an invitation to heal

 

Listening is a critical skill for health care providers--for doctors, nurses, and therapists in every field. All day long we listen to patients as they tell us their stories...their symptoms, and the timing, severity, and course of their illness. We organize and record the facts in order to arrive at an accurate diagnosis and formulate a treatment plan. 

Deep listening adds another layer of connection with our patients. It involves more than just getting the facts down. It requires us to remain open-hearted, receptive, attentive, and nonjudgmental in each and every patient encounter. It is the key to accurate diagnosis and to healing. It is not, however, an easy skill to acquire or to sustain.

"In deep listening, we listen

with the sole purpose of helping

the other person feel heard and accepted."

~Thich Nhat Hanh~ 

 

In his book, "The Road Home," Ethan Nichtern describes some similarities between deep listening and mindfulness meditation. Deep listening involves sustained awareness, intention, patience, and compassion. As such, the deep listener encounters some of the same obstacles that trip us up during meditation: 

• DISTRACTION: Attention is difficult to sustain because we are distracted much of the time. Linda Stone ("The Attention Project" at https://lindastone.net/) coined the phrase "continuous partial attention" to describe the difficulty we have sustaining focus. Our minds are constantly darting from task to task, from issue to issue, from patient to patient, or simply drifting from one thought to another. We divide our attention between the story the patient in front of us is telling while worrying about the next difficult case, or the results of the tests we ordered on the last patient we saw. Not to mention the emails and text messages that are waiting for a response. Just as we do during meditation, we need to acknowledge the fact that our attention has wandered and return to the present moment.

• FEAR: Another obstacle is the anxiety that can arise during the patient encounter. We worry about getting behind schedule. We worry about making a mistake or missing the diagnosis. The patient's story may trigger a memory from our own experience that reminds us of a painful ordeal we thought we'd put behind us. Suddenly, our hands are shaking and our heart is racing.

• INTERJECTING OUR OWN STORY: In an effort to identify with the patient, we may be tempted to interject our own story into the conversation. Perhaps, like the person sitting in front of us, we, too, have lost a child or struggled through chemo and radiation. We want to share our experience with her--what helped us get through it, where we turned for support, how we coped with side effects. This attempt to create connection and identification can backfire if our story is not what the patient wants to hear, if he is not ready to hear it, or our experience does not accurately reflect his story.

• OFFERING ADVICE: This, of course, is what we do all day long. We order tests, prescribe medication, recommend diets and exercise programs, and make plans for follow-up. The sooner we get to this, the sooner we can move on to the next patient. The problem is that we run the risk of intervening too soon, before we understand the patient's whole story, or worse, before the patient is ready to listen to us.

"The biggest communication problem

is we do not listen to understand.

We listen to reply."

~Stephen Covey~ 



When the patient tells us his story ("the history of the present illness"), he offers us a glimpse into his most private thoughts and feelings. He makes himself vulnerable...literally and figuratively naked before us. We elevate and dignify his presence when we receive his story with an open and non-judgmental heart, when we are attentive and responsive to his needs, and when we respect and welcome his offering.

"The most precious gift

we can offer anyone

is our attention."

~Thich Nhat Hanh~

Deep listening embodies compassion, empathy, and equanimity. It relieves suffering by providing the storyteller with a safe, nonjudgmental, receptive listener. It is an invitation to heal.

jan



how to know when you need help

 

If you are a healthcare provider in any field, or a caretaker for someone...because it is your profession, or because you offered to help out, or because circumstances forced you into the role...you know how hard this kind of work can be. You know what it feels like to do your job when you're exhausted, hungry, scared, unsure. You know how stressful it can be when you're running behind schedule, or you're asked to work an extra shift. It can be hard to make time for your family and friends with everything your work requires. You sometimes miss your kids' games and recitals. You miss family celebrations and holiday gatherings. You do your job even though you're not feeling well or you're in pain. Or when your bladder is full.

"You must find the place inside yourself

where nothing is impossible."

~Deepak Chopra~

We all understand this. We accept it, and we choose it. It is hard at times, but this is what I think is harder. It is harder for me when someone I care about, someone I love, is struggling, and I can't be with them to lend a hand.

"I cannot do all the good the world needs,

but the world needs all the good I can do."

~Jana Stanfield~

I was reminded of this last week when my brother went into the hospital for some pretty scary tests because of a complicated assortment of medical conditions. I couldn't be there with him because he lives far, far away. Which left his wife to manage by herself.

A long time friend is navigating treatment for cancer on her own. Also, far away.

My son's dog ran out of steam this week, leaving us with broken hearts. 

Impotent: how you feel when you are kept from providing care, or support, or encouragement to someone you love, when they need it most. You feel powerless. Helpless. Empty.

"We can't help everyone,

but everyone can help someone."

~Ronald Reagan~

Which is why we need helpers. This week I had to take a step back and turn the care I longed to offer over to other people. My brother's wife stayed with him in the hospital day and night all week long. An old friend of hers stayed at my friend's side during chemo and stood by to offer whatever support she needed at home. My son's girlfriend stood by him with comfort and compassion.

I called. I sent cards. Flowers. Whatever I could. Nothing, really.

"Do all the good you can,

by all the means you can,

in all the ways you can,

at all the times you can,

to all the people you can,

as long as ever you can."

~John Wesley~

This is a reminder to accept all the help you are offered.

jan

the difference between fiction and nonfiction

 

True story.

I used to live in the country, and I loved to walk out there. An afternoon stroll "around the block" was a good four or five mile hike, no matter which route I took.

But there was one road that used to spook me out.

The trees and vines had overtaken a ramshackle trailer settled askew a few yards off the road.

www.2.tbo.com
 It looked something like this.

A pile of old tires spilled up against a dilapidated shed where a muddied pickup truck was parked.

www.flicker .com

You get the picture...it was the kind of place meant for stereotyping. The kind of place you'd expect to find some redneck, beer-swigging, abusive boor with his toothless girlfriend and ragamuffin kids. Or, perhaps some psycho loner with his stash of semi-automatic weapons, his shortwave radio, and a fully stocked bunker somewhere out back.

www.ar15.com

Or, on a more empathetic note...an elderly couple living in poverty who could barely afford their medication, much less the upkeep on their place. I used to cross to the other side of the road whenever I passed the place. It was that spooky.

Then...one fine summer day as I passed, the front door opened and out stepped the lady of the house, a fiftyish woman in a flowered house dress and fuzzy slippers (I kid you not). She waved and called me over. I'm thinking, "This is not happening!" But I crossed the road, worried she might be sick. Maybe she needed help. She stood on the stoop and this is what she said:

"I see you walking by every so often. Do you have any books you could bring me?"

 

True story.

 

I walked away laughing to myself. Books?? When I got home, I put together a bag of old paperbacks and castoffs...and the next time I passed her place, I put it in the mailbox for her.

 

 

 

Not long after that, the place went empty. Gradually, bushes and vines overran the place, and then one day it was gone. The trailer--gone. The shed--gone. The truck and tires--gone. Today there is nothing left of it...just the woods, as though they'd never been disturbed.

 

www.flicker.com

Nothing spooky about it at all.

The end. 

"The difference between fiction and nonfiction

is that fiction has to be absolutely believable."

~Mark Twain~

Epilogue: I never saw the woman again. I have no idea who she was or where she ended up. And I still sometimes wonder what happened to those books. 

 

If books are made of stories, I guess stories can be made of books.

jan

 

is there a better way?

Rocky Mountain National Park

Nowadays, patients frequently complain about the fragmented and impersonal relationship they have with their healthcare provider. They often feel as though they aren't being heard, or understood. Important issues are dismissed or left untouched by physicians who appear hurried, distracted, or disinterested in their problem.

The physician can hardly help himself. He is forced to practice in a health care system whose number one priority is corporate profit. His schedule is overbooked. He struggles with an electronic medical record system that doesn't work for him. He has to navigate a baffling coding and reimbursement system, and he faces the ever-present threat of litigation. And, of course, he is tethered to his very own, personal productivity quotient, a.k.a. how much income he is expected to generate.

"Medical practice is not knitting and weaving

and the labor of the hands,

but it must be inspired with soul and

be filled with understanding and

equipped with the gift of

keen observation."

~Maimonides~

These stresses drive a wedge between the patient and provider, disrupting the fundamental patient-doctor relationship. The patient is disappointed in his care, and the physician is disappointed in himself. 

Is there a better way?  

Training in the practice of narrative medicine empowers the physician to elicit, assimilate, interpret, and respond to the stories patients tell us about their illnesses. In addition to tracking the appearance, location, and progression of their symptoms, it encourages the physician to explore the nature and course of suffering, attitudes about healing and recovery, and the ways family members, community, and circumstances influence these attitudes, all of which have been proven to affect patient outcomes.

"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~

The overwhelmed (or uncaring) physician may suggest this is what we have nurses, social workers, psychologists, pastors, and family and friends for. But by disengaging himself from the patient's psychological, emotional, and spiritual life, the physician sacrifices his connection with his patient, and with it, empathy. And with loss of empathy, morale suffers, and when morale suffers, physicians tend to burn out.

Storytelling is one of many art forms that encourages and enables patients to explore the full scope of illness and recovery. It is already built into the clinical encounter under labels like "the history (or story) of the present illness", "the past medical history" (or story), "the social history" (or story), and "the family history" (or story), almost as though an epic novel is about to unfold.

"Ask not what disease the person has,

but what person the disease has."

~Oliver Sacks~

In addition to promoting accurate diagnosis and effective treatment, this brand of storytelling remains a useful tool for the patient himself as a means of exploring the cause, effect, and meaning of his own illness. Narrative medicine then begins the process of narrative healing.

"But this, too, is true:

 stories can save us."

~Tim O'Brien~

jan