To every thing there is a season, and a time to every purpose under heaven" begins one of the best-loved passages in the Bible. From that passage (Ecclesiastes 3:1-8), with its successive, elegantly balanced antitheses, the verse that has lingered in my mind over the past several weeks is: "A time to rend, and a time to sew, a time to keep silence, and a time to speak." Just under a month ago, I was rent and sewn. My breastbone was sawed in two and my rib cage pried open for triple-bypass heart surgery. Then I was sewn up again (with state-of-the-art dissolving sutures), and now, happily, I am convalescing in peace at home.What makes Ecclesiastes 3:7 so haunting for me is its juxtaposition of rending and sewing with silence and speaking. An American hospital is a city that never sleeps and rarely shuts up. As a patient, one speaks in the course of an average 24-hour cycle with at least a dozen professionals of one stripe or another, and one is keenly aware of their further, constant consultation with one another. Outside each room in the cardio-thoracic wing of the Huntington Memorial Hospital, in Pasadena, California, where I recovered from my surgery, a small filing cabinet is built into the wall. The cabinet has a panel that can drop down and function as a mini-desk. Each visiting doctor or nurse pulls that panel down and adds his or her notes to the burgeoning record before leaving, and each reviews the record before speaking to the patient. Amid all this speech, is there any place for silence? As is so often the case with silence, one can easily miss it and fail to appreciate the role it plays, but, yes, there is a place for silence even in the hospital's cacophony of hyper-communication. As I write, I have on my desk the American Heart Association's concise but complete pamphlet "Coronary Artery Bypass Graft Surgery." Reading this pamphlet in the hospital helped me give informed consent to the surgery. But I find what the pamphlet does not say-its silence, if you will-striking in retrospect. The coronary artery bypass graft proper is surgery of an extraordinary delicacy, but getting to the point where that work can begin-cutting down through skin, nerves, muscle, and bone to where the unseen heart hides out-is controlled butchery. To put it mildly, the pamphlet is not richly descriptive when covering this part of the surgery, but somewhat to my surprise, I applaud its abstention. I do so because I am now so vividly aware that between the moment when one signs the consent to surgery and the surgery itself, the adult in one plays host to a baby awash in primal emotion, and what that baby needs is not more information. As I was being wheeled off to the operating room, my orderly or "personal care associate" said, "Now, I'm going to give you something, and you'll have to give it back to me after surgery." "What is it?" I asked, and she gave me a kiss. Is there a parent alive who has not calmed a baby with a kiss? The amount of medical information conveyed by a kiss is roughly zero, But the baby who was helped by being discreetly insulated from knowledge that would have been disturbing to no point went into the operating room calmed by that kiss. Here in my home study, well along on the road to recovery, I find that my normal, ravenous appetite for information has returned along with my other appetites. I have placed a large on-line book order for books on cardiac surgery, and I once again turn a cold cheek to strangers offering kisses. Well and good, but "to every thing there is a season," and the season of recovery is not the season of surgery. The phrase "conspiracy of silence" puts me in mind of the plays of Harold Pinter. In the typical Pinter play, a tacit and destructive agreement not to mention something is blown apart by the arrival of an outsider who is not party to the agreement. That kind of silence is malignant, but there can be such a thing as a benign conspiracy of silence. In the Huntington Memorial Hospital, the silence collectively maintained on my behalf about details that I did not, in truth, need to know to be an informed medical consumer was a benign conspiracy. So was the uncondescending and unspoken allowance of staff at all levels for the fact that during a period of about forty-eight hours, I was more child than man. American medicine, so often decried as knowledge untempered by wisdom, sometimes belies its reputation. In my case, it knew that when caring for someone about to be rent and sewn, there is indeed a time to keep silence as well as a time to speak.
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