Episode 3: “Timing is Everything, Part II” (aka “To Fart Or Not To Fart”)

The English say that every cup of tea is different, and so it was for Matt Sarisob, MSW, LICSW: every fart is different. Considering his anal issue the purest expression of his individuality, he covets it for that very reason, savoring the aromas like a connoisseur, loving them in the same way that mothers do their children: protectively, always surprised by the next one, more gleeful with each inhalation, each finger-sniff.

Sarisob feels similarly about his calling as a social worker: the second-purest expression of his individuality. He loves helping his Oncology patients along their path to recovery as surely as he loves smelling his flatus. And the sweetest fart of all, he thought, flushing the come-clotted toilet paper down the toilet—the mere thought of his unprecedented public masturbation earlier that morning set his prick astir, compelling him to beat off again just before lunchtime to the mental reenactment of his al fresco wank—is the fart that his 10 a.m. patient Rick Landsman didn't receive during their session. The sweetest fart of all is the one that combines the two purest expressions of Sarisob's individuality: the Patient Fart.

Sarisob discovered the Patient Fart two years into his practice at MGH, and it has become one of several unique therapeutic tools in his, er, arsenal. When he chooses to cut a PF, Sarisob relishes that moment more than any other. What made PFs so precious was that Sarisob allowed himself exactly one fart per patient. Only one, which was placed at the exact right moment to provide optimal therapeutic value to the patient. The PF wasn't for all patients, but could come at any time to those who merited it. When to let fly, the volume, his reaction to it—all are critical factors in creating the optimal patient response. When to let fly is the most important factor, and Sarisob’s instinct for placement is impeccable, unwavering. He is the Miles Davis of the butt-trumpet.

Sometimes he broke wind in the early stages of their collaboration. (Sarisob considers social work a symbiosis between himself and the patient, working together to guide them through the journey of despair and despond to the other side of their disease and into the light of new life.) When patients evinced discomfort in receiving help from a social worker, Sarisob could sense it immediately, feel it in their body language, their reluctance to make eye contact, the quaver in their voice as they answered his questions. It is that cohort of patients who received the early fart. For maximum impact, Sarisob gently slipped one into a pause in the patient’s dialogue. Disarmed by the eructation, the nose-hair-curling bouquet somehow lowered the patient's guard and humanized Sarisob, revealing the caregiver’s own occasional lack of control over his bodily functions. Despite being at the epicenter of stench—or because of it—the fart relaxed the patient, brought them together, and the patient was his from there on.

Intended to break down walls of repression, early farts needed a strong reaction from Sarisob to ensure success. If he let the patient interpret his malefic stink he was lost. So Sarisob took charge, being quick to dismiss the odor with a matter-of-fact wave of the hand. He would own up to the fact that he sometimes farted and that people shouldn’t have to apologize for such a natural human expression. “People always want you to apologize for things, you know what I’m saying?” Sarisob would ask the patient, prompting them to offer variations on the theme he was leading them toward, which was “You’re right! My mother/father/wife/husband/girlfriend/boyfriend/son/daughter/brother/sister/boss/co-worker) makes me feel like I need to apologize for having cancer!” Sarisob would then boldly proclaim that cancer and farts are nothing to apologize for, and ask the patient if they’d heard of Benjamin Franklin’s pungent manifesto “Fart Proudly”. If they hadn’t, Sarisob would offer to give them his copy, which they often accepted. Sarisob stocked his desk with several copies of “Fart Proudly”, taking care to dog-ear and monogram each one so it would indeed look like his book. “And, if you ever need to let one go in a session with me,” he would tell the patient, “don’t hold back! Repressing it is a waste of your energy.” Sometimes they took him up on it, to Sarisob’s enjoyment and edification: one of the many things his patients have taught him over the years is that chemo farts are truly vile. But it was easy to abide their loosened sphincters when he could see their bodies relax, feel the change in their auras.

Later-in-relationship farts were a trickier matter. Those farts had an entirely different therapeutic modality, reserved for patients who have worked with Sarisob for quite some time, for years in certain cases. They’d come to depend on Sarisob long after he felt it was time for them to “leave the nest”. It was this cohort of patients who received the later-in-relationship fart, intended to help them with their separation anxiety. His aim was to offend, however subtly, and set them on a thought process whereby they’d choose to break their dependence on him and move forward with their cancer-free lives. The late fart, or “separation fart”, as he called it, would be delivered not during a pause in their dialogue but while Sarisob himself was speaking. He would release a loud one in mid-sentence, pushing hard for a real splat effect, and would then stop talking, widening his eyes and covering his mouth for an embarrassing two seconds. As the tear-gas permeated his office, Sarisob would apologize profusely, attributing the errant toot to his latest spicy meal. Then he would pretend to lose his train of thought and continue to apologize awkwardly, all the while spraying his odor neutralizer to little effect. Late-fart patients seldom remembered what it was he was talking about, stunned as they were by the smell. In this context, Sarisob appeared quite ashamed of the fart, overdoing his shame and causing the patient to think that their longtime counselor might have repression issues of his own.

“Separation fart” recipients might think that their social worker simply doesn’t have 24-7 control of his gas, but this is far from the truth. SFs actually require great physical control for the reason that one seldom talks and farts simultaneously. One talks, one farts, but one rarely does both at the same time unless by accident. The fortissimo flatus always offended the patients—a risk Sarisob was prepared to take on their behalf. These patients, Sarisob concluded, were ready to take their recovery to the next level, and needed to be roused from their complacency in order to do that. And like the early-in-relationship fart, the SF was successful more often than not: the majority of this cohort decided soon thereafter to stop seeing Matt as regularly. A few patients broke off the relationship immediately, others more gradually, and some bought him lavish parting gifts to thank him for his devoted care—overcompensating, Sarisob thought, for the disgust with which they now viewed their caregiver.

If only they knew, Sarisob mused while returning from the bathroom stall, nibbling off the little bits of toilet paper adhering to his left hand’s index finger, how much care and compassion a PF contained.