on the brink

 

Most of us would agree that the key to a long life has something to do with maintaining a healthy lifestyle. Following a healthy diet. Maintaining a normal BMI. Exercising regularly. Keeping the mind active and engaged. Avoiding cigarettes, alcohol, and other drugs and inhalants. Managing hypertension, diabetes, and other chronic diseases. Controlling stress. Some of us even believe that relaxation techniques and meditation are helpful. Some people embrace faith as a factor. It all makes sense.

"The secret to living well and longer is to:

Eat half,

walk double,

laugh triple,

and love without measure."

~Tibetan Proverb~

This past week, though, a few other possibilities came up. These are based on studies performed by people who have dedicated their professional lives to unlocking the secrets for living longer and better. One study looked at napping patterns as an indicator. It turns out the timing of naps, their duration, and frequency can be an indicator of poor health. So, try to avoid long naps late in the morning and around midday. Thankfully, however, a quick power nap every so often seems to be safe.

"Let's begin by taking a

smallish nap or two."

~Winnie-the-Pooh~

A number of studies promote the idea that social interaction is important and that loneliness and isolation are detrimental, which is a bit off-putting to those of us who enjoy solitude and prefer silence. We can be perfectly happy, healthy, and engaged in relative isolation. Then there's the suggestion that having a dog can help. A dog provides companionship and requires exercise, so that makes sense. Poverty seems to have a negative impact, while wealth is good. Duh!

The problem with these studies is that it's hard to control for all the factors that play a role in longevity. So, for the most part, these associations suggest they are correlated, but don't prove causation. This is reassuring because, if napping shortens one's lifespan, I'd need to dramatically increase my caffeine intake. And if having a dog adds years to one's life, I know right where to get one. (It's a rescue...)

The point is longevity is partially determined by genetics and luck (meaning whether you're lucky enough not to get sick). No one questions the value of a healthy diet and lifestyle, exercise, and loving relationships. To these, I would add:

• Stress management in the form of meditation, yoga, and practices such as Tai Chi and Qigong
• Spending time outdoors

"Everybody should be quiet 

near a little stream and listen."

~Christopher Robin~

• Engaging in creative and/or cognitive activities
• Relaxing into music you love
• Self-care, whatever that means to you

"Self-care is a divine responsibility."

~Attribution Unknown~

As we totter on the brink of nuclear war this week, remember this:

"In the end, 

it's not the years in your life that count.

It's the life in your years."

~Abraham Lincoln~

jan

truth or consequences

Don't judge anyone, ever. Not for their green hair, or the ring in their nose, or the tattoo on their bum. Not for the clothes they wear, or the car they drive, or the shelter they depend on. That's one lesson I learned at the "Writing from the Heart" workshop with Nancy Slonim Aronie. Don't judge people when you don't know their stories. You can't tell what they've been through by the look on their faces when you pass them on the street. You can't imagine the heartache that keeps them up at night. If you knew, you'd invite them all in for milk and cookies.

"Everyone you meet is fighting

a battle you know nothing about.

Be kind. Always."

~Robin Williams~

Another lesson we learned? Humans need to feel safe. Free from judgement. Embraced just as they are, all tattered and torn. Why? Because until they feel safe, they'll never tell us their stories. Unless they can cry right there in front of people--strangers, even--without fear, they won't say a word.

"Lokah Samastah Sukino Bhavantu."

~May all beings, everywhere, be happy and free~

At this workshop, twenty-two of us, strangers one and all, sat in a circle and bled onto the page for 10-15 minutes at a time to prompts like these:

• The hardest thing...
• What I didn't tell you then...
• A time you acted one way, but felt another...
• Dinner at my house...
• I picked up the phone...
• Waiting...

At the end of fifteen minutes, we read what we had written. This wasn't one of those workshops that invites you to read your piece if you'd like to...because you're so proud of it. No--everyone read what they had written. 

"As a writer, the worst thing

you can do is to work

in an environment of fear of rejection."

~Carol Leifer~

It wasn't the quality of our prose that mattered, but the depth of feeling and the honesty that went into it. There were tears and there was laughter. There were breakthroughs. Transformations. Victories. 

Here's one piece: 

True Story:

A time I acted one way, but felt another...

Visiting hours had ended. The lights had been turned down for the night. Except for an insistent call bell somewhere down the hall, the floor was quiet.

I was standing at the nurses' station with the attending on the case, Dr. Bush, and a man he introduced as the husband of the latest after-hours admission. 

Dr. Bush presented the case in standard rhythm and verse: "The patient is a 46-year-old Caucasian female who presents with a one-month history of shortness of breath and cough, a twenty-five-pound weight loss, and night sweats. She is being admitted for further evaluation and treatment."

He slipped her X-rays into the viewing box, and there it was--the smattering of hazy white balls in both lungs that shouted the word "cancer."

Dr. Bush glanced at the patient's husband. "Paul?"

The man straightened his shoulders and looked me in the eye. "The word cancer is not to be used around my wife. Do you understand?" he said. A tear escaped. "It would kill her if she knew."

Suddenly, what appeared to be a sad but straight forward case became a moral dilemma.

Dr. Bush repeated, "Doctor? Do you understand? She is not to hear the word cancer. Tell her anything, just not that."

The name of this game is "Let's Pretend." Let's pretend the patient doesn't have cancer. That it's something else. Let's pretend that this will somehow make it easier for her. That it will erase her worry, relieve her pain, give her hope.

But what was I supposed to say when she asked, "What's the matter with me, Doctor? What did you find?"

That pneumonia sometimes presents like this? That even adults can develop asthma later in life? That we'll get to the bottom of this, don't you worry?

How will she prepare for the end? Who will be there to help? Who will stay at her bedside and hold her when she cries? How will she say goodbye to her children? How will she plan her funeral? Who will choose the music and prayers?

I wanted to say, "No, Dr. Bush. I do not understand. It isn't right to lie to her. This isn't the time to pretend."

Instead, I picked up my stethoscope and started down the hallway to the patient's room. 

So, what would it be? Tell her the truth, or face the consequences?

*

Go ahead. Give it a try. Tell us what, for you, was the hardest thing. What you wish you had done differently. What you wish you had said but didn't. You have fifteen minutes. Go!

Then, find a safe person and read it to him or her.

"Write your story on my heart."

~Brene Brown~

jan

true stories & big ideas

 

In a couple of weeks, I'll be heading to a writing retreat with Lara Love Hardin who, prior to registering to spend the weekend with her, I'd never heard of. Looking back, I think I should have known something about her because I've read several books she co-authored with none other than the Dalai Lama and Archbishop Desmond Tutu (The Book of Joy and The Book of Forgiving) Out of curiosity, I ordered a copy of her memoir, "The Many Lives of Mama Love", you know...just to see if her writing resonated with me. To see if I thought I could learn something from her...

...because, it turns out, we're nothing alike. 

Or maybe we are.

She was a typical suburban soccer mom until she got hooked on Vicodin, "as needed for pain". Long story, short...she eventually became addicted to heroin and plunged into a life of crime to support her habit. That landed her in jail. Me? I've never so much as smoked a cigarette and the last time I drank a little too much, I was in high school. The closest I've come to a run-in with the law was a speeding ticket, also in my teens.

Her story portrays the time she spent in jail and on probation. Her utter helplessness against the system. The injustices she suffered. The shame that blanketed her. And then, the redemption she earned as a writer.

"True redemption is when

guilt leads to good."

~Khaled Hosseini~

I would not generally choose to read a woman's prison memoir, but I have not been able to put this book down. It resonates deeply with me because I can identify with her story even though it is so different from mine. I understand her struggles. I can identify with her desperation, uncertainty, and despair. Her heartache. Her surrender. Turns out, we have quite a bit in common.

This is the thing: These are universal themes that we all encounter in one way or another in our very different lives. Our weaknesses and longings sometimes lead to defeat. We are betrayed, shunned, or abandoned by people we trust. Most of us will beg, borrow, or steal, metaphorically speaking, at some point in our lives in order to meet our needs. We feel shame. We bear blame. But, as this story posits, forgiveness, redemption, and reconnection are within reach for all of us.

Books like this seem to land on my nightstand out of the clear blue sky. I wasn't looking for it. I never would have pulled it off the shelf at the bookstore or library. It's as though the muses conspired to provide me with what I needed before I knew something was missing. 

"Some books find us

at just the right time in our lives

and those books change our lives forever."

~Matthew Kelly~

This is something we should all strive for in our writing. To touch on universal themes and emotions. To lead the reader into the depths of our fear, grief, and despair...and then to resurrect him. To show him the way out. To show him how we found our way back. To give him hope.

Now I'm really excited about spending the weekend with the author. I feel as though I know her already. I think I'll learn a lot from her.

jan

hunting for zebras

 

When we were studying the art of clinical diagnosis in medical school, we were cautioned not to look for "zebras"--those rare, exotic diseases and conditions we studied but were unlikely ever to encounter in clinical practice. In other words, when a child presents with fever and rash, Fifth Disease or chicken pox should come to mind before you think about less common causes, like Rocky Mountain Spotted Fever or rubella. When a patient comes in with abdominal pain, rule out appendicitis and cholecystitis before you start to worry about Familial Mediterranean Fever. If the problem is dehydration and diarrhea, consider viral gastroenteritis or food poisoning before you think about cholera.

 

"If it looks like a duck,

and walks like a duck,

and sounds like a duck...

chances are it probably is a duck."

~unknown~

 

Not always, though.

 

True stories:

• The patient was a woman in her sixties. She was admitted from the ER directly to the OR with a diagnosis of "acute appendicitis." She'd had increasing pain and tenderness in the right side of her abdomen for two days. As the intern on call that night, it was my job to perform the admission history and physical, and to write orders before the surgeon could begin the operation. The patient was already on the operating table and the OR team was ready to go. "Don't waste time," I was told. So I took a quick history, checked the patient's vital signs, and listened to her heart and lungs. Then I examined her abdomen. She was tender deep in the right lower quadrant directly over McBurney's point--a classic finding in appendicitis--except for one thing. When I pushed in, something throbbed against my fingertips. It was painful for her as expected, but I caught my breath when I felt the pulsating mass and heard the whoosh, whoosh, whoosh of blood coursing through it. I'd seen several cases of appendicitis by that time, and trust me, the appendix does not pulsate. But a dissecting aortic aneurysm does. This was a problem. The OR wasn't prepped for this kind of procedure. The blood bank would need to be alerted, the vascular team assembled, and ICU notified. And time was critical. Zebra #1.

• A twenty-two-year-old man presented with a several week history of fever and malaise. Two weeks earlier, he'd seen a doctor who diagnosed him with a non-specific viral illness. Upon careful examination, he now had a soft (barely audible) diastolic heart murmur and mild enlargement of his spleen, classic findings for subacute bacterial endocarditis. He died two weeks later. Zebra #2.

• A sixteen-year-old presented to his PCP with a two-week history of a cold and sore throat. Everyone in his family had had the same symptoms and had recovered uneventfully. The patient's sore throat, however, persisted and was getting worse. Long story short, what sounded like a straightforward case of pharyngitis or Strep throat in a healthy adolescent, turned out to be gonococcal pharyngitis in a closeted gay teenager. The sexual history is not something most of us routinely obtain when we're seeing a patient for upper respiratory symptoms. Zebra #3.



"Medicine is a science of uncertainty

and an art of probability."

~Sir William Osler~



Today, more than ever before, physicians and other health care providers are under intense pressure to see more patients faster. It's tempting to jump to conclusions. To rush through the patient's history and to gloss over portions of the physical exam in order to save time. Sooner or later, though, you're likely to miss an important detail in the patient's story, or to overlook a subtle finding on examination that points to the diagnosis. 

 

What you think is just another pony over there in the field, may turn out to be a zebra, after all.

 

"The intuitive mind is a sacred gift,

and the rational mind is a faithful servant."

~Albert Einstein~

jan

 

how storytelling reopens the wound

 

If you follow this blog, you probably have some familiarity with, or curiosity about, the concept of storytelling as a healing practice. If you are a health care provider, a therapist in any field, a caregiver—or if you have been sick yourself—an untold story may be wreaking havoc in the back of your mind. Perhaps it reflects a painful, sad, or frightening episode from your past…something you’d rather not resurrect. Maybe there was a time of such joy or relief or healing you can’t imagine putting it into words so you haven’t given it a try. Yet.

This post is dedicated to my brother who, I believe, fits the first of these profiles--the painful one--as the result of a serious childhood illness. At the age of 79, he has started to write his memoir. Cue thunderous applause!

"A writer is someone

for whom writing is more difficult

than it is for most people."

~Thomas Mann~

Perhaps you’ve started to write your own story again and again and gotten nowhere with it. It turns into a rambling description of places, persons, and events that fails to capture the emotions that made the experience meaningful to you. That fails to explain why it stalks you so many years later, and still affects your feelings and behaviors.

This is where a good writing prompt can be helpful. That and a supportive reader who knows how hard this is for you and heaps praise upon you just for trying.

If you need a little nudge to get you started, here are a couple of writing prompts for health care providers that might help:

·         Write about “expectations” you’ve embraced (or rejected).

·         Tell us what it feels like to work without sleep, on an empty stomach, when you have to pee, in the middle of the night.

·         What goes through your mind on the way to work in the morning…or on your way home at the end of the day.

If you are the one who was sick, or you cared for someone who was ill, try these:    

•    Write about "waiting."

·         Tell us what you fear the most.

·         Tell us what you do to care for yourself.

When you begin, don’t worry about grammar, spelling, or punctuation. That’s the easy part. It can wait. Instead, write about the first thing that comes to mind.

"When in doubt, tell the truth."

~Mark Twain~

Give yourself 15 minutes or so, then rest. Wait a couple of days and try again. Write until you come up against the piece that is hardest to put into words…a time when you were so sad or scared or angry you still hesitate to commit it to paper…or so comical or comforting or inspiring it leaves you groping for words.

"The most important things are

the hardest to say

because words diminish them."

~Stephen King~

When you write, include details even if they seem insignificant. The missing tile on the ER wall. The overflowing trash can in the visitors’ lounge. The ladybug that made its way into the OR. These familiar images connect the reader to your story. Use the senses to bring the scene to life. The sight of blood pumping out of a tiny artery after the other bleeders were all tied off. The taste of cold, black coffee in the middle of the night…and why you sometimes need it. The smell of stale urine.

"To create something exceptional,

your mindset must be relentlessly focused

on the smallest detail."

~Giorgio Armani~

An untold story can leave us with a vague sense of frustration, anxiety, or confusion that we don’t understand, and can’t dispel until we put it into words...until we set the scene, name the characters, and face the feelings that have festered out of sight for so long.

Storytelling unmasks the wound so healing can begin.

"Nobody cares how much you know,

until they know how much you care."

~Theodore Roosevelt~

jan

opting out

 

Last week I spent a few days with my granddaughter. She's five years old. One day, she invited a friend over to play, and everything seemed to be going well until her friend came to me asking to take her home.

"I don't want to play anymore," she said...and I thought to myself, I completely understand...because I don't want to play anymore, either.

I, too, want to go home, which in my ideal world would be somewhere near where this photo was taken, in the mountains along the Northface Trail near Murren, Switzerland, or in Wengen, or in Lauterbrunen...far, far away from a culture that is self-obsessed, driven by wasteful consumerism, and addicted to power and wealth. Far away from the political nonsense that is fueled by the media. In denial of climate change and its effect on the planet. Far away from the bigotry, cruelty, and abandonment of those in need. Ridden with conspiracy theories, outright lies, and fraud.

Health care providers, in particular, should understand that we are tottering on the brink of disaster at the hands of political appointees who lack the knowledge, experience, and wisdom required to protect both health care delivery and public health policy. 

Our narrative is shifting.

"Suffering by nature or chance

never seems as painful

as suffering inflicted on us

by the arbitrary will of another."

~Arthur Schopenhauer~

I don't know about you, but I get tired of it. I get discouraged. I am fearful. Some days, I just don't want to play anymore. I want to go home, to a place of relative solitude, simplicity, and peace. Of respite and restoration. Of mindfulness and healing...if only for a little while.

"...walk away from situations

that threaten your peace of mind,

self-respect, values, morals, or self-worth."

~marcandangel.com~

Last week, my granddaughter's friend went home for a little while, too...but the next day she was back, full of joy and playfulness, rested and energized, ready to reconnect...

...which is how we should all be. 

So...what do you do when things get to be just too much? What do you do that helps? Where is home for you?

"Whatever is good for your soul...

do that."

~attribution unknown~

jan

an untapped resource for patients and healers alike

 

If you work in health care as a doctor, or a nurse, or a therapist in any field, it's probably safe to assume you understand how the human body functions. How the heart maintains its steady beat without any effort or awareness on your part. How the lungs manage to deliver just the right percentage of oxygen to your tissues, and how they eliminate the carbon dioxide you exhale. How an open wound closes, or a broken bone heals.

"Your body's ability to heal is greater 

than anyone has permitted you to believe."

~Roger Ford~

If the way the heart and lungs operate is something that amazes you, the way the brain works should mystify you. How it oversees and regulates every bodily function. The way it controls movement, maintains our sense of balance, orchestrates vision and hearing, enables our senses of taste, touch, and smell, and modulates the neuroendocrine system. And on and on...

If you're in health care, you studied human anatomy and physiology for years. You learned about the anatomy, physiology, biochemistry, microbiology, and cellular biology that life, as we know it, depends upon, and illness disrupts. You are familiar with the functions and processes that make healing possible. Except one.

"Your body hears everything 

your mind says."

~Naomi Judd~ 

The one thing we don't study, or dissect, or measure in preparation for patient care, which is our calling, is the nature and essence of thought. We don't examine memory under the microscope, or trace the course of creativity and imagination. We don't fully grasp the location or power of human consciousness, and we don't come close to understanding the function of the unconscious. Because no one understands it.

The hardest thing we can do is to think about our own thoughts.

"Consciousness poses the most baffling problems 

in the science of the mind.

There is nothing that we know more intimately

than conscious experience,

but there is nothing that is harder to explain."

~David Chalmers~

Interestingly, it is not so much the biologists, physiologists, pathologists, or psychiatrists who are making headway in the quest to understand consciousness, but the quantum physicists, contemporary incarnations of the likes of Einstein, Bohr, Planck, Bohm, Heisenberg, John Wheeler, and Paul Levy who are compelled to define reality without any proof of it. To understand consciousness without any image of it.

If, like me, you are in awe of the complexity, precision, and perfect timing that mark the biology and physiology of the human body, you can't help but be mystified by the brain. Sooner or later you will be led to contemplate the role of consciousness in health and disease. The benefits of meditation. The influence of mood and emotion on well being, all of which should amaze you. Humble you. And naturally spiritualize you.

"Attempting to understand consciousness

with your mind

is like trying to illuminate the sun

with a candle."

~Mooji~

I just finished a book about quantum theory. It opened with an introduction, foreword, and preface, and it ended with 896 footnotes. It suggests that there is a precise, elegant, and exact parallel, down to the most minute detail, between the laws of subatomic physics and the workings of the human mind. That would be hard enough to comprehend if we understood the mathematics that proves it. The problem is we don't have a language to express it yet. And, until we do, the nature of consciousness will remain a mystery, and an untapped resource for patients and healers alike.

"If you think you understand

quantum mechanics,

you don't understand quantum mechanics."

~Dr. Richard Feynman~

jan