this time we are in

I don't know how you're feeling today, but lately a lot of people I know have been feeling a little, well, let's call it "funky". Tired. Anxious. Discombobulated. I blame some of it on the oppressive heat and humidity we've been experiencing...a daily reminder that climate change is real. If you don't like it, now is the time to do something about it. Before you lose your chance.

"We are living on this planet

as if we had another one to go to."

~Terri Swearingen~

Or maybe it has something to do with the fact that we are teetering on the brink of nuclear disaster, which, unlike climate change, is something most of us are helpless to prevent. Or perhaps the problem is a smoldering pandemic that has somehow spawned an outbreak of monkeypox which most of us have never heard of, as well as the reappearance of polio among the unvaccinated, which some of us know all too well. Thank you very much. 

We are witnessing fires and floods the likes of which we never thought possible. The financial security we have been working so hard to secure is being squandered by our political and corporate taskmasters. We are confronted with lies and deception every day.

Our concerns are not only global, but personal. Not only political, but existential. Not only secular, but sacred.

Which is why I would like to share a piece that was posted by a friend (thank you, Michael Naylor) on Facebook this week. For a little change in perspective. For a way and a reason to go on. To serve as food for thought:

*

 This Time We Are In

~John G. Bennett~

We must not have any attitude of blame towards people for what is occurring; this is a cosmic event, this is what Gurdjieff called Solioonensius (in Beelzebub’s Tales), a state of tension when people - all people - become intensely dissatisfied with the situation in which they find themselves and they react to this state of dissatisfaction differently.

Here is what is the right and wrong of it: those who are wise and understand this, know that this force of dissatisfaction that is developed can be converted into a dissatisfaction with oneself and a wish to change and to work on oneself, and it is the greatest and most powerful force that one can have. It is the realization that only those who have attained to an inner freedom through work can pass safely through this kind of crisis.

As was amply proved during the great revolutions like the Russian Revolution and elsewhere, this is the path of wisdom in front of this. Other people project the causes outside of themselves and then you have this sort of tension between races, between generations, between classes, between people who want to change things one way, people who want to preserve things in another way.

All these tensions result in people blaming others, and when things go wrong this becomes acute and ultimately threatens violence and disaster. This is happening all over the world, but it is most intense in the United States because the United States is the key to the solution of it all. But this does not mean that the people in power in the United States can do something. In fact, it has now become terrifyingly evident that really no one is in power, that events have taken charge. Neither the president, nor the Senate, nor congress, nor big business, nor wise people, nor leaders of this or that movement, none of them are in charge of the situation. They are all reacting to this state of tension.

This does inevitably occur periodically in the life of man, and it is a part of the general condition of the existence of life on the Earth. It is because of this that we have to work specially nowadays, at this time, and one part of our work is as far as possible removing from ourselves, even in our thoughts, criticism and hostility to people whose behavior we may disapprove of; constantly look upon these people as helpless, not as hostile; as machines, not as evil men – really as victims, and not as persecutors. And this is irrespective of what they may be doing.

Even the most dreadful things are really not done intentionally, or from the desire for evil. They are either done through a mistaken hope for good, or simply helplessness. This helplessness of man is something that people cannot bear to face up to. It is much easier, or much more satisfying to our vanity as human beings to think that things go wrong because of bad will, but things go wrong because man is helpless. But there is nothing really to fear or to be ashamed of in this because this is what we have to work ourselves out of.

For those of you who are in America at the present time, this is a very great opportunity, even if the smallest number of people can manage to preserve a constant state of compassion and abstain from criticism. This does not mean putting away one’s critical faculty which is quite a different thing; it does not mean seeing that mistakes are made. All this we have to do. It is to not criticize people for doing what they can’t help doing; not to find fault where people are being carried along by a stream without any possibility of changing the course of events.

If the course of events is to be changed as I believe it will, and I am not a pessimist, not an alarmist about the situation; in fact I am more optimistic than almost anyone can be because I have complete conviction that there is a higher power working in human life at this time, with far greater wisdom and far greater resources than we have any notion of. But this confidence does not mean that I think that human beings can help and put the situation right. And as I have said over and over again in the past year or two, our task is, to my mind perfectly clear: to do everything we can to make ourselves into instruments for the higher wisdom channels through which this wisdom can flow, putting aside our worn wisdom, putting aside any belief in our own powers, to allow the higher power to work through us. Perhaps very wonderful things will happen.

*

Perhaps...

"Not everything that is faced can be changed,

but nothing can be changed until it is faced."

~James Baldwin~

jan

fact or fiction?

 

This is a piece I wrote several years ago about a busy night in the emergency room:

 

"Just after midnight, they brought Jeremy Crane in, lifeless, on a gurney. He'd wrapped his car around a telephone pole doing eighty miles an hour. Without a seatbelt. After having enjoyed a few underage drinks with his friends.

 

Not six months earlier he'd been in my office to have his learner's permit signed. I'd made him look me straight in the eye and promise me that he would wear his seatbelt every time he drove. That he would wait until all of his friends had fastened theirs before he would start the engine. That he would never drink and then drive, and if he did drink, he would call someone to drive him home. I made him promise me he wouldn't fiddle with the radio, or neck with his date while he was driving. And he did. He looked me in the eye and solemnly promised. He lied right to my face, and then he signed his name to it.

"The difference between

fiction and nonfiction is that

fiction must be absolutely believable."

~Mark Twain~

 

And look what happened to him. They wheeled him in with IVs running in both arms. He was sucking air in through his shattered ribcage with a tube down his throat so the medic could pump a little oxygen into his lungs. A stiff brace held his neck straight. Blood seeped out of the gash above his right eye, and the one behind his right ear, and the one on his left arm. His face was bruised and his eyelids swollen. His left shoulder was out of joint, his abdomen distended, his left foot missing, his pupils fixed and dilated. He was dead. At two o'clock in the morning, I was on the phone to his father."

 

Now that you've read the scene, can you tell if it's part of my memoir (nonfiction)? Or is it a scene from a novel (fiction)? Can you tell?

  

"Fiction reveals truth

that reality obscures."

~Ralph Waldo Emerson~

  

One of the goals in narrative medicine is to apply storytelling techniques to the process of obtaining the patient's medical history...his story. This exercise reflects the fact that reality shapes good fiction, while good fiction accurately reflects the truth. 



 jan

PS: This is a fictional scene from my (unpublished) novel, The Bandaged Place.



when the work of your heart is your gift to the world

 

As health care professionals, we are obligated...indeed, sworn under oath...to provide thorough and expert care to our patients...to arrive at the correct diagnosis, and to provide effective and appropriate treatment whenever possible. The trouble is, it doesn't always happen that way.

This is what transpired in my daughter's orbit last week. True story:

On Friday, she stubbed her toe. That would have been painful enough, but she'd dropped the lid from cast iron pot on the same foot several weeks earlier, and it was still bothering her. She was optimistic it would eventually take care of itself, but it was still painful and swollen. Then, BAM! The toe! 

"I told the doctor that I broke

my leg in two places.

He told me to quit going to those places."

~Henny Youngman~

By Saturday morning, it was apparent the toe was broken so she agreed to go to one of the nearby orthopedic walk-in clinics to have it checked out. When she got to the first one, it was closed. No problem. She made her way to the second one, a little farther away. It, too, was locked up tight...even though both websites indicated they were open for business. 

She ended up at an urgent care clinic which, she conceded, was better than nothing. There, she explained that she'd experienced two injuries--one to the top of her foot and one to her toe. She showed the radiology tech where the pain and bruising were. The initial reading on her X-rays suggested no fracture, so she came home with nothing. No boot, no crutches, and no diagnosis...until hours later when the radiologist read her films and identified the fracture at the base of her toe. They had failed, however, to include films of the dorsum of her foot, so the nature of that injury will forever remain a mystery.

"I know you believe you understand

what you think I said,

but I am not sure you realize

that what you heard is not what I meant."

~various attributions~ 

They invited her to come back so they could apply a post-op boot, but by then something else was developing at home. Something urgent. Her older dog had picked up a mild case of kennel cough from his younger sibling, and all afternoon he was becoming more and more short of breath. He was anxious and lethargic. He wouldn't eat or drink. He clearly needed help. So at 9:30 that night she bundled him off to the nearest emergency vet clinic. When she got there, she was told that they were "at capacity," meaning they weren't seeing any more animals that night. They told her that the next closest clinic was also at capacity, which meant a 30 minute drive to an animal hospital in another town. In another state. In the middle of the night.

There, she explained her pet's symptoms. She told the vet that her other dog was being treated for kennel cough but so far, nothing was helping. She'd already been on two antibiotics and it sounded like her cough was getting worse. Now her older dog was clearly in distress. It's no wonder she was upset when the vet neglected to get an X-ray to r/o pneumonia. When he prescribed the same antibiotic that failed to help her younger dog, and he refused to explain why. Then he became defensive because she asked questions in an effort to understand how this was expected to work...and what she should watch for over the weekend if it didn't help. She left feeling frustrated, angry, and disrespected.

"People start to heal

the moment they feel heard."

~Cheryl Richardson~

To be perfectly honest, the vet was probably justified in foregoing the chest x-ray. Clinically, the pup didn't require IV hydration or oxygen at that point in his illness so he didn't need to be hospitalized. And he did prescribe a widely accepted broad-spectrum antibiotic for the infection. I'm sure the vet was confident everything would be fine, even though he failed to communicate that to my daughter. He didn't answer her questions, or address her fears. Similarly, earlier in the day at the urgent care center, her concerns about her foot were not heard, and the full extent of her injury was overlooked.

This story is intended to convey the healing power of a patient, gentle, and compassionate relationship between the physician and the patient (or, in this case, the patient's caregiver)…when everything else is foreign and frightening. It speaks to the importance of trust and confidence in the healer’s character and expertise. It should remind us to treat every patient with the same respect, kindness, and care we would extend to our best friend, to our own family members, and even our beloved pets.

Unfortunately, we've watched medicine change over time. How sad it is that the physician/patient relationship is no longer what it used to be. How little time we have with our patients. How continuity of care has been sacrificed in favor of efficiency. How the drive for corporate profit outweighs the compassionate care of our patients.

Even when care is appropriate and thorough, it may not be good enough. We can do better. The patient's or the caregiver's fears must be allayed, his questions answered, and trust established before healing can begin. There is always room at the bedside for gentleness, patience, and compassion. 

"The work of your heart,

the work of taking time to listen,

to help is also

your gift to the whole of the world."

~Jack Kornfield~

jan

storytelling is good for you

 

If you are reading this and you know me as a family physician, my interest in narrative medicine shouldn't surprise you. However, if you know me as a writer, but not as a doctor, you might wonder why I take such an interest in the field.

 

"Writing improves clinicians'

stores of empathy,

reflection, and courage."

~Rita Charon~



You might ask yourself what narrative medicine has to do with you. Why should you be interested in it?

 

This is the thing. Training in narrative medicine is important to health care providers because it makes us better practitioners. It's good medicine so, of course, I'm interested in it. But it's a hard sell. It takes time to explore the patient's full narrative, and in today's medical culture, time is money. It defeats the purpose of the EMR with its time-saving bullet points, and it doesn't conform to diagnostic and billing codes. It requires us to enter into a special connection with patients who would otherwise come and go as strangers. It tests our dedication.



"There isn't

a stronger connection between people

than storytelling."

~Jimmy Neil Smith~



On the positive side, it teaches us to elicit and interpret the patient's whole story...how he got sick, what it feels like for him, how it affects him and the people around him. What strengths he brings to the healing process, and what obstacles he encounters. All of which affect the course of his illness and the process of recovery.

 

Not to mention our own stories. I can tell you about the moment I first knew I wanted to become a doctor. I can tell you about the day I was convinced I'd made a mistake. My most challenging case. My greatest triumph...my most bitter defeat. The fatigue. The uncertainty. The fear. The first time I saved a life...or lost one. All this is fair game in the field of narrative medicine.

 

But narrative medicine isn't just for health care providers. It's meant for you, too. It might interest you if you have ever been a patient, especially if your experience was an unhappy one. If the doctor was rude or arrogant. If he never made eye contact with you, or explained your diagnosis, or discussed your treatment. Your story might describe the moment you first heard the word cancer, or heart attack, or stroke and everything in life changed for you. It might require you to put into words what you felt when your child got sick, or you lost the baby, or you had to depend on somebody else to feed and bathe you. These are the stories that chisel away at us inside, out of sight. Stories someone else needs to hear so that their healing can begin.

 

"Telling our story does not

merely document who we are.

It helps make us 

who we are."

~Rita Charon~

 

Maybe your story is a happy one. The day your cancer went into remission, or your child left the hospital, or you passed your stress test with flying colors. Tell us about the elation, or gratitude, or relief you felt.

 

We all have a story to tell. If your story quickens your pulse, or brings a tear to your eye, or makes your stomach turn, you should try to put it into words. Somebody needs to hear it.

 

If it opens your heart, or makes you smile, or lifts you up, someone definitely needs to hear it. Narrative is good medicine for all of us.

 

"For human beings,

life is meaningful because it is a story,

and in stories, endings matter."

~Atul Gawande~

 

jan





 

 

 



how to tell a story without words

...in case the heat is getting you down.

It has been said:

"Everybody walks past

a thousand story ideas every day."

~Orson Scott Card~

What is your story? Who will you share it with?

What have you lost? Your job? Your home? Your faith?

Who do you miss? Your mother? Your father? Your child? Your friend?

What is it that scares you? The chemo? The pain? The end?

Where are you broken? Where does it hurt?

How will you heal?

Maybe it's a story without words. Something stuck in your throat. Something too painful for words.

Perhaps you can draw it for us.

Or put it to music.

Or bang it out on a  drum.

The Kripalu Drummers

Even if your story is locked up tight, if your fingers are frozen and your feet are like lead, someone may need to hear it...to read it, or see it, or feel it as it's being told, before they can tell their own. If you can't tell it, find someone who can. 

"Tell your story with your whole heart."

~Brene Brown~

This post is dedicated with deep gratitude to everyone who has shared their stories with me, so I can share them with you. You know who you are...

jan