THE BEAUTY OF MEN SERVING AS CARE-GIVERS

Some recent estimates of the time span that our ancestors have resided on this planet state that homo-sapiens have been here between five and six million years. We cannot begin to imagine such a period of time, and we have little cultural information about our species for more than a few thousand years. But that information tells us that from time immemorial, the roles and responsibilities of men and women have been different and defined.

The usual men's responsibilities were hunting, erecting dwellings and community structures, and conducting tribal rituals. Sadly, we must also include engaging in warfare. Women's roles primarily consisted of domestic responsibilities, gathering food and caring for community members, especially those at the beginning of life and those approaching the end. The tasks of being there at times of birthing and dying have largely been delegated to women through the ages. It seems the only times that men have welcomed the opportunity to participate in the process of reproduction is at the very beginning of pregnancy. That is just the way we men are, it seems!

Mores have changed significantly during the 20^th Century. With the dramatic development of health-care systems and generous compensation for doctors, it is often men who now assume a major responsibility for the events of birthing and dying. While it is men who are usually in charge of the medical care from the time we are born until we die, still the basic hands-on care is provided by nurses, and most nurses are women. Whether it is because women are more genetically designed to be care-givers or because of long-standing social mores, one can't be certain. Our experience in the field of hospice and palliative care tells us that men can and should have just as special a role as women, and that men are just as needed. Wouldn't it be wonderful if we could, somehow, initiate a cultural shift that would result in men being care-givers equally with women!

In the field of hospice and palliative care, it is unusual to have male volunteers. In my seventeen years as a volunteer with hospice and palliative care, seldom has there been a man volunteering other than myself. We know that men can make a special contribution to the dying, but it seems that society has this cultural concept that a man is supposed to be strong, and therefore cannot also be tender. Strength and tenderness do not need to be opposites, for they are the greatest gifts when they are together, and they are special when the giver is a man.

That little space in time when we can be with the one who must shortly leave this life is most precious and significant. It is a time for listening thoughtfully and intently. It is a time with moments of poignancy that will make you want to cry. Men seem to have difficulty when it comes to tears. We find that in palliative care we let go of the fear of tears, for tears help to relieve pent-up emotions, and when shared, they help to dissolve the walls that tend to separate us.

I must emphasize that the end-time is not all filled with grief and sorrow. It is also a time to celebrate life by remembering the good deeds and the memories of a lifetime. There needs to be laughter as well as tears.

Early in my own volunteering, our hospice and palliative care doctor was a fatherly figure. He was an expert at pain-control and was always there when needed. He was totally comfortable with the dying patient. Not everyone is emotionally at ease at such times. But men, as well as women, can learn the skill of active listening and being a comfort to a patient who is nearing the end.

Ward has been a dear friend for many years. As a young man he was handsome, intelligent, sophisticated and popular. And he loved life. In his travels, on occasion he did some mountain climbing. On one adventure, just once, he made a fateful mistake and he fell. He survived, but he would be a quadriplegic for the rest of his life. Only someone who has had such an experience could know the pain and the despair from such a disaster. For years his greatest wish was that, somehow, he could die. His disability prevented him from carrying out that wish. Then it began to dawn on him that it was futile to make a career out of wishing that he were dead. Somehow, he began to find hope and meaning.

With limited funds, Ward managed to buy half of a large house and had it designed to meet his needs, and he bought a specially equipped van. He learned to befriend his pain, for it had become his constant companion. It is not easy to accept being almost totally dependent on help, but he did manage to get over his reluctance to ask for assistance. He had no choice, for he opted to live independently on his own. That meant assistance in practically every detail of his life. He attended the local university for further training, so he could become more self-sufficient financially. He has taught classes in personal development and feminism at the university and the community college. He took art classes for his own enjoyment and he further supplements his income with the sales of his paintings and gives some of his artwork to his friends. Two of his watercolors grace my office walls.

Ward brings a special gift for those who have met a disaster such as his. His suffering has enabled him to make connections with those who suffer. The following bears this out.

A patient named Jerry had just been admitted to the orthopedic ward and he was one of the patients on our volunteer list. He was not terminal at the time, but he had been seriously injured and was suffering acutely from pain and depression. The cervical part of his spinal column had been fractured in a fall. In order for any healing to take place, a steel crown, called "the halo" was placed on his head and fastened with screws imbedded into his skull. This structure, the halo, was then secured to his thorax. It was hell.

I tried, as a volunteer, but I could not make contact with Jerry and it was troubling to me, for he was in deep distress. He was isolated in a world of pain, overcome with the knowledge that he was permanently disabled. Then I thought of my friend, Ward, but I was reluctant to ask him for help. To get to the hospital, he would have to call for the special handicapped bus. That would be an expense. Would it be fair to suggest to him that he do something quite time-consuming, when he had limited physical resources? But I guessed that if Ward knew that another person was going through a hell, such as he was familiar with, he would want to help. I was right.

Ward did not need to go through the hospice and palliative care training sessions as the rest of us did. He already knew what suffering was, and it still was his constant companion. It had taught him well. Virgil, the Roman philosopher, long ago said, "Knowing sorrow well, I learn to succor the distressed." Ward was able to make a break-through with Jerry and, as he began to come out of his self-imposed exile, he began to tell the two of us about himself.

He was from the Mediterranean area, his family had emigrated while he was a child and he had no knowledge of English at the time. He had not learned to read or write, for he had been placed in classes with the mentally handicapped. He may have had a learning disability, but he certainly was not mentally challenged! In spite of such a literacy handicap, he had operated his own automotive paint shop. His great concern now was for his two teen-age daughters. His wife had left him while they were young and he had raised his girls as a single parent. They were the center of his life. He had not even dated. All of this, Jerry was gradually free to tell us over time.

Some patients, because they have been immobilized, develop pneumonia and Jerry was to have successive bouts with it, each one weakening him more. Just before he drifted off into a coma, and he knew that he was going to die, I told him that he could be a guardian angel for his girls and he was able to express his gratitude that Ward and I "had helped him a lot." We had given him the opportunity to share something of his life's story before he died. One of the basic hopes as we approach death, is that we will be remembered because we were here, and we made a difference.

During the years that we spent volunteering at the hospitals, Ward was often there, wheeling around in his chair, and he would be a support for patients with special needs. There is a law of compensation, though we may not perceive how it always applies. We now live almost a continent away, too far to be of direct assistance when the time comes, but we know that loving friends will be there for Ward too, for he has been a special gift in special ways to so very many.

Through the years that I have volunteered, our small groups regularly meet to share our thoughts on those who have died since we last met, and to discuss the needs of the patients that we are currently seeing. Our follow-up grief counseling and contact with the bereaved is also shared. At such times, we are be privileged to glimpse something of each other's deepest feelings and share our perceptions of the basic issues of life and death and human suffering. So often I deeply regret that there are so few men among us. Birthing and dying are basic events in life, and between the beginning and the end, it is in the caring for each other and the love that we share that makes it all worthwhile and meaningful, each step of the way. Let us encourage men to serve as equals in care-giving, and especially in the areas of hospice and palliative care volunteering.

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