Adele V. (not her real name), mid-60s, morbidly obese, heart disease, diabetes, dependent edema that became painful by late afternoon … Adele’s husband, slim and well dressed, strides through the front door. He nods at his wife, then me, and sits without a word in the corner … What the room tells me, what her requested time for a visit tells me, what their silence tells me, I do not hear. Instead, I hear only the first words Adele speaks after her husband arrives, ‘‘Late in the afternoon, I’m in pain. My legs become so swollen that they hurt. Late afternoons are the most difficult for me .’’
For every suggestion I made about how to intermittently elevate her legs, she countered with a reason for why it would not work. Now and then I’d glance at her husband, hoping he’d join in and encourage, even generate an idea. Instead, he simply returned my gaze with a look of resigned patience, as if he’d heard all this before but understood what I did not, that this exercise in futility must run its course and that the outcome had, long ago, been predetermined.
Nothing would allow me to know Adele’s answers. But time, in-home training, exposure to the humanities, and awareness of ourselves are, nevertheless, essential for us to make the space for those we serve to find their own answers.
‘‘My legs do hurt in the afternoon. Yes, I could elevate them and get some relief, but it’s all I could think of. I was afraid to ask you what I really wanted. By telling you that afternoons were hardest for me, maybe you’d come home a little earlier. That’s all I want. Just for you to come home a little earlier, a little more often. I just want you to spend a little more time with me before I die.’’ I don’t know if Adele ever said these words. Or words like them. I never saw her again.
from Karen Whitley Bell’s In a Language Spoken and Unspoken: Nurturing Our Practice as Humanistic Clinicians J Pain Symptom Mgmt 2012:43:973