why me? why this? why now?

 

 

Serious illness can strike hard and fast. It could be a sudden heart attack or stroke. A deadly infection. Cancer. Suddenly, patients have a lot to process. They want to understand what is happening to them, and why. What treatment is available. What their prognosis is. It's a lot to think about. After the initial shock wears off a bit, other issues surface. What if I can't work? What if I can't take care of my family? What if I don't get better? It can be downright scary.

 

"It may take a doctor

to diagnose someone's disease,

but it takes a friend to recognize

someone's suffering."

~quoteideas.com~

 

At some point in the process, most patients want to know three things:

 

Why me? Why this? Why now?

• Why me?

                     The answer to this question sometimes comes easily. You ended up with lung cancer because you've been smoking since you were twelve. Or maybe it was a heart attack because you enjoyed a high fat diet and refused to exercise. It makes sense that you would be the one. If you look hard enough you may be able to uncover the cause that explains why you were so unlucky. Maybe the cancer is encoded in your genes. Perhaps you lived near a toxic waste site. Maybe your the water you've been drinking to stay hydrated (in keeping with your doctor's advice) is polluted. When all reasoning fails, the existential answer is this: Why not you? What sets you apart from the rest of mankind and protects you from  the kind of unfathomable pain and suffering that strikes even innocent children? Why them?

 

 "The bad news:

there is no key to the universe.

The good news:

it was never locked."

~Swami Beyondamanda~



• Why this?

                      Why cancer? Why not a benign growth? Why a traumatic head injury? Why not a broken wrist? Why, of all things, SIDS, or a miscarriage, or an accidental overdose? Don't say, "Why not?" That doesn't answer a thing.

 

"A life can get knocked out of orbit

by a car crash, a lottery win, or

just a bleary-eyed consultant

giving bad news in a calm voice."

 ~David Mitchell~

 

• Why now?

                          Is there ever a good time to get bad news? Is there any way to prepare for it? If you could prepare yourself for it, would that make it any easier? Because we have no control over it, the question is better phrased, "What now? What's next?"

That's where the health care provider or therapist comes in. We can help the patient understand his diagnostic and treatment plan, and his prognosis. How he can help by taking care of himself. Why rest is important. Why nutrition is a concern. What kind of activity can be helpful.  

The patient's narrative doesn't end with his diagnosis. It's important to listen to his story all the way to the last chapter in order to understand why he isn't getting better, what he fears, who he can count on, what he needs...all of which affect his ability to heal.

"You are so brave and quiet,

I forget you are suffering."

~Ernest Hemingway~

 

jan

 

 





 

 







writing pure memoir

Yes, I admit it. I'm working on a memoir. It's an illness narrative I share with my brother. To that end, I spent this past week at Omega Institute for Holistic Studies in Rhinebeck, NY, under the tutelage of Nick Flynn, author of several memoirs including "Another Bullshit Night in Suck City."

 

 

http://www.nickflynn.org



 

 

Nick's work explores his relationship (or lack of relationship) with his father during the years his father was homeless on the streets of Boston. It also captures the catastrophic aftermath of his mother's suicide. In memoir and in poetry.

 

The question is: Why do we write memoir? Why would anybody be interested in our story? We all have problems. We all weather hardship, loss, sorrow, anger, betrayal, even illness...not a redeeming memory among them.

 

Until you consider the fact that you survived.

 

How are you going to process survival if you don't put it into words?

 

"We don't write what we know.

We write what we wonder about."

~Richard Peck~

 

So...some of us write to make sense of our lives. We do it for our own good. That fear we can't name? The anger the rises up unprovoked? The despair that shadows us wherever we go? It needs a name, a place, a person. Until we know its identity we can't negotiate our relationship with it.

 

"We do not write in order to be understood.

We write in order to understand."

~C.S. Lewis~

 

And who knows? Your story may be just what someone else needs to hear. How you survived. Where you found strength. Who you forgave. In other words, you write for the rest of us. Thank you.

 

"Tell your story

because your story will heal you

and it will heal someone else."

~Iyanla Vanzant~

 

The point is that narrative medicine is pure memoir, doctors and patients alike sharing their stories. Their pain. Their fear. Despair. Bitterness. Loneliness. All of us seeking a reason for hope. Relief. Joy. Healing.

 

When will you start yours?

 

"All you have to do

is write one sentence.

Write the truest sentence you know."

~Ernest Hemingway~

 

jan





 





 









can you hear me now?

Clearly, storytelling is important in the practice of medicine. All day long patients tell us their stories. During hospital rounds colleagues discuss interesting and difficult cases. This often continues over lunch, after office hours, even on the golf course…wherever health care providers convene.

We tell stories hoping that someone will listen, and by listening, understand…and by understanding, come to care. This helps patients make sense of their illness, find meaning in it, and begin the healing process. Storytelling helps answer the questions: Why me? Why this? Why now? It enables providers to share information and experience, to celebrate when patients recover, and to bear the loss when they don’t.

We all benefit from telling our stories…but who benefits from hearing them?

 

"We all have a story

we will never tell."

~unknown~

 

In fact, listening connects us in extraordinary ways, not just cognitively and emotionally, but physiologically. This is a measurable phenomenon. Yay for technology!

www.web.utk.edu

Functional MRI scans detect changes in blood flow and oxygen uptake in different regions of the brain. It has been shown that when listening to a story, changes occur in the listener’s brain that coincide with or mirror the pattern in the teller’s brain. This is called speaker-listener neural coupling. The greater the coupling, the greater the understanding. The extent of speaker-listener neural coupling predicts the success of the communication. (Here is a link to a highly technical paper on this subject for any skeptics out there: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922522/
 

The concept of neural coupling has enormous implications for narrative medicine. If we want to understand a patient’s illness, we need to listen to his story. Not interrupt his narrative. Not redirect him to satisfy our own agenda. Not fix our gaze on a computer screen and check off boxes.

 

Miscommunication between patients and health care providers can lead to misdiagnosis, and misdiagnosis can lead to inappropriate treatment. The patient’s condition can worsen because the doctor doesn’t understand the patient's illness. Because he didn’t listen to the patient’s story.

 

"Histories must be received,

not taken."

~Sir Richard Bayliss~

jan