies, that every man, woman, and child
should consider him, her, or itself privileged especially to advise me.
Why? That is precisely what I want to know." And this is what I have to
say to them. I have been advised to go to every place extant in and out
of England--to take every kind of exercise by every kind of cart,
carriage--yes, and even swing (!) and dumb-bell (!) in existence; to
imbibe every different kind of stimulus that ever has been invented. And
this when those _best_ fitted to know, viz., medical men, after long and
close attendance, had declared any journey out of the question, had
prohibited any kind of motion whatever, had closely laid down the diet
and drink. What would my advisers say, were they the medical attendants,
and I the patient left their advice, and took the casual adviser's? But
the singularity in Legion's mind is this: it never occurs to him that
everybody else is doing the same thing, and that I the patient _must_
perforce say, in sheer self-defence, like Rosalind, "I could not do with
all."
[Sidenote: Chattering hopes the bane of the sick.]
"Chattering Hopes" may seem an odd heading. But I really believe there
is scarcely a greater worry which invalids have to endure than the
incurable hopes of their friends. There is no one practice against which
I can speak more strongly from actual personal experience, wide and
long, of its effects during sickness observed both upon others and upon
myself. I would appeal most seriously to all friends, visitors, and
attendants of the sick to leave off this practice of attempting to
"cheer" the sick by making light of their danger and by exaggerating
their probabilities of recovery.
Far more now than formerly does the medical attendant tell the truth to
the sick who are really desirous to hear it about their own state.
How intense is the folly, then, to say the least of it, of the friend,
be he even a medical man, who thinks that his opinion, given after a
cursory observation, will weigh with the patient, against the opinion of
the medical attendant, given, perhaps, after years of observation, after
using every help to diagnosis afforded by the stethoscope, the
examination of pulse, tongue, &c.; and certainly after much more
observation than the friend can possibly have had.
Supposing the patient to be possessed of common sense,--how can the
"favourable" opinion, if it is to be called an opinion at all, of the
casual visitor "cheer" him,--when different from that of the experienced
attendant? Unquestionably the latter may, and often does, turn out to be
wrong. But which is most likely to be wrong?
[Sidenote: Patient does not want to talk of himself.]
The fact is, that the patient[31] is not "cheered" at all by these
well-meaning, most tiresome friends. On the contrary, he is depressed
and wearied. If, on the one hand, he exerts himself to tell each
successive member of this too numerous conspiracy, whose name is legion,
why he does not think as they do,--in what respect he is worse,--what
symptoms exist that they know nothing of,--he is fatigued instead of
"cheered," and his attention is fixed upon himself. In general, patients
who are really ill, do not want to talk about themselves. Hypochondriacs
do, but again I say we are not on the subject of hypochondriacs.
[Sidenote: Absurd consolations put forth for the benefit of the sick.]
If, on the other hand, and which is much more frequently the case, the
patient says nothing, but the Shakespearian "Oh!" "Ah!" "Go to!" and "In
good sooth!" in order to escape from the conversation about himself the
sooner, he is depressed by want of sympathy. He feels isolated in the
midst of friends. He feels what a convenience it would be, if there were
any single person to whom he could speak simply and openly, without
pulling the string upon himself of this shower-bath of silly hopes and
encouragements; to whom he could express his wishes and directions
without that person persisting in saying "I hope that it will please God
yet to give you twenty years," or, "You have a long life of activity
before you." How often we see at the end of biographies or of cases
recorded in medical papers, "after a long illness A. died rather
suddenly," or, "unexpectedly both to himself and to others."
"Unexpectedly" to others, perhaps, who did not see, because they did not
look; but by no means "unexpectedly to himself," as I feel entitled to
believe, both from the internal evidence in such stories, and from
watching similar cases: there was every reason to expect that A. would
die, and he knew it; but he found it useless to insist upon his own
knowledge to his friends.
In these remarks I am alluding neither to acute cases which terminate
rapidly nor to "nervous" cases.
By the first much interest in their own danger is very rarely felt. In
writings of fiction, whether novels or biographies, these death-beds are
generally depicted as almost seraphic in lucidity of intelligence. Sadly
large has been my experience in death-beds, and I can only say that I
have seldom or never seen such. Indifference, excepting with regard to
bodily suffering, or to some duty the dying man desires to perform, is
the far more usual state.
The "nervous case," on the other hand, delights in figuring to himself
and others a fictitious danger.
But the long chronic case, who knows too well himself, and who has been
told by his physician that he will never enter active life again, who
feels that every month he has to give up something he could do the month
before--oh! spare such sufferers your chattering hopes. You do not know
how you worry and weary them. Such real sufferers cannot bear to talk of
themselves, still less to hope for what they cannot at all expect.
So also as to all the advice showered so profusely upon such sick, to
leave off some occupation, to try some other doctor, some other house,
climate, pill, powder, or specific; I say nothing of the
inconsistency--for these advisers are sure to be the same persons who
exhorted the sick man not to believe his own doctor's prognostics,
because "doctors are always mistaken," but to believe some other doctor,
because "this doctor is always right." Sure also are these advisers to
be the persons to bring the sick man fresh occupation, while exhorting
him to leave his own.
[Sidenote: Wonderful presumption of the advisers of the sick.]
Wonderful is the face with which friends, lay and medical, will come in
and worry the patient with recommendations to do something or other,
having just as little knowledge as to its being feasible, or even safe
for him, as if they were to recommend a man to take exercise, not
knowing he had broken his leg. What would the friend say, if _he_ were
the medical attendant, and if the patient, because some _other_ friend
had come in, because somebody, anybody, nobody, had recommended
something, anything, nothing, were to disregard _his_ orders, and take
that other body's recommendation? But people never think of this.
[Sidenote: Advisers the same now as two hundred years ago.]
A celebrated historical personage has related the commonplaces which,
when on the eve of executing a remarkable resolution, were showered in
nearly the same words by every one around successively for a period of
six months. To these the personage states that it was found least
trouble always to reply the same thing, viz., that it could not be
supposed that such a resolution had been taken without sufficient
previous consideration. To patients enduring every day for years from
every friend or acquaintance, either by letter or _vivâ voce_, some
torment of this kind, I would suggest the same answer. It would indeed
be spared, if such friends and acquaintances would but consider for one
moment, that it is probable the patient has heard such advice at least
fifty times before, and that, had it been practicable, it would have
been practised long ago. But of such consideration there appears to be
no chance. Strange, though true, that people should be just the same in
these things as they were a few hundred years ago!
To me these commonplaces, leaving their smear upon the cheerful,
single-hearted, constant devotion to duty, which is so often seen in the
decline of such sufferers, recall the slimy trail left by the snail on
the sunny southern garden-wall loaded with fruit.
[Sidenote: Mockery of the advice given to sick.]
No mockery in the world is so hollow as the advice showered upon the
sick. It is of no use for the sick to say anything, for what the adviser
wants is, _not_ to know the truth about the state of the patient, but to
turn whatever the sick may say to the support of his own argument, set
forth, it must be repeated, without any inquiry whatever into the
patient's real condition. "But it would be impertinent or indecent in me
to make such an inquiry," says the adviser. True; and how much more
impertinent is it to give your advice when you can know nothing about
the truth, and admit you could not inquire into it.
To nurses I say--these are the visitors who do your patient harm. When
you hear him told:--1. That he has nothing the matter with him, and that
he wants cheering. 2. That he is committing suicide, and that he wants
preventing. 3. That he is the tool of somebody who makes use of him for
a purpose. 4. That he will listen to nobody, but is obstinately bent
upon his own way; and 5. That he ought to be called to the sense of
duty, and is flying in the face of Providence;--then know that your
patient is receiving all the injury that he can receive from a visitor.
How little the real sufferings of illness are known or understood. How
little does any one in good health fancy him or even _her_self into the
life of a sick person.
[Sidenote: Means of giving pleasure to the sick.]
Do, you who are about the sick or who visit the sick, try and give them
pleasure, remember to tell them what will do so. How often in such
visits the sick person has to do the whole conversation, exerting his
own imagination and memory, while you would take the visitor, absorbed
in his own anxieties, making no effort of memory or imagination, for the
sick person. "Oh! my dear, I have so much to think of, I really quite
forgot to tell him that; besides, I thought he would know it," says the
visitor to another friend. How could "he know it"? Depend upon it, the
people who say this are really those who have little "to think of."
There are many burthened with business who always manage to keep a
pigeon-hole in their minds, full of things to tell the "invalid."
I do not say, don't tell him your anxieties--I believe it is good for
him and good for you too; but if you tell him what is anxious, surely
you can remember to tell him what is pleasant too.
A sick person does so enjoy hearing good news:--for instance, of a love
and courtship, while in progress to a good ending. If you tell him only
when the marriage takes place, he loses half the pleasure, which God
knows he has little enough of; and ten to one but you have told him of
some love-making with a bad ending.
A sick person also intensely enjoys hearing of any _material_ good, any
positive or practical success of the right. He has so much of books and
fiction, of principles, and precepts, and theories; do, instead of
advising him with advice he has heard at least fifty times before, tell
him of one benevolent act which has really succeeded practically,--it is
like a day's health to him.[32]
You have no idea what the craving of sick with undiminished power of
thinking, but little power of doing, is to hear of good practical
action, when they can no longer partake in it.
Do observe these things with the sick. Do remember how their life is to
them disappointed and incomplete. You see them lying there with
miserable disappointments, from which they can have no escape but death,
and you can't remember to tell them of what would give them so much
pleasure, or at least an hour's variety.
They don't want you to be lachrymose and whining with them, they like
you to be fresh and active and interested, but they cannot bear absence
of mind, and they are so tired of the advice and preaching they receive
from every body, no matter whom it is, they see.
There is no better society than babies and sick people for one another.
Of course you must manage this so that neither shall suffer from it,
which is perfectly possible. If you think the "air of the sick room" bad
for the baby, why it is bad for the invalid too, and, therefore, you
will of course correct it for both. It freshens up a sick person's whole
mental atmosphere to see "the baby." And a very young child, if
unspoiled, will generally adapt itself wonderfully to the ways of a sick
person, if the time they spend together is not too long.
If you knew how unreasonably sick people suffer from reasonable causes
of distress, you would take more pains about all these things. An infant
laid upon the sick bed will do the sick person, thus suffering, more
good than all your logic. A piece of good news will do the same. Perhaps
you are afraid of "disturbing" him. You say there is no comfort for his
present cause of affliction. It is perfectly reasonable. The
distinction is this, if he is obliged to act, do not "disturb" him with
another subject of thought just yet; help him to do what he wants to do:
but, if he _has_ done this, or if nothing _can_ be done, then "disturb"
him by all means. You will relieve, more effectually, unreasonable
suffering from reasonable causes by telling him "the news," showing him
"the baby," or giving him something new to think of or to look at than
by all the logic in the world.
It has been very justly said that the sick are like children in this,
that there is no _proportion_ in events to them. Now it is your business
as their visitor to restore this right proportion for them--to shew them
what the rest of the world is doing. How can they find it out otherwise?
You will find them far more open to conviction than children in this.
And you will find that their unreasonable intensity of suffering from
unkindness, from want of sympathy, &c., will disappear with their
freshened interest in the big world's events. But then you must be able
to give them real interests, not gossip.
[Sidenote: Two new classes of patients peculiar to this generation.]
NOTE.--There are two classes of patients which are unfortunately
becoming more common every day, especially among women of the richer
orders, to whom all these remarks are pre-eminently inapplicable. 1.
Those who make health an excuse for doing nothing, and at the same
time allege that the being able to do nothing is their only grief.
2. Those who have brought upon themselves ill-health by over pursuit
of amusement, which they and their friends have most unhappily
called intellectual activity. I scarcely know a greater injury that
can be inflicted than the advice too often given to the first class
"to vegetate"--or than the admiration too often bestowed on the
latter class for "pluck."