Tuesday, May 30, 2017

the missing piece

If you are a health care provider or therapist in any discipline, you may find yourself frustrated from time to time when a patient does not respond to treatment. You find yourself questioning the diagnosis. You ask the patient about his symptoms over and over again, re-examine him, and order additional tests without getting anywhere. Something doesn’t add up. There must be a missing piece. Too often, the patient is labelled as uncooperative, difficult, or mentally ill...when you may not have heard the patient’s whole story.
“The simple yet complex act of listening is,
in and of itself,
a clinical intervention.
Listening constitutes the very heart and soul
of the clinical encounter.”
~Mary T. Shannon~
Some days there just isn’t time to explore the details of his illness with every patient. Perhaps you’re running behind schedule, or an emergency interrupts you. Some patients can’t bear to disclose the sorrow or fear or shame that underlies their symptoms. Some remain in denial for reasons we don’t understand.
Rita Charon pioneered the practice of “narrative medicine” almost twenty years ago as a path to help clinicians uncover the missing piece in their patients’ histories. It trains the healer to recognize the fact that the problem exists, and then to elicit the patient’s untold story—to listen, receive, interpret and apply what the patient reveals.
Image result for rita charon
This is how she begins with a new patient. She simply invites the patient to “tell me what you think I should know about your situation.” Then she listens to the patient without interrupting, clarifying, correcting, or taking notes. Instead, she focuses her attention on what is revealed and how it is communicated…paying attention to the patient’s posture and gestures, images and metaphors, facial expressions, and the characters who play a role in the story. This approach may take more time at the beginning but, in the long haul, it saves us from revisiting the history again and again, from ordering unnecessary tests, and from wasting time and resources on ineffective interventions because of what we have missed.
“I am, by calling,
a dealer in words;
and words are, of course,
the most powerful drugs used by mankind.”
~Rudyard Kipling~
When we reach into our patients’ cholesterol-laden hearts to understand why they are poisoning themselves with food, we need to know more than what they putting into their mouths. When we let the patient talk, we may discover that the real reason for this one’s fatigue or that one’s intractable headache is end-stage disappointment or anger or shame that has festered for years.
Only then we can help them heal.
“Histories must be received,
not taken.”
~Sir Richard Bayliss~

Monday, May 22, 2017

off topic...but not really

A friend of mine recently returned from a trip to Machu Picchu, one of the “new” seven wonders of the world. In my humble opinion, the self-proclaimed experts who, back in 2000, voted to rename the Seven Wonders of the World, missed the point. They were looking at manmade monuments and structures of lasting beauty and grandeur while overlooking what I believe to be the Seven True Wonders of the World. I was reminded of them last week with the arrival of my newest grandson. This is what was so extraordinary about it:

Oh, and sex…where it all begins.
When you consider all the changes the body has to orchestrate flawlessly in order for a healthy baby to enter the world—the timing of the hormonal and anatomical changes, the electrochemical shifts, the first breath—it astounds me that it ever goes according to plan. So much can go wrong…and often does. If you want to hear inspiring stories…as well as sometimes tragic stories…listen to a group of women sharing their birth experience.
“The mind of a woman in labor
is power unestimated."
They will tell you how excruciating pain leads to immense joy…or, when the process fails, to deepest sorrow. They will describe fear, even panic, at the slightest suggestion of trouble. They may reflect back on how hard it was to get pregnant…or how easy or even unexpected it was. How they learned the meaning of longing and of love.

“Story is the umbilical cord
that connects us to the past, present, and future…
Storytelling is an affirmation of our ties
to one another.”
~Terry Tempest Williams~
There is nothing new in the history of childbirth, but there are an infinite number of unique stories about it. Birth narratives are packed with sensory and emotional detail, victory and defeat, courage and cowardice, mystery and manifestation. Each story is epic in scope…part fantasy, part mystery, part thriller, part love story. Something for everyone.
Every birth is a wonder to behold.

“There are no seven wonders of the world…
There are seven million.”
~Walt Streightiff~


Wednesday, May 3, 2017

ten reasons to join a writing group...or start one

Here are ten good reasons you might be interested in joining a narrative medicine writing group:
1.      You are a health care provider or a therapist in any field. You have been a patient at some point in your life, or you know someone who is. Trust me: you have plenty to write about.
“Anybody who has survived his childhood
has enough information about life
to last him the rest of his days.”
~Flannery O’Connor~
2.      People keep telling you, “You really should write a book…” because of all you have endured and overcome, or because of your special expertise, or exceptional courage, or unique perspective.
3.      You keep telling yourself, “But I’m not a writer,” even though there’s a story chiseling a hole in your heart…something that caused such sorrow, or anger, or despair you can’t bear to revisit it, or such relief, or gratitude, or inspiration you can’t imagine how you would put it into words.
“There is no greater agony
than bearing an untold story
inside of you.”
~Maya Angelou~
4.      You keep telling yourself, “I wouldn’t know where to begin,” even though you’ve been over the details in your mind a thousand times.
5.      You keep telling yourself, “My life (or work or experience…) is so ordinary, I have nothing interesting to say, nothing new to add, nothing helpful to share.”
“Write what disturbs you, what you fear,
what you have not been willing to speak about.
Be willing to be split open.”
~Natalie Goldberg~
6.      You like to write, but convince yourself you’re not good enough at spelling, grammar, or punctuation to share what you have written.
“If you hear a voice within you saying:
you are not a painter,
then paint by all means, lad,
and that voice will be silenced…”
~Van Gogh~
   The same can be said for writing.
7.      You think you’re too busy. (You’re not.)
8.      You’re afraid you’ll offend someone if you write the truth…the surgeon who botched your operation, or your uncle who abused you as a child, or the colleague you don’t trust.
“All you have to do
is write one true sentence.
Write the truest sentence you know.”
~Ernest Hemingway~
9.      As a patient, you sometimes feel like giving up. If you’re a provider, you sometimes feel like quitting.
10.  You harbor questions you can’t answer…doubts that won’t go away…pain that nothing can heal.
“While medicine creates material for writing,
perhaps even more important is that
it also creates a psychological and emotional
need to write.”
~Daniel Mason~
If you’re still not sure writing is for you, I’d like to recommend a couple of good books for beginning writers, especially those who are reluctant to get started:
·         The Artist’s Way by Julia Cameron
·         If you Want to Write by Brenda Ueland
·         Writing from the Heart by Nancy Aronie
If you’re interested but can’t find a narrative medicine writing group near you…think about starting one.