Sunday, April 30, 2023

"Quando?" "Jamais!" Chapter 262 of my French novel

 I thought someone might be interested in this little story, which is a chapter of the book I am writing in French, as I study French with my teacher, Claude Convers, a native of Switzerland.  Here’s our process: Claude gives all her students the same title for whatever they are going to write for their lesson the next week, and it's up to us to work it into our writing.  Early on, I decided that I had always wanted to write a novel, so I would write another chapter each week, as our writing assignment, and that I would make the assigned word the title of that chapter.  I’m now up to chapter 262, although I skipped some numbers, so the total number isn't quite that high.  But still, it seems to have gotten significant.

This week’s title was "Jamais."  In this chapter, the three characters who are professors of sociology are at a southern France city (without a name so far, despite the fact that other locations do have names, and this is the central area where action takes place) where they will be meeting with most of the other characters to discuss what to do about this allegation that they are all just characters in a novel.  Originally, the two women, Laura and Juliette, colleagues  in the department and friends, had attended an annual party given by Morton, the older head of their department.  Morton was a notorious bore, and Laura discovered Morton and Juliette in rapt conversation during the party, and she was appalled that Juliette was the trapped victim.  But it turned out that this was the beginning of a passionate affair that led to their living together and being now engaged.  Laura, for her part, is single and notorious for being seductive and attracting all sorts of men, but not sticking with them.  There is a brief mention of Hortense, an older woman who was active in the May 1968 student revolt, who has her own history with men, which I won't bother you with.

Note that my translation is kind of awkward - as a translator, I don't give myself much freedom to be colloquial.

                                                                262 Jamais

In France, they say that the best strolls end in a cafe, especially when there is a threat of showers.  And in this season, in this town, there is a threat of showers almost every day, even with a clear sky.  As a result, the city’s cafes are prosperous, as are the boot stores and umbrella stores.  It was because of these two things, shelter from the storm, and to continue the conversation with a glass of wine, that the three colleagues from the Department of Sociology at the University of Lille found themselves at a table at the Café de la Chanteuse (the Café of the Singer.)

“Who is this singer that the cafe is named for?”  

Morton set the question to the waitress, a small young brunette with blue green eyes.  “She’s a beauty,” Morton told himself.  “What a body!”

“Oh, Monsieur, there is a special story here in our town.”  The voice of this small woman sounded like honey.

“Well, mademoiselle, we’re not from around here, so we’d like to hear the story.  Do you have the time?  I know the place is full, before the shower comes.”

“I doubt a storm, Monsieur,” said the waitress.  They say there is a threat of showers and everybody thinks is a good time for a glass of wine.  I think if there were too much sun they would say it’s a good time to have a drink to protect us from a sunburn.  It’s a good business, this cafe, don’t you think?”

“Is there a story?” said Laura.

“Oh, yes, the story,” said the waitress.  She sat herself down on the fourth chair at the table, very much at ease.  “Once upon a time, there was a small lady, no taller than I am, and she could sing like Edith Piaf.  Two real sparrows, those two.  And she and her boyfriend wrote songs, about the seasons, about the sea, and especially about love, of course, since they were young and French.  Anyway, at that time there was a very popular song, Quando Quando Quando.  You know, that means When When When in French.  And this one summer there were a load of Italian women here in town — there were courses in French for Italians, and many young Italian women needed to learn French for their work, I suppose.  After class, the Italian ladies usually here to have a drink and to eat something — too much pizza, actually, too much pizza, disgusting pizza, our town is well known for having pizza like a rubber tire.  But anyway, the cafe had its little band, and they were fed up with the requests to play Quando Quando Quando.  All the city residents, especially my mother, who was a waitress here just as I am today, all the French detested that terrible song.

“But what could you do?  The young customers request the song from their country, they pay for their drinks and their disgusting cardboard pizzas, and they wanted their song.”

“Yes, what could you do?” said Juliette.  The customer is always right, no?

“Here in France?  You speak French perfectly, Madame, is it possible that you could really be an American?  That’s an American myth, I think.  Here in France, the waiter are kings, certainly!

“Did the musicians refuse to play it?” asked Morton.

“More amusing than that, Monsieur.  Remember, the singer and her boyfriend were song writers.  So, they could find a creative solution.  In place of Quando Quando Quando, they wrote another song.  They declared that it was a love song, and indeed the words referred to love but the title was a clever answer to the students.  The song was called Jamais Jamais Jamais (Never Never Never).  You understand that?  When When When?  Never Never Never!”

“I remember that song,” said Laura.  “I loved it!  When am I going to get married?  Never Never Never!  A very romantic song.”

“Why is it romantic, Laura?” said Morton.  It says I’m never going to get married.  It’s anti-romantic, isn’t it?”

“Not at all, Morton, the song and the singer doth protest too much!  I will never be in love again, they say.  That’s something Hortense would say.  This is after an affair that had to end badly.  It was too painful at the end, to say see you later, or goodbye.  That doesn’t work, it’s never worth the pain.  Never again!  At least, never again for now.”

“Madam is right,” said the waitress.  It was very romantic.  The song and the singer were like Edith Piaf.  After the first performance, every one requested Jamais Jamais Jamais instead of Quando Quando Quando, even the Italian students, in fact the students more than anyone.  They planned to go back to Italy with their new discovery.  The cafe became famous.  So, they were going to rename the cafe Jamais Jamais Jamais.”

“But that didn’t happen that way?” said Laura.  “What happened?”

“Unfortunately, the singer and her boyfriend separated.”

“Did success spoil their relationship?”

“No, I don’t think so.  I think that at bottom they were first of all partners, and that their love relationship was secondary.  They were together, so why not be a couple, I suppose.  Anyway, the boyfriend left the relationship, the singer stayed, and it seemed that it would be unlucky to name the cafe after a relationship that ended.  So, they gave it the name of the singer, Café de la Chanteuse.”

“And your mother was a waitress here then?”  The young waitress nodded her head.  “And she stayed here after the guy left?”

“Well, in fact, she left at the same time as he did.”

“She did?”

“Yes.  In fact, the two of them became my parents.  But now that the singer is long gone, I took the old place of my mother.”

“Oh, yes.  And what do you do?  Are you a student?”

“Nope, I’m a waitress.  And I’m waiting for my prince someday.”


“Yes.  That’s my family history, that’s what we do.”

And at that, Laura exclaimed, “Me too!  Someday!”

And with that, the two women, one a little tall and a little bit redheaded and a little older, and the other a little short and a little brown haired and a little younger, kissed each other and looked at each other warmly, and them they turned around and scrutinized the crowd to find their prince.

Meanwhile, distractedly. Morton was whistling the melody of Jamais Jamais Jamais, and over the loudspeaker came the sound of Miles’ Davis’s trumpet, One Day My Prince Will Come.  A small shower started.


Et en français, la version originale:

                                     262 Jamais (corrections by Claude Convers)

En France, on dit que les meilleures promenades se terminent dans un café, surtout lorsqu’il y a une menace d’averse.  Et en cette saison, dans cette ville, il y a presque tous les jours une menace d’averse, même lorsque le ciel est clair.  En conséquence, les cafés de la ville sont prospères, comme aussi les magasins de parapluies et de bottes.  C’était donc à cause de ces deux choses, l’abri d’une averse, et pour continuer la conversation avec un verre, que les trois camarades du Département de Sociologie à l’Université de Lille se trouvèrent à table au Café De La Chanteuse.

— Qui est cette chanteuse après qui ce café est nommé ?  Morton posa la question à la serveuse, une petite jeune femme avec des cheveux brun foncé et des yeux bleus-verts.  C’était une beauté, observa-t-il à lui-même.  Quelle silhouette !

— Ohhh, monsieur, il y a une histoire particulière de notre ville.  La voix de cette petite femme résonnait comme du miel.

— Ah, bon, mademoiselle, nous ne sommes pas d’ici, alors on aimerait bien [] entendre l’histoire.  Vous avez le temps ?  Je sais qu’il y a du monde ici, avant [] l’averse.

— Je doute d’une averse, Monsieur ! dit la serveuse.  On dit qu’il y a une menace d’averse et tout le monde pense que c’est un bon moment pour prendre un verre.  Je pense que s’il y avait trop de soleil on dirait que c’est un bon moment pour prendre un verre pour se protéger d’un coup de soleil.  C’est une bonne entreprise, ce café, n’est-ce pas ?

— Il y a une histoire ? dit Laura.

— Ah, oui, l’histoire, dit la serveuse.  Elle s’assit sur la quatrième chaise, à table, très à l’aise. Une fois, il y avait une petite dame/femme, pas plus grande que moi, assez petite, et elle pouvait chanter comme Edith Piaf.  Des vrais moineaux, les deux.  Et elle et son copain écrivaient beaucoup de chansons, sur les saisons, sur la mer, et surtout sur l’amour, bien sûr.  Ils étaient jeunes et ils étaient français.  En tout cas, à l’époque, il y avait une chanson italienne très populaire, [] Quando Quando Quando !  Vous savez, ça veut dire Quand Quand Quand en français.  Et [] cet été il y avait beaucoup d’italiennes, ici dans la ville — il y avait des cours de français ici pour les italiennes, beaucoup de jeunes femmes italiennes [] avaient besoin d’apprendre le français pour le travail, j’imagine.  Après les cours, d’habitude les italiennes venaient ici pour prendre des verres et manger - trop de pizza, en fait, trop de pizza, de pizza dégoutante, notre ville est bien connue pour la pizza qui ressemble à du pneu.  Mais, en tout cas, le café avait son petit groupe qui jouait ici, et ils en avaient marre des demandes pour cette chanson, Quando Quando Quando.  Tous les habitants, surtout ma mère, qui était serveuse ici comme moi aujourd’hui, tous les français détestaient cette chanson épouvantable.

— Mais quoi faire ?  Les jeunes clientes demandaient la chanson de leur pays, elles payaient leurs verres et leurs pizzas en carton dégoutantes, et elles voulaient leur chanson.

— Qu’est-ce qu’on [] fait ? dit Juliette.  Le client a toujours raison, n’est-ce pas ?

— Ici en France ?  Vous parlez le français parfaitement, madame, mais est-ce [] possible que vous puissiez être, en réalité, américaine ?  C’est un mythe américain, je pense.  Ici en France, les serveurs sont les rois, certainement !

— Les musiciens ont refusé de la jouer ? dit Morton.

— Plus drôle que ça, Monsieur.  Rappelez-vous que la chanteuse et son petit ami étaient [] chansonniers.  Donc, ils pouvaient trouver une solution créative.  Au lieu de Quando Quando Quando, ils ont écrit une autre chanson.  Ils ont affirmé que c’était une chanson d’amour, et en effet les mots parlaient d’amour, mais le titre était une réponse maline aux étudiantes.  La chanson s’appelait, Jamais Jamais Jamais.  Vous comprenez ça ?  Quando Quando Quando ?  Jamais Jamais Jamais !

— Je me souviens de cette chanson ! dit Laura.  Je l’aimais beaucoup !  Quand est-ce que je vais me marier ?  Jamais Jamais Jamais !  Une chanson très romantique.

— Pourquoi c’est romantique, Laura ? dit Morton.  Il dit, je ne me marierai jamais, c’est antiromantique, n’est-ce pas ?

— Pas du tout, Morton, la chanson et la chanteuse protestent trop !  Je ne serai jamais plus [] amoureuse, elles disent.  C’est quelque chose qu’Hortense dirait.  C’est après une aventure qui a dû mal se terminer.  C’était trop pénible à la fin, de dire au revoir, ou plutôt adieu.  Ça n’a pas marché.  Ça n’en vaut jamais la peine.  Jamais plus !  Au moins, jamais plus pour le moment.

— Madame a raison, dit la serveuse.  C’était très romantique.  La chanson et la chanteuse ressemblaient à Edith Piaf.  Après la première présentation, tout le monde demandait, Jamais Jamais Jamais au lieu de Quando Quando Quando, même les étudiantes italiennes, en fait, surtout ces étudiantes.  Elles avaient l’intention de rentrer en Italie avec leur nouvelle découverte.  Le café est devenu très connu.  Alors, on a eu l’intention de renommer le café, Jamais Jamais Jamais.

— Mais ça ne s’est pas passé comme ça ? dit Laura.  Qu’est-ce qui s’est passé ?

— Malheureusement, la chanteuse et son copain se sont séparés.

— Le succès a gâché leur relation ?

— Non, je ne [] pense pas.  Je pense qu’ils étaient au fond, en premier, des collègues, et que leur relation amoureuse était en effet secondaire.  Ils étaient ensemble, pourquoi ne pas être un couple, j’imagine.  Quand même, le copain a quitté la relation, la chanteuse est restée, et il semblait que ce serait de la malchance de nommer le café après une relation finie.  Alors, ils ont donné le nom à la chanteuse, Café de la Chanteuse.

— Et votre mère était serveuse ici à l’époque ?  La serveuse hocha la tête.  Est-ce qu’elle est restée ici après que l’homme soit parti ?

— Non, en fait, elle est partie au même temps que l’homme.

— Oui ?

— Oui.  En fait, les deux sont mes parents.  Mais maintenant la chanteuse est partie depuis longtemps, et j’ai pris l’ancienne place de ma mère.

— Oui.  Et que faites-vous ?  Vous êtes étudiante ?

— Non, je suis serveuse.  Et j’attends mon prince d’un jour à l’autre.

— Oui ?

— Oui.  C’est l’histoire de ma famille, c’est ce que nous faisons.

Et avec ça, Laura s’exclama — Moi aussi !  D’un jour à l’autre !

Et avec ça, les deux femmes, une un peu grande et un peu rousse et un peu plus âgée, l’autre un peu petite et un peu brune et un peu moins âgée, s’embrassèrent et se regardèrent chaleureusement, et puis elles se retournèrent et scrutèrent la foule pour trouver leur prince.

Entre-temps, distraitement, Morton sifflait la mélodie de Jamais Jamais Jamais, et par les haut-parleurs arrivait le son de la trompette de Miles Davis, Un Jour Mon Prince Viendra.  Une petite averse commença.

Sunday, April 23, 2023

Humanistic Medicine Defined, and Why We Need To Teach It

Humanistic Medicine, and Why We Need To Support Teaching It


This is the age of amazing medical advances – I personally have had my own share of medical gifts of life and limb that former generations could only dream of, and the odds are that you, the reader, have had your own. The touch of modern medicine is everywhere. But in this age of scientific advance, there are unforeseen consequences. Just as the scientific doctor has advanced, so has the role of traditional healer, the practitioner of humanistic medicine, been partially eclipsed.

That is a shame. Because as much as we welcome the newly empowered doctor as scientist with miracle cures in the pocket, we still need the doctor as humanist, a tradition that goes back for millennia in human history. Scientific and humanistic medicine are both necessary; one does not go without the other.

Let's be more specific about what Humanistic Medicine is. “Humanistic medicine” encompasses a lot. It can mean interviewing patients to find out where they're at, how best to reach them, how to be empathetic. It can be befriending patients, even while being a professional. It can refer to adopting the proper stance according to the problem, as indicated by the classic article on the doctor-patient relationship by Szasz and Hollender, a relationship that can go from (a) active-passivity, to (b) guidance-co-operation, and to (c) mutual participation. It is part of the art of medicine to determine which situations and which patients require (a), (b), or (c).

It can mean becoming wise, as old time doctors were reputed to be, rabbi-like. It can be becoming attuned to the cycles of life, from birth to death, knowing when and how to intervene and when to let nature take its course, to acquiesce. It can be giving advice that is not strictly medical. It can be being able to call upon literature, philosophy, art and other forms of wisdom to help patients and give them perspective.

It can mean being part of a team that works with patients when curing is not an option. It can be helping patients navigate so they can do things they really want to do, when it becomes very hard. It can be giving patients and families bad news in a sensitive manner, different for each practitioner and each family. It can be caring for the bedridden, turning and cleaning, cheering up, relating, simply being there. It can be tending sensitively to the dying patient, and the families of the sick and dying patient, in all their variety.

Humanistic Medicine is that part of medicine, the softer side.


If you look at the medical miracles of modern life, it's understandable that an unintended consequence of its rise would be to put the traditional role of caring in the shade. The new possibilities of curing are so exciting as well as demanding. There is so much more science to master. It can be overwhelming in its difficulty and obvious importance. The time for learning to care can be crowded out.

In addition, it's not clear that medical schools and large research institutions were ever very good at teaching the softer side of medicine, the feeling side, the relational side, the empathetic side, the long term supportive side. The role of the scientist has taken over the medical turf, and the humanistic doctors are not the top recruits for medical schools, which think of themselves as research institutions. Curing has crowded out caring.

And that is a shame, because caring for and caring about the patient, and relating intimately to the patient and the family, and caring for the chronically ill, is as important as it ever was. Even when doctors could do very little to cure patients, they still rendered important services by being there. They always coordinated care for patients with ongoing illnesses, and for patients who were dying.

Caring for people, moreover, is not only important for patients, but for the doctors as well. It's hard to be a doctor. It's hard work to tend to patients, it's hard to prepare and learn so much and to keep learning all your life, it's hard just physically to work all that time including nights, and nowadays, of course, it's hard to cope with the corporations that run medicine. It's a very hard job.

But more than in most jobs, medicine can have so much meaning. You are doing so much, you have all the expectations on you, and when you meet them, when you actually do your job and help people in this most important aspect of people's lives, their health – talk about satisfaction in your work, few things match medicine, at least when things go right. So for all the difficulty of the job, there is a lot of upside.

Humanistic medicine is not a frill. Most doctors who have been in practice know how fulfilling it is to both patient and doctor when the softer requirements of medical care are fulfilled. And most doctors who have been practicing for a while realize how hard it has been to achieve that status of the wise and sensitive and caring physician. When you have been at it a while, you realize how important it is that humanistic medicine be taught and emphasized, perhaps more consciously than ever.


And, on a personal note, this all came home to me in spades over the last few years as my wife was afflicted with Alzheimer's. I had tried as best I could in a long career in primary care pediatrics to be that practitioner of humanistic medicine that I've advocated here. It was a long slog, I had a lot to learn, although I tend naturally towards being empathetic, which was a help. In pediatrics, I did have some bad diagnoses to deliver, and I did better at that as time went on. I tended to people's personal lives. I tended to try to put things in perspective. I wasn't a “Just the facts, ma'am” practitioner. But still, it wasn't easy.

And then I sat with my wife as our neurologist delivered the diagnosis, "I'm afraid it's Alzheimer's," a direct and caring face to face encounter, a heartfelt “I'm sorry.” She didn't at all shy away from the direct, personal connection while giving bad news. I was able to tell her, our neurologist, that we liked her very much as a doctor and ask her if she could schedule us for periodic visits a few times a year even if there was little she could do, because she was our doctor. She said yes, and told me later she had learned something from me and that she was scheduling her patients more frequently, just to give them care, if not prescriptions.

I cared for my wife as she needed more and more care, as I had to drive her everywhere, to the hairdresser, to take her shopping for clothes she would never wear and books she would never read, help her in showers, I had to help her in the bathroom, I had to prepare meals on an ever more restricted menu of things she would eat. I had to get care for her, thank God I found our Angelicare agency with professional caregivers, wonderful giving people, based in nearby Vallejo, all from the Philippines, eventually 24/7 care when Ann couldn't get out of bed and they had to keep her clean, which wasn't easy, but they did it so well in a way that I never could have. She never had a bedsore. The nurses came from hospice, as did the aide who washed her body and her hair twice a week as she was in the hospice-supplied hospital bed. We had to give her more and more medicines to control her neurological symptoms, especially when the seizures came. What I didn't see in pediatrics was professionals who take over when they know their patient is going to die, prepared to see that happen and move on to the next dying patient.

And then the final days, the kids assembled, sitting with her when she couldn't eat or drink anymore, I sat by her side and held her arm as she took her last breaths and gradually her heart stopped.

I realized that although primary care pediatrics had prepared me for some of all this, a lot actually, my training had left out a lot. I had never sat with a patient for a long time to see what it was like – I mean, it would take 12 hours of sitting there to really absorb it, and more than that, longitudinally. In med school and in residency I had never learned to give a dreadful diagnosis properly, and as a result I had botched some of those instances in practice. I had never sat with someone as they died – my only direct death encounters were after the fact, although one time at the Mass General ER a patient had coded in the radiology suite and the staff doc had taken me with him and as the patient wasn't responsive he opened the chest and massaged the heart manually and urged me to do the same, which I did. But that wasn't caring for a patient and then being there for the death, the way the movies of old-time doctors show that that's what used to happen.

So, it occurred to me that our training left out a bunch of stuff on the humanistic side. And that's why I'm writing this.


Budd Shenkin