A couple of the more memorable patients who have visited our clinic recently presented with very different presentations, yet were united by the "unlucky" number 13.
One patient was a mother in her late thirties who presented with low back pain. She had no red flags on her history or exam to raise concern for a more worrisome source of her back discomfort aside from a musculoskeletal etiology. However, during the course of her visit, she became tearful as she explained that her previously healthy 13yo son had died recently. While hospitalized at the government hospital an hour away from our site, he succumbed to complications related to Dengue Fever. Our patient was suffering from an ache that would not be ameliorated by the NSAIDs prescribed for her back pain. I listened. We prayed. Her son was gone. This hard fact was immutable. Hopefully, our patient departed her clinic visit with some modicum of comfort and renewed strength.
A second patient, cared for by my clinic colleague, Dr. Dina, was a 13yo female accompanied by her mother. She presented with irregular menses and mild nausea. Her pregnancy test was positive. She and her mother also experienced grief. They grieved the abrupt end of our patient's childhood and a far too premature entrance into motherhood. Dina listened. She offered the appropriate referrals for such a high risk pregnancy. The innocence of childhood had departed and would not be returning.
The above cases are frustrating and heartbreaking for both provider and patient. They have no easy remedies. Cases such as these are unfortunately not uncommon in our clinical setting. There is no clean and concise treatment algorithm to address victims of structural violence and social injustice. The "gold standard" that we strive to apply "is to make solidarity operational" via ACCOMPANIMENT.
Dx: Loss of Child/Loss of Childhood
Rx: Accompaniment
Dr. Paul Farmer has been referenced repeatedly in this blog and his words are featured prominently on the home page of our website. Farmer and the organization he cofounded, Partners in Health, were influenced heavily by Gustavo Gutiérrez (who died a few days ago in Peru at the age of 96). Stated differently, Gutiérrez (pictured below) was one of our hero's heroes.
The wonderful book, In the Company of the Poor, is a collection of conversations with Paul Farmer and Gustavo Gutierrez. (1) The introduction includes a nod to the etymology of accompaniment.
"Indeed, sharing bread together- in Latin, cum pane- is the original meaning of the word accompaniment." (p14)
The afterword includes a section entitled: "Accompaniment in Action." The section is packed with concentrated wisdom defining accompaniment and emphasizing its importance. A few excerpts are included below.
"This attitude of God must serve as a model for the people of God," Gutiérrez writes. "As Micah puts it, 'He has showed you O man, what is good; and what does the Lord require of you but to do justice and to love kindness, and to walk humbly with your God?' (6:8)." There is an urgency to the message- walk humbly together, with God and with one another, in search of justice and mercy. (p194)
"Yet accompaniment is not simply walking together. It requires recognizing real-world complexities, acknowledging the asymmetries of power and privilege, and being willing to address them while walking together. There is something fundamentally but beautifully radical in this idea. In a society so focused on individual attributes and achievement, this simple concept of walking beside another humbly and ever toward justice, could change the world." (p194)
"Accompaniment flips the impuse of 'how do we help them?' into an assertion- 'we're in this together.' We are connected, tied, and bound together. We need to walk together and learn together, and maybe, together, we can envision and create better, more equitable tomorrows, both for the big issues 'over there' and also in our daily lives, loving our neighbors- that is everyone- as we love ourselves." (p195)
Thank you for walking with us as we walk with our patients.
Thank you for joining us in operationalizing solidarity via accompaniment.
Thank you for helping us "envision and create better, more equitable tomorrows."
Top Photo by hello aesthe on Unsplash
Photo of Gustavo Gutiérez from https://windowlight.substack.com/p/gustavo-gutierrez-1928-2024
In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez. Edited by Michael Griffin and Jennie Weiss Block. Maryknoll, NY: Orbis Books, 2013.