the story of the present illness

The story of my life during the years leading up to my retirement could have been recorded in ten-minute installments, patient after patient, day after day. This is in keeping with the trend toward shorter and shorter sound bites, 280 character tweets, and snarky comebacks that have come to replace the leisurely, thoughtful exchange of ideas that human beings have always enjoyed, and/or depended upon.

It wasn’t always this way. There was a time, not many years ago, when I could scan my schedule for the day and envision every patient. I knew them that well. With a quick glance at the chart I knew who was getting ready to start chemo, who had just welcomed her first grandchild into the world, whose mother had been transferred into the dementia unit. I knew because I asked about it, the patient told me the story, and I noted it in the chart.

“Wherever the art of medicine is loved,

there is also a love of humanity.”

~Hippocrates~

Nowadays, rather than dictating a note about the patient encounter (a.k.a. narrating the patient’s story), you open an electronic medical record. This is intended to expedite the ten-minute appointment. After all, as a physician you have productivity quotients to meet, and income to generate. Whether you recognize your patients or not.

The EMR presents you with a confusing array of bulleted items, complicated charts, and abbreviated details. You can tell what symptoms were problematic at the last visit, when they started, how often they occurred, and how long they lasted. You know what tests you ran and what treatment you ordered, but you might not remember the patient because nothing else about his or her story is recorded there. He looks like any other older patient with diabetes, or heart failure, or COPD…because you missed the fact that he’s a decorated Vietnam veteran. You can’t understand why your pregnant patient is so anxious because you failed to ask about her sister…who had three miscarriages in a row. You don’t know because you didn’t record the whole story. There just isn’t enough time for that in a ten-minute slot, and there is virtually no place to enter it into the EMR.

You don’t realize that the patient’s intractable headache started when she discovered the cigarette burn on the sleeve of the sweater her ten-year old wore to school last week. You can run every test under the sun and prescribe every medication known to mankind, but unless you address the problem she is having with her child, nothing will help.

You have no way of knowing that the patient’s heartburn and indigestion have been a problem because of the pile of unpaid bills collecting on the kitchen counter. Until he has some help with them, nothing is going to help his heartburn.

Unexpected details like these rarely emerge as part of the history taking process. When the patient is seeing you for a straight-forward problem, these details are often missed. They are dismissed as unimportant or extraneous when, in fact, they may hold the key to the diagnosis, and to the patient's response (or his failure to respond) to treatment. 

“You are not your illness.

You have an individual story to tell."

~Julian Seifte~

jan

 

 

 

may the force be with you

Last week I tuned into the on-line Science of Healing Summit where I learned about bioenergetic fields, epigenetics, the flow of consciousness, resonance, coherence, entrainment, intuition, and the power of music/sound/vibration to heal. All taught by brilliant and forward thinking researchers and practitioners. 

I may have posted a few tongue-in-cheek comments on facebook because, frankly, I'm miffed. This constellation of concepts and insights first emerged in the seventies, which is when I started medical school...and it was all dismissed by "real" doctors as so much hocus-pocus. Snake oil. Those of us who were curious about it were belittled for our naivete, and shamed for our gullibility.

But I knew better. When I was a medical student, I worked with a resident who had gained a reputation as something of a maverick when he underwent an inguinal hernia repair under self-hypnosis. No anesthesia, thank-you-very-much. When I worked with him in the Emergency Room, he reduced a patient's dislocated elbow after a brief hypnotic induction, and I was sold. I studied self-hypnosis myself. I squandered my vacations on meditation and yoga retreats. I connected with energy healers. I learned to chant, to visualize auras, to breathe. I understood energy. It all made sense to me.

"There is more wisdom in your body

than in your deepest philosophy."

~Friedrich Nietzsche~

So...this is the question:

If you are a hands-on healthcare provider, how do you "see" your patients? As an orchestrated system of organs, muscles, bones, nerves, and flesh that can be distinguished by their structure and function? What is that structure? And how do they function? When something goes wrong, do you immediately think of a pill or a procedure?

Are you willing to see things differently? 

Imagine seeing your own body on a microscopic scale. Imagine the little blood cells coursing through your arteries and veins. Watch the fibers in your muscle contract and relax. Now get smaller. See it on a molecular scale. A subatomic scale. It might surprise you, from this perspective, that there's not much to you but space. On this scale, the distance between the molecules that make up your body is as vast as the distance we are familiar with...the distance between the stars in our own galaxy. Bone feels hard to us because the electromagnetic force between those distanced molecules is so strong. Flesh feels soft because the force that attracts its molecules to one another is weaker.

So...we are pretty much pure space and energy. 

Now look in a mirror. What do you see? That annoying mole on your forehead? Those sagging wrinkles on your neck? Teeth you wish were whiter? All the things that make you less perfect than what you were hoping for? 

Now get smaller. Go inside. That heart in your chest? It's like a perpetual motion machine. It just keeps beating without any attention or awareness on your part...as it has been since before the day you were born. Amazing!

That scar on your belly? The skin healed, the muscle closed, the fascia mended, and the wall of the uterus healed completely after they pulled the baby out...squirming, squealing, and breathing all by itself. Unbelievable!

Do you remember the song that made you cry at your grandmother's funeral? The solo you sang at the spring concert in sixth grade? The first time you heard a Kirtan chant? You have sound waves to thank for that...your whole complicated auditory system, your memory, and whatever made you sad, or happy, or amazed when it all came back to you. All connected across time and space...all vibrating in sync, all resonating, all coherent. In you!

"May the force be with you."

~Obi Wan Kenobi~

The next time you glance at yourself in a mirror, or lay hands on a patient, or make a wish, or shed a tear, remember:

"You are braver than you believe,

stronger than you seem,

and smarter than you think."

~a.a. milne~

You are pure potential.

jan

the science of health summit

 

This week I'm tuning in to the Science of Healing Summit. You might think this would be about recent advances in biomedical engineering, epidemiology and vaccine development, diagnostic testing, and the newest therapeutic techniques, but it isn't. This is a 5-day program of discussions by experts in our understanding of the new biology, energy medicine, and quantum healing that connect the mind, body, and spirit. 

Deepak Chopra, MD and Rudolf Tanzi, MD will explore the difference between awareness and consciousness, and how they influence self-healing.

Bruce Lipton, PhD will go into epigenetics, quantum physics, and the role of the mind in health and disease.

There will be presentations about the roles of intuition and intention in the practice of medicine. The effect of sound, music, and vibration on healing. Neuroplasticity. Spirituality. And a forward looking blueprint for allopathic practitioners.

I've already seen a few disparaging critiques of the Summit by people who have already made up their minds that this is all just a bunch of hoopla, all this talk of consciousness, nonduality, microbiomes, and energy fields. To which I say:

"The highest form of ignorance

is when you reject something

you don't know anything about."

~Wayne Dyer~

Gotta go, now. Gregg Braden is about to begin with a discussion of our origins and potential, and how they relate to immunity and longevity. This should be interesting!

jan

why you should take up writing

 

I often find myself encouraging friends and random acquaintances to take up writing. I may have heard their stories over a glass of wine or a cup of good strong coffee, on a hike in the woods or along a riverbank, so I know they can do it. I nag them because I know someone who needs to hear their story. Someone recently diagnosed with cancer needs to hear from a person who has been through it. They need to know the diagnosis was devastating, the treatment grueling, the recovery painstaking, the victory glorious. If you're struggling to work from home while you school your children, or you're a caretaker for someone who isn't doing well, it helps to know how difficult it is for others in the same situation. How they cope. How they keep their spirits up.

"A day will come

when the story inside you

will want to breathe on its own."

~Sara Noffke~

I encourage people to write even though I know how hard it can be to get words on the page. To stick with it. To go back to it again and again. Like meditation, it can be hard to quiet your mind while sitting alone, in silence. Our minds like to be busy, thinking back on things that have happened, thinking ahead to what awaits us, guessing, planning, judging, fretting, when our goal is to stay focused on the work at hand.

In meditation, when our minds wander, we are encouraged simply to acknowledge the interruption and refocus, not to chastise ourselves for getting distracted, or berate ourselves for letting our attention wander. When unbidden thoughts arise, we label them "just thoughts" or "just thinking," and we move our attention back to the breath--in, out, in, out. Letting go of intrusive thoughts helps mitigate the impact of negative emotions such as anger, anxiety, bitterness, and resentment that may have a stranglehold on us.

"You should sit in meditation

for twenty minutes a day, 

unless you're too busy;

then you should sit for an hour."

~Old Zen Saying~

This, I believe, is a practice writers should embrace. We are accustomed to labeling our own negative thoughts as "voices" we hear. It's an interesting metaphor. We are advised not to pay attention to the voices of negativity that discourage our creative efforts. Voices that insist we're wasting our time, that we have no talent for this kind of thing, that we have no hope of success. Voices that make us feel inferior, or guilty for indulging in something we enjoy when others are so hard at real work.

"Tell the negative committee

that meets inside your head

to sit down and shut up."

~Ann Bradford~

The point is that those negative voices are just thoughts. Just echoes from the past, not worth arguing about. They are opinions, and they do not have your best interests at heart. Banish them! Return to the breath. Or take a walk. Or call up a friend, someone who encourages you, and supports your dream. Someone who understands how hard this is, and respects you for trying. Someone whose friendship isn't invested in your wealth or fame. 

Do whatever it takes to stay on the optimistic side. Do whatever it takes to tell your story. Turn your attention to the truth:   

"People start to heal

the moment they feel heard."

~Cheryl Richardson~

jan