International Balint Award (Ascona Prize)

My name is Ermine Berberyan. I’m a 2^nd year student in the master’s programme of Russian-Armenian (Slavonic) University in Yerevan. I want to become a psychologist. I’d like to tell about an event that had a great influence on my professional and personal development.

The second year at the University provides a practical training, which means that we, the students, are taken to different hospitals where we learn to communicate with the patients, to talk to them. First, our teachers show us how to do it, then, our independent work begins. The patients are not the easiest people to talk to. The sick can be nasty, feel bad, be out of humor – and thus, they can’t change the situation they are in. This is the way they differ from the healthy people. It is clear that you need special skills to talk to the sick and that you need to develop these skills.

That time we were taken to a hospice for oncology patients. The word “cancer” sounds like a death warrant to a usual person. But being a student in medical science, I understand that it’s not always true. Tumors can be excised, metastases can be treated by radiation and poisons (radiation and chemotherapy), but nobody can guarantee 100% result. Chances of a recurrence are also high.

Of course, I knew about the hospices as well. I imagined it as follows – hospice is a hospital for severe patients, a person in a hospice is likely to die soon. I don’t know how often people are released from hospices, but, in my opinion, it doesn’t happen very often. But they still live in hospices. I mean that patients spend different amounts of time in hospices, sometimes weeks, sometimes months, the last months of their lives. The hospices provide a palliative care to patients, they struggle with the pain caused by the underlying disease, provide the care that can’t be provided at home due to the severity of the disease.

I even thought that I was ready to all of this – ready to see people who were aware of the cancer and were living in the hospital for months, who suffered from a painful therapy for their bodies…

I was appointed as a curator for one patient, a middle-aged men. The oncologist told me briefly about his diagnosis, a hopeless condition and made a passing mention that they have several times sent a psychologist to this patient, but he refused to talk. “Try, may be he’ll talk to you”, – said the doctor. So, I had to do something that professional psychologists failed to do. It was a huge responsibility.

I asked her to tell me more about this patient. And I found out, that it was a man, 53 years old, a former translator (he translated famous movies). He has a wife and an adult son, who he hasn’t communicated with even before the disease. When he became ill, the family took part in his life. His wife visits him, cares for him, but he’s already on edge. The patient doesn’t want to live and doesn’t resist to his disease. Now he has a tongue cancer at the final stage. Thus, he can’t speak and obviously he doesn’t want to. From the books about a palliative care, such as a wonderful book by V. Zorza, I learnt that sometimes the severe oncology patients turn away from their relatives, but continue to communicate with the medical staff and it lightens up their last days. Being a future doctor and a human, I also understood that it was important for a person to sort out all internal conflicts before the death so he/she could rest in piece. I decided to make my best in order to fulfill my professional and human duty.

I didn’t go to him the same day. I came home, found the movies he had translated; I was watching them the whole day. And I felt that those films were about him as if they wanted to tell me something about him that nobody knew. The next day I went to the hospice. At first I thought I wouldn’t be afraid, but when I came up to his room I had to stop for a few minutes to recollect my courage. When I entered the room, I saw a terrible picture – I could hardly find a man on the big bed where he lied snug. And to think that all the beds are standard in hospices.

I came up to him, said hello and introduced myself. He slightly turned his head to me. He had a haunted look. I sat down on a chair next to the bed. I started a conversation, tried to talk to him like I talk to a usual healthy person, although, I must confess, it was very difficult. First, I was pretending, overcoming myself, telling rubbish.

And in the middle of the conversation I said that I saw the movies he translated (of course, I didn’t say that I had done it the day before). As soon as I said that, he turned to me and I saw a faded but still a twinkle in his eyes. And the rest of the time I was sharing my impressions about these films and he was just looking at me and writing something from time on time on a piece of paper (because he couldn’t talk). But I have created some kind of a bound between us, and now it was easy for me to talk to him as if he wasn’t an incurable patient, but just a man who translated the films we were talking about at that moment. I was very happy that I could help “my” patient, draw him out, remind about the good, about his successful work.

I had another meeting with him and then, when I came for the third time, I was told that he had died. It was a shock for me. For a long time I’ve been thinking about this man. From time to time my thoughts are coming back to him.

I felt that man was not a stranger to me. And he wasn’t a stranger to me indeed. A death is always a serious shock, but I was going to become a psychologist and I am not a child to assume that a very sick man will live forever. For me it was the first death… of “my patient”, perhaps it would be the right word. May be one day there will be the others but at that time I was living with the thoughts of one death – I was constantly thinking that I had missed something to save him, to help him. The feeling of our relationship’s incompleteness, my default plans to help him evoked the incoherent multitude of emotions – I was either dissatisfied with myself because of what I “didn’t have time to do” and “didn’t complete” or resentful to the patient because he “did not wait for my help”. I started to think that I was mistaken, perhaps, I hurried up to choose my profession – if I keep on feeling every patient’s death, not only I will not be able to work effectively but to live.

At that time our department at the University hosted a Balint meeting presentation. I first learned about the medical personnel self-help groups. I was very interested in the Balint work and I enrolled in a Balint group. There were psychologists, psychotherapists and students of psychology departments in our group.

At first I hesitated to submit my case (the one I was thinking about). But over time I realized that it was safe to do it and that I could share my feelings. I’m very grateful to my colleagues for their support and participation, I put the situation into perspective and I managed to feel that I am not guilty not only in words but in my soul and that I could not help in any other way apart from what I did. I realized that there are no ideal medical cases when the patient goes almost happy, surrounded by a 100% successful help from his family and medical staff, and even if they exist, they are mostly an ideal we have to achieve but not a rule. I also realized that my professional choice was correct and that on the one hand, as a young girl, I will have to learn how to cope with the death and its presence in my immediate circle, on the other hand, as a future specialist, I have already began to learn it. Namely, it was a part of my practical training in hospice, not just the skills to communicate with patients.

After the group work I felt easy and calm. After that I was determined to study to become a Balint group leader so I could try and help my colleagues as they helped me, support them and let them understand that there is a space where they will understand you, help you to put the situation into perspective, help to realize the limits of your competence and most importantly to do it without any criticism or advice, just because they want to help and to participate!

And now – your obedient servant – has already passed the first module of the long-term educational course to become a Balint group leader.

And with every Balint group I appreciate this idea more and more and I believe in it!