don't provoke the beast

 So, this happened:

I've been working on a project through a site called "Storyworth." Every week they send a writing prompt and you submit a short piece in response, usually a brief memoir or autobiographical ditty. At the end of the year, you have 52 stories they assemble into a book you can give to your children or grandchildren for Christmas. It includes topics like "What was your favorite candy when you were a child," and "Did you have any pets when you were a child?" Nothing too deep.

Last week I tackled this one: What Is One of Your Earliest Childhood Memories?"

I'd been avoiding the topic because my earliest memories date back to my hospitalization with rheumatic fever when I was three years old. What fun is that? I've written about it before. In fact, I published a brief memoir about the ordeal a couple of years ago. I have analyzed the experience in detail from every perspective over the years. I thought I was at peace with it.

I jotted down a few lines and then I went on-line to search for a couple of pictures. I found an image of The Children's Hospital of Buffalo, where I spent two weeks when I got sick. 

Then I found this:

www.ECMC.edu

This is a photograph from the Acute Scarlet Fever Ward at the hospital, and it made me catch my breath. It is exactly as I remember the ward I was in. Except that it was taken many years before my admission there, that little girl could be me. That was where my bed was in the ward. In the bed next to me was a boy about five years old. Back then the nurses wore stiff white uniforms, and they were proud to wear the official nursing caps they worked so hard to earn. I remember it all, but I did not expect the gut-punch I took when I saw this picture. It brought me to tears, it was so uncannily real to me. 

It made me wonder where that emotion has been hiding all these years, and why I felt it so viscerally when I saw this image.

It turns out we store memories in different ways. Narrative memory is the story we tell about what happened to us. Visceral memory expresses the sensory and emotional experience of the story without using words. It's what we feel, physically and emotionally, when the memory emerges. Fear. Sorrow. Anger. A racing heart. Sweaty palms. Nausea. 

"Trauma comes back as a reaction,

not as a memory."

~Bessel van der Kolk~

It's important for health care providers to understand the difference. I can describe the ward where I was hospitalized in great detail. I can tell you about the other children who were there with me. I remember the toys and books I kept at my bedside. I can tell you the whole story calmly and accurately, as though it were no big deal. In fact, I can narrate my entire medical history without blinking an eye. But there's more to it than that. Apparently, something else is still stored away inside, unwilling to be acknowledged and released. Something that still needs to heal.

When a patient presents with anxiety or depression that doesn't seem to fit the picture, or his symptoms don't respond to treatment, think about unresolved childhood trauma. When he senses a racing heart but his EKG is normal, or his headaches won't go away, go back in time with him. What triggers it? A certain song? The scent of his mother's cologne? The sight of a needle? Or like me, a random photograph he came across on-line? 

Narrative memory may be clear and accurate while visceral memory lurks in the shadows. Without warning, an innocent trigger can release a lifetime of unexpected emotion that can wreak havoc on the body. If you're a healthcare provider and things don't add up, go back. Try again.

"I may look peaceful,

but don't provoke the beast."

~Gautham Balaji~

jan

the scars that are hardest to heal

 

Those of us who support the narrative medicine/narrative healing movement would like you to believe that the simple (or not so simple) act of telling your story and knowing it has been heard can bring about healing. How does that happen?

"I will soothe you and heal you.

I will bring you roses.

I, too, have been covered with thorns."

~Rumi~

Perhaps something like this has happened to you:

You wake up and it's a beautiful day. The sun is shining. Your bills are paid. The laundry is done. You pick up a good book and head out to the porch to read. But you can't concentrate. You sense a heaviness in your chest, and you can't stop sighing. You're tired, even though you haven't done much all day. You feel a certain sadness but you don't have anything to be sad about. Your neighbor sees you and comes over to say hello. She immediately senses something is wrong. You shrug her off, and then it hits you. This is where you were sitting when you heard the screeching tires that you knew meant trouble. This is the same kind of beautiful September day you lost your dog on the street in front of your house. Seventeen years ago. 

"If you never heal from what hurt you,

you'll bleed on people who did not cut you."

~Karen Salmonsohn~

Or, you go out for the mail and in it is an invitation to your friend's baby shower. You burst into tears. Because you never got to have a baby shower. You lost the baby before anyone knew you were pregnant, so you never told anyone. Or maybe you were never able to get pregnant in the first place. And your arms feel so empty.

Or, maybe your story plays out like this. You didn't mean to put a dent in the fender the first time you took the car out alone when you were sixteen. Your father told you to be careful when he handed you the keys, and you promised you would. Then, a ball rolled out into the street and to avoid it, you swerved and grazed a tree in someboby's yard. You knew you'd be in trouble when you got home, but you didn't expect a beating for it. I mean, you were being careful, and it wasn't your fault. But your dad had been drinking that day, and when he saw what had happened, he hauled off and bloodied your nose, and gave you a huge swollen black eye. In school the next day, you told the teacher you'd slipped and fallen down the basement stairs. And that was the end of it, but not really. Now your heart races and your head throbs and you break out in a sweat every time your own son takes the car out. And you don't know why.

"The scars you can't see

are the hardest to heal."

~Unknown~

If you sometimes react to situations in ways that don't make sense, or you can't explain why you feel sad, or tired, or anxious, or people often ask you what's wrong, your untold story may be hiding in the shadows, playing tricks on you. Because until you call it by name you may not know it's lurking there.

When you give your story a title, and describe how it unfolded, you may begin to understand why it still disturbs your peace after all these years. If someone you trust is listening, you may come away with an entirely fresh perspective on it. You may be able to forgive yourself, or the person who hurt you. You may be able to cast aside some of the things you've always imagined were wrong with you, but never were. Your energy may improve, your headaches may lessen, your heart may open. 

If your story has been under lock and key for years, or you've forgotten where you left it, or you can't imagine finding the words to express it, you should consider getting back to work on it. Somebody else may need to hear it.

"Just because no one can heal you 

or do your inner work for you

doesn't mean you can, or should, or need to

do it alone."

~Lisa Olivera~

jan

a healing presence

 

 

True story:

 

When the nursing home called, my mother was already on her way to the emergency room. She’d been experiencing a deep cough and increasing shortness of breath for two days. When her oxygen levels fell to dangerously low levels, her doctor ordered her off to the hospital.

 

I left as soon as I got the call, hoping to get there ahead of her because, by this point in her decline, my mother had lost the ability to speak. She didn’t suffer from dementia. Rather, her inability to communicate was the cumulative result of multiple small strokes. I knew she would be scared and confused, and ultimately frustrated by her inability to express herself. As sick as she was, she would be unable to give her medical history or answer questions. Nevertheless, I had no doubt she would receive excellent care—the ER staff would start an IV, administer oxygen, get a chest X-ray (and a scan if needed), draw her blood, and monitor her vital signs. She would receive antibiotics, or medications for her heart, or anticoagulants depending on the test results (pneumonia vs heart failure vs pulmonary embolism). If worse came to worse, she would be intubated. The doctors and nurses would do everything they could for her automatically and efficiently, without a second thought. Without knowing a thing about her.

"You treat a disease: you win, you lose.

You treat a person: I guarantee you win."

~Patch Adams~

When I got to the emergency room, my mother was sucking down oxygen via IPPB. She was weak and pale, but alert. The minute I pulled the curtain back and stepped to her bedside, she relaxed. A faint smile of recognition and relief appeared. She closed her eyes and squeezed my hand as if to say healing could now begin.

"A kind gesture can reach a wound

that only compassion can heal."

~Steve Mariboli~

I kept an eye on the monitors that surrounded her bed while I sat with her and explained what was happening and why. I requested an extra blanket for her. I answered the nurses’ questions. I ached to know the results of the tests the doctors had run, what her diagnosis was, what was in store for her. Through it all, I kept a smile on my face while all the worst-case scenarios played out in my imagination.

"Isn't it fascinating

how long a few minutes can seem

when you are completely alone 

with not a familiar face in sight?"

~Kirby Larson~

 

Imagine the relief I felt when the ER physician returned to check on her…when he drew the curtain aside and I recognized a trusted colleague, a man I knew to be compassionate, gentle, and wise. Like my mother did when she saw me, I relaxed as soon as I saw him. I smiled with a deep sense of relief and gratitude. I could talk to this man and I knew he would listen. He would treat my mother like his own, and me like a sister. As if we were family. I felt as though healing had already begun.

*

This story is intended to convey the healing power of the personal relationship between the physician, the patient, and the patient's family…the sense of relief a familiar face can bring when everything else is foreign and frightening to the patient. It speaks to the importance of trust and confidence in the healer’s character and expertise. It should remind us to regard every patient with compassion, and to treat every patient with the same respect, kindness, and care we would extend to our best friend, and to our own family members.

This story should also remind us that patients with Covid are admitted to the hospital alone and scared. They are not permitted a familiar face at the bedside. Many have died there alone. 

None of us can change this reality, but we can always offer a gentle touch, and a kind word, and we can serve as a healing presence to all.

"I've learned that people will forget

what you said.

People will forget what you did,

but they will never forget

how you made them feel."

~Maya Angelou~ 

jan