Emptiness

 Mayara Floss

“(…) Now one of you says to me, "But Grandpa: does time you are counting as was his boyish life, in the fields And now you start talking about emptiness ..." Then I explain: "It's the fields it is where the emptiness is large. the city is the place where emptiness is small. " In the city we look out and eyes just hit a building, a wall, automobiles. In the city we see short. In the fields, because the emptiness is large, the eyes see far, far away: the fields, the woods, the mountains on the horizon, the sun dies, the moon rises, the stars ... What a beautiful thing to see the white curtain rain is coming ... When emptiness is big world grows. (...)“ – Rubem Alves

I met him in the green cold and welcoming emptiness of Connemara. At night it is possible to see all the stars and in the distance his house near to the mountains is visible. It is necessary to cross a bridge and drive some Kilometres  to get there. When I met him I did not know he was a painter, he came into the Surgery with allot of smiles and jokes and a red nose. He had a obvious cough, sounded chesty and after an examination it was suggested that he take an antibiotic. He declined with a shake of his head saying that it would probably make him  more ill and cause him to be unable to work. His GP and myself a Medical Student gave some medication options but he was kindly sceptical.

While the Doctor spoke on the phone I got a chance to sit behind him and explained with a drawing all about Pneumonia, Bronchitis, emptiness and fullness. He raised his eyebrow and said you have made it very clear, now with your drawing I understand he said.

He accepted a prescription for medication but his GP and I felt that he was unlikely to take the medicine. Before he left the surgery with his prescription the doctor changed a big paper clip for a smaller one and he jokingly chided the doctor for being a penny pincher.

We laughed and I went with him to his car to be greeted by his Labrador, “ I never leave home without her".

The Doctor told me about his patient and friendship and the long life of difficult negotiation with medications. Sometime later we went to visit him which was more a social visit than a House call. The Labrador was on the road waiting for us before we turned in the dirt road. She already knew when the doctor was coming. According to the painter she feels the doctor coming and runs and waits in the ground to welcome him. He recounted how he happened to arrive in that place which he called his spiritual home. Back then may years ago there were only 2 or 3 houses and he described the enchanted emptiness of that rural island.

He was in the process of painting the local landscape, the greenery and lakes outlined with geometrical figures which he painstakingly re altered depending on the view he utilized . His little triangles and squares of paint were repeated thousands of times to get the colour and light exactly right so that he could produce the right green emptiness. His house and structure had evolved over the years based on previous adventures and alliances. Everything there had his personal touch, little pulleys  to close doors, solar panels to provide light, a fireplace strategically constructed in the middle of the house to heat bedrooms behind it and the living room in front. His house spoke his personality and was like a painting of himself. He invited us to sit at a table and sample food including Soup a routine played out often between him and the doctor that I was lucky to be part of on this occasion. Where the doctor sat an envelope with his name which on opening the GP found a chain of paper clips all that had been given by the doctor to the painter in the previous years. We all laughed at his reinforcement of the doctor as a penny pincher. Many people choose to be city dwellers where things are full, less empty, places where there are many things to do a lot of structure for treating diseases and a lot of everything. I learned with a bowl of soup some clips ink and people that emptiness is what could fill myself.

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 Mayara Floss is an undergraduate student of medicine Federal University of Rio Grande (Universidade Federal do Rio Grande - FURG) in Brazil. She is the co-creator of project "League of Education in Health" based on the freirean principles and co-empowerment of communities and students (Blog in Brazilian Portuguese: www.lesfurg.blogspot.com ). She was Fellow of the Science Without Borders Program at the National University of Ireland, Galway 2014-2015. She is the creator of SUS Series ( https://www.youtube.com/channel/UC7p_rNpzJmlIQp2xFMMtk_g  ), a video Series about the Brazilian National Health System. She created in 2015 the Rural Family Medicine Café (https://sites.google.com/site/someambassadors/familymedicinecafe ) and she is coordinating the recently created Word Rural Medicine Student Network (WRMSN). She also co-created with the Indian Dr. Pratyush the project "Rural Health Success Stories"  and writes weekly for the Blog of Popular Education, Arts and Health - the Ferry Street of 10 (www.balsa10.blogspot.com - in Brazilian Portuguese ).

The silence of tired tongues

 

Brazilian "mate" at an Irish background

Mayara Floss

* Thoughts about one of my experiences as a Brazilian medical student in the countryside of Ireland

When I was leaving an elder’s home care in a rural area of Ireland, a doctor told me: "you know, one of the last things a person with dementia loses is the sensation of the touch on the skin, and this is the reason that touching your patients is so important in this stage of their lives."

 With these few words I started to realize how much this explains to us. One of our first sensations is the tact, and in the end everything is the same sensation. The knowledge to feel before speak. But, as we grow up, the tact becomes rarer. Sometimes the symbol of a friendship becomes a simple handshake. And we start to get used of how not to feel. We leave our parents’ laps and start “learning” that too much proximity often is invasive or not common. 

 However, the sensation of the touch continues to be important, even in our unconscious. People with dementia do not lose the capacity of having emotions or the recognition of a caress. Probably this is one of the sensations the doctors need to revive in their practicing. The tact is essential, even if just feeling the pulse. In the song “Casa no campo” (house at countryside), by Zé Rodrix, he speaks about “the silence of the tired tongues”, something not so common in our society nowadays. However, when the dementia process starts, this silence makes more sense. 

The care also changes its form, the silence of tired tongues makes us try to approach people in other ways. Sometimes, words lose their meaning, as well as communication (which seems to be many times attached to concept of speaking) with the patient becomes in body language. Although the person with dementia is most of times isolated from the conversation and loses the reference of the listening, what we learn is the importance of smiling, of giving hands and hug each other – be human without talking. Sometimes I think that words left the world more distant. Probably, the importance of the touch continues to everybody since his/her childhood, but masked by words. By finding a patient in the process of dementia, we have the chance to rediscover ourselves and our own tact. Due to this, tired tongues or not we still could say a lot of things touching.

The song about the house on the countryside and the "tired tongues"

Originally written in Portuguese: http://balsa10.blogspot.com.br/2014/05/silencio-das-linguas-cansadas.html?q=sil%C3%AAncio