stuck? try this.

I often find myself encouraging my friends and family members to begin writing. The stories they could tell would be full of wisdom, humor, and insight. They have something to teach all of us. To encourage us. To rescue us, if only they would begin.

Are you keeping an untold story in lock down? A chapter stored somewhere in your heart under lock and key? A tender memory smoldering out of sight?

Why won't you share it with us?

Perhaps your story is too painful to revisit. Too achingly sad to put into words. So confusing it doesn't make sense.

Or, perhaps the voices have been messing with you. The voices that insist you have nothing important to say. That you have no talent for this kind of thing. That no one wants to hear what you have to say.

"You are so brave and quiet

I forget you are suffering."

~Ernest Hemingway~



If this resonates with you, you MUST begin writing. Do it for the rest of us. Open a new document, or run out and get yourself a journal that strikes you as welcoming and forgiving. Go now! We’ll wait.

As Maya Angelou reminds us:

"There is no greater agony than

bearing an untold story inside you."

~Maya Angelou~

Can’t do it? Try this, then. Ask yourself these three questions:

1.    What do I know?

Perhaps you lost a child. Maybe it happened because of a miscarriage no one saw coming. Perhaps someone convinced you to have an abortion when you were too young to understand what was happening…and now you can’t forgive yourself. Maybe you spent an inestimable number of sleepless nights at your child’s bedside fighting for his survival to no avail.

You know everything there is to know about suffering.

2.   Who else needs to know it?

If you survived, someone else needs to know how you managed to pull it off. Someone, somewhere needs to know that survival is possible. It might be the father who suffers a disabling injury. Or the parent of a child with special needs. Or the woman who is hearing the word “cancer” for the first time.

The story of your journey maybe a wellspring of hope for others. Your strength may be the only thing that keeps them standing under the weight of the burden they are carrying. When you express your anguish, it gives them permission to admit theirs.

"These mountains you are carrying,

you were only supposed to climb."

~Naajwa Zebian~

3.   How will I tell them?

One painful word at a time. One affirmation after another. Honestly. Openly. Courageously.

"Write hard and clear about what hurts."

~Ernest Hemingway~

Still can't do it? Try writing something else first, then--maybe a poem or a letter. Perhaps instead you should run out for some new paints and a fresh white canvas. Or raise your voice in song. Or put on some music and dance.

There is more than one way to tell a story. How will you tell yours? When will you begin?

"Write about what disturbs you, 

what you fear,

what you have not been willing to speak about.

Be willing to be split open."

~Natalie Goldberg~

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how to learn a new language

 

I feel as though I've had to learn two new languages in the past few weeks just to get through the books I was reading. "The Mind Illuminated" by John Yates, PhD (aka "Culadasa") introduced me to terms like extrospective awareness, grades of piti, metacognitive introspective awareness, samatha, and shared receptivity, concepts involved in deepening the meditative state. The author was kind enough to include an extensive glossary at the end of his book so I didn't have to flip back through hundreds of pages to refresh my memory when definitions escaped me.

"To have another language is

to possess a second soul."

~Charlemagne~

The other book, "Being You" by Anil Seth, about the science of consciousness, dealt with concepts like sensory prediction errors, metacognition, free energy, posterior probabilities, and Bayesian inference... no glossary included, thank you very much.

These subjects are difficult enough to understand and apply without introducing a foreign language. So why did I bother to struggle through them?

"Our passion for learning...

is our tool for survival."

~Carl Sagan~

Simply put, I am curious, with a passion, about the neurophysiology of the brain, especially the nature and manifestations of consciousness. Not only the origin of thought, but the mysteries of perception, volition, memory, and imagination, as well as higher states of consciousness, all of which segue into my interest in meditation. This is perfectly consistent with the curiosity that propelled me into the study of medicine in the first place: how the heart works, how babies are made, how a broken bone heals...ad infinitum. There are so many languages to learn.

"A different language is

a different vision of life."

~~Federico Fellini~

You don't have to attempt anything as bewildering as consciousness studies or deep meditation to understand this. You might be curious and impassioned about other things. NASCAR racing, for example, or climate change, or cooking...something you are driven to learn about. How hard are you willing to work at it? Are you willing to learn a new vocabulary in order to succeed at it? 

If you're lucky, you may not have to learn a new language to pursue your passion in life. But, if you don't mind learning one new language, why not shoot for five? You might consider starting out with something like "The Five Love Languages" by Gary Chapman. I learned a lot from him, and I understood every word.

"The capacity to learn is a gift;

The ability to learn is a skill;

The willingness to learn is a choice."

~Brian Herbert~

jan

three big ifs

The last time I saw my primary care physician, I was handed a clipboard and instructed to answer page after page of questions...as always. The questions included updates to my demographics, my insurance information, my family medical history, and a "health risk assessment" that included questions about lifestyle (exercise, diet, smoking, and alcohol/drug use), about my mood and stress levels, current and previous health conditions, dementia screening, recent falls, and my ability to perform daily activities such as feeding myself, dressing, and bathing. It's annoying to fill out the same questionnaires year after year because it's time consuming and redundant...but it makes sense from a health maintenance perspective. This line of questioning helps the physician identify problems that predict poor health outcomes. It provides information he can use to institute preventive strategies, as well as timely interventions to correct or compensate for developing problems.

"A facility that asks you to fill out

a health screening form is a sign of one

that really cares about its members."

~Kathi Davis~

This, however, only works if the patient is honest with his answers (ie. how much he really drinks, or how many times she really has fallen). It only helps if the health care provider takes the time to review his patient's answers, and who has time for that? And, it only benefits the patient if he is willing to follow his provider's recommendations. THREE BIG IFs.

I know this because I'm a physician, and at times, I'm a patient.

As a physician, I learned not to ask my teenaged patients if they were sexually active because the answer was always, "No"...lest the truth get back to Mom and Dad. Instead, I asked how many sexual partners they'd had. Two...twelve...twenty? You'd be surprised.

Likewise, when (if) my PCP asked me whether I felt anxious or depressed, I might have said "No"...because I wasn't comfortable sharing it with him, and I was pretty sure he had neither the time nor the expertise to help me, so why bother?

Meaning we miss a lot of important information when we explore a patient's medical history...

"There is no greater agony than

bearing an untold story inside of you."

~Maya Angelou~

...not to mention their backstory. 

Let's say your patient has breast cancer. She is forty-four years old, the same age her mother was when she was diagnosed. But her mother died following surgery and a full course of radiation and chemotherapy. This is what scares her. She jumps to the conclusion that this is her fate as well, despite the fact that her mother's cancer was far more advanced when it was detected. Despite the fact that treatment has improved in the twenty years since her mother's diagnosis. The patient's initial reaction to her diagnosis may be to give up right then and there...her unnamed, invisible, and unspoken thoughts, feelings, and emotions left unchecked.

"Your body hears everything

your mind says."

~Naomi Judd~

Or, perhaps the patient is a middle-aged man who schedules a ten minute appointment with you so he can get something for his heartburn. But he isn't simply experiencing indigestion. He has angina, and it's getting worse. He has convinced himself that it's just his stomach because the thought of a heart attack scares him. His brother had one last year, and ended up with a pacemaker and a defibrillator. His ten minute appointment ends up requiring an EKG and blood work, and it stretches into a forty-five minute dialogue about unstable angina and the need for hospitalization. He tries to laugh it off, but beneath his cavalier manner, he fears for his life. His family. His business. All of it unspoken, invisible, unacknowledged.

"A physician is obligated to consider

more than a diseased organ,

more than even the whole man.

He must view the man in his world."

~Harvey Cushing~

Clues to the unspoken forces at work in the patient's life include refusal of or noncompliance with treatment. Denial, anger, impatience, or resistance. Reticence. Despair. 

As health care providers, we must handle these patients with care. We need to ask about their fears, expectations, and perceptions. We have to take the time to speak about what we intuit to be unspoken or unacknowledged. To take the time and make the effort to uncover the truth.

If you are the patient and your story is too scary, or shameful, or complicated to put into words, let your provider know you are struggling. The words will come to you when you have a dedicated listener. He needs to know.

"Anything will give up its secrets

if you love it enough."

~George Washington Carver~

jan

 

the difference between practicing medicine and narrative medicine

RMNP

It's one thing to be able to put a name to your illness. To say, "I have cancer," or "I'm in heart failure," or "I have arthritis." It's another thing to describe all the ways it affects you. All the ways it makes you feel...physically, psychologically, and emotionally. This defines the difference between medicine and narrative medicine.

"Science tells you when and how you are ill;

your particular culture, or subculture tells you

when and how you are sick."

~Ken Wilbur~

It isn't enough to know that you have a disease. You want to know why you have it. You want to attach some sort of meaning to this illness. What did you do to deserve it? What can you expect? How will it affect the people in your life? These issues describe your sickness, and they have everything to do with the culture that surrounds you and the stories it tells. Those stories reach into your family, your environment, your experience, your expectations, and your longings.

"There's a phenomenology of being sick,

one that depends on temperament, personal history,

and the culture we live in."

~ Siri Hustvedt~

Oh, you have lung cancer? Why did you smoke? Why didn't you quit? Who will miss you when you're gone?

You have diabetes? What did you expect? Your mother and father were both diabetic...and overweight, just like you.

Cancer? When no one else in your family ever had it? That's so sad.

The culture you live in can create an entire narrative around your illness.

"Patients tell stories to describe illness.

Doctors tell stories to understand it. 

Science tells its own story to explain diseases."

~Siddhartha Mukherjee~

In some cases, your narrative is fueled by speculation, judgement, ignorance, and blame. Not a healing thought among them. The patient's pain is intensified by guilt. Weakness is compounded by shame. Fear morphs into despair. The patient feels sicker and sicker.

In other cases, illness is met with concern, compassion, and care. 

Your confused or agitated grandmother is treated patiently and gently. The abject beggar is bathed, clothed, and fed. The smoker with lung cancer, the obese diabetic, and the middle-aged banker with the STI are all cared for without speculation, judgement, or antipathy.

The stage is set for healing.

When we are ill, the diagnosis is just that: the name we give the disease. The sickness is the story that surrounds it.

"It is more important to know

what sort of person has a disease

than to know what sort of disease a person has."

~Hippoctares~

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our collective narrative

Okay, I admit it. Yes, I am working on a memoir. It's an illness narrative that I share with my brother. It explores the wildly disparate outcomes of our hospitalization as young children with the same illness (rheumatic fever), at the same time, in the same place.



Buffalo Children's Hospital today

 

I could write about other aspects of my life in medicine. I could tell you what motivated me to go into medicine in the first place, and the chance encounter that clinched my decision. I could tell you about my most difficult cases as well as the amazing recoveries I've witnessed. I could write about my struggle to balance my professional life with my family life. But that's not the medical narrative you need to hear. That's all about me. 

 

"Healing yourself

is connected with healing others."

~Yoko Ono~

 

You need to know if my story reflects your story and how our narratives are connected. Not because we had the same illness, underwent the same treatment, or achieved the same outcome, but whether we share the same lingering aftermath of the experience. 

 

"People start to heal

the moment they feel heard."

~Cheryl Richardson~

 

Think about how illness shaped your life, affected your relationships, and influenced your moods. Did it leave you with fear? Anger? Shame? Or did you emerge healed? Grateful? Strong? What did illness teach you? What can you teach me?

 

Your story is uniquely yours, but it is, in fact, connected to everyone else's story on an emotional, psychological, and even spiritual level. Your voice makes our collective narrative deeper, stronger, and wiser.

 

"Tell your story

because your story will heal you

and it will heal someone else."

~Iyanla Vanzant~

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