illness, inside and out

 

Illness has to be understood in terms of its effects on the patient, both inside and out.

Within, it interrupts normal physiology and function. It alters anatomy. It causes pain. Traditionally, this has been the domain of the healer: diagnosing and treating the illness or injury by asking about symptoms, examining the patient, ordering diagnostic tests, and formulating a plan of treatment. It can all be done at the bedside.

But illness also triggers a cascade of cognitive, emotional, and psychological responses. It affects the patient’s relationships, his capabilities, his expectations, and his role in the family and community. Positive mental and emotional changes have been shown to support the ability to heal. On the other hand, negativity is believed to impede recovery. Unless we take into account the patient’s sense of self when tending to his illness or injury, we may neglect one of the most important determinants of his ability to heal.

"It may take a doctor to diagnose
someone's illness, bit it takes a friend
to recognize someone's suffering."
~author unknown~

For example, when the family's breadwinner is laid off because of illness, he loses wages. It’s possible he will lose his job, so he worries how he will support his family. Fear and uncertainty aggravate the illness. His self-respect and confidence take a punch to the gut. That’s the thing that really hurts, but he won’t tell you about it unless you ask.

"To me the ideal doctor

would be a man endowed with 

profound knowledge of life and of the soul,

intuitively divining any suffering or disorder

of whatever kind,

and restoring peace by his mere presence."

~Henri Amiel~

Or perhaps your patient is a mother with young children at home. Who will take care of them while she is in the hospital? She worries about them. She feels guilty because she can’t be there for them. She may actually lie to you in hopes of being discharged from the hospital sooner, denying the pain she still has, or pretending to be stronger than she actually feels. Her narrative is misleading.

The patient’s story extends beyond the bedside. It embraces more than his illness. One person will be crippled by it while another is healed.

We can’t understand a patient’s illness unless we understand how it affects everything and everyone around him—his family and friends. His hopes, dreams, and plans for the future. We can’t hope to heal the patient until we hear his whole story.

“The doctor may learn more about the illness
from the way the patient tells the story
than from the story itself.”
~James B. Herrick~

jan

words of wisdom for writers who sometimes waver

 

In anticipation of my presentation on the healing power of sharing our stories at the 2024 Pennwriters Conference next month, I would like to share inspiration and wisdom from some really awesome writers and teachers:

~Words of Wisdom for Writers Who Sometimes Waver~

"There is no greater agony than bearing an untold story inside of you."
~Maya Angelou~

"The healing that can grow out of the simple act of telling our stories is often quite remarkable."
 ~Susan Wittig Albert~
 
“One of the most valuable things we can do to heal one another is listen to each other’s stories.”
~Rebecca Falls~
 
"Telling our story does not merely document who we are. It helps make us who we are."
~Rita Charon~
 
"Writing is medicine. It is an appropriate antidote to injury. It is an appropriate companion for any difficult change."
~Julia Cameron~
 
"Dancing, singing, storytelling, and silence are the four healing salves."
~Gabrielle Roth~
 
"The greatest story commandment is: make me care."
~Andrew Stanton~
 
"One day you will tell the story of how you overcame what you went through
and it will be someone else's survival guide."
~Brene Brown~
 
"The most important part of a story is the piece of it you don't know."
~Barbara Kingsolver~
 
"If we are artists...it is our job, our responsibility, perhaps even our sacred calling to take whatever life has given us and make something new, something that wouldn't have existed if not for the fire, the genetic mutation, the sick baby, the accident."
~Dani Shapiro~"
 
There isn't a stronger connection between people than storytelling."
~Jimmy Neil Smith~
 
"Because right now there is someone out there with a wound in the exact shape of your words."
~Sean Thomas Dougherty~
 
"You'd be surprised what lengths people will go to not to face what's real and painful inside them."
~unknown~
 
“Good writing is not about good grammar. Good writing is about truth.”
~Nancy Slonim Aronie~
 
"Everything you need to know about life can be learned from a genuine and ongoing attempt to write."
~Dani Shapiro~
 
"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~
 
“Stories are not material to be analyzed; they are relationships to be entered.”
~AW Frank~
 
“Can you tell me about a moment that was big for you…an instant when you saw things differently from then on? Not a sensational moment—you won ten-thousand dollars in the lottery, you were lost in the woods alone with no food—but a quiet moment when your whole awareness shifted?”
~Natalie Goldberg~
 
"Tell your story with your whole heart."
~Brene Brown~
 
"We read to learn about the world. We write to change the world."
~Lori Jamison Rog~
 
"Write hard and clear about what hurts."
~Ernest Hemingway~
 
"Share your story with someone. You never know how one sentence of your life story could inspire someone to rewrite their own."
~Demi Lovato~
 
"Everybody walks past a thousand story ideas every day. The good writers are the ones who see five or six of them. Most people don't see any."
~Orson Scott Card~
 
"If a story is in you, it has got to come out."
~William Faulkner~
 
"The truth is, in order to heal we need to tell our stories and have them witnessed."
~Sue Monk Kidd~
 
“The degree to which you can tell your story is the degree to which you can heal.”
~Stasi Eldredge~
 
“Your body’s ability to heal is greater than anyone has permitted you to believe.”
~unknown~
 
“Instructions for a long life: Pay attention. Be astonished. Write about it.”
~Mary Oliver~
 
“People start to heal the moment they feel heard.”
~Cheryl Richardson~
 
“Tell your story, because your story will heal you and it will heal someone else.”
~Iyanla Vanzant~
 
“We write out of revenge against reality.”
~Francine du Plessix Gray~
 
“It may be that when we no longer know what to do, we have come to our real work, and when we no longer know which way to go, we have begun our real journey.”
~Wendell Berry~
 
“At some point you are going to want to give up. Consider this a reminder:
don’t you dare.”
~Karen Salmansohn~

*

I could go on...

jan

what to do when you can't write, or you don't want to

If you have a story that keeps playing itself out just when you're dozing off at night, or after you've  been driving for a while, or when you're walking in the woods or on the beach...when your mind is free to wander and you were hoping for some peace and quiet...it may be begging you to share it with the rest of us. It may be time to put it into words on the page.

"If a story is in you, 

it has got to come out."

~William Faulkner~

The problem is that life hands us all kinds of interruptions and distractions. Some are happy events like the birth of a baby, a wedding, or an overdue vacation. We celebrate them with the people we love, and we enjoy doing it even when it puts our work on hold.

Unfortunately, some are unhappy occasions--a death in the family, the loss of a job, or an illness. Because there is so much to think about and so much to do, writing has to take a back seat for a while. People need our attention and our care. We may not be able to shake off our own sadness, or pain, or fear. It can be a challenge to put two consecutive thoughts together in proper order.

Still, when life gets in the way, we can't simply ignore it in the battle to make our word count for the day. We can't just sneak away when no one is looking to hang out with our manuscript.

In fact, we may not want to.

So what will you do when you can't write, or don't want to write? When you don't have the time, or the energy, or the motivation to line up perfect little sentences one after the other for someone else to judge?

Quoting James Baldwin:

"One writes out of only one thing--

one's own experience. 

Everything depends on how relentlessly

one forces from this experience

the last drop, sweet or bitter, it can possibly give."

~James Baldwin~

Whether your experience is sweet or bitter, savor it. Submit to every moment. Don't waste a drop. This is what will inform your writing when you do take up your work again. Anticipation, joy, and kinship, deeply felt, have the power to uplift the reader. Likewise, tribulation, well written, connects the reader with his own reality and tempers his own sorrow.

"Share your story with someone.
You never know

how one sentence of your life story

could inspire someone to rewrite their own."

~Demi Lovato~

Is it hard for you to maintain your writing practice? What is preventing you from writing? When will you begin?

"There's a secret that real writers know

that wannabe writers don't,

and the secret is this: 

It's not the writing part that's hard. 

What's hard is sitting down to write."

~Steven Pressfield~

The secret is to sit. Stay. Write. Remember that to get started:

"All you have to do is write one true sentence.

Write the truest sentence that you know."

~Ernest Hemingway~

jan

compassion, surrender, and equanimity

 

This past week was difficult, not so much for me individually, but for people I know and love. It can be described in two words: helplessness, which is what I felt, and hopelessness, which was the rock bottom truth.

It started with someone close to my heart who took ill, and required hospitalization for both evaluation and treatment. It turns out the management part of the story will require long, complicated surgery. That happens tomorrow, followed by that treacherous period when we have to wait for results, and hope for healing, while trying to keep everyone's spirits up. The trouble is I can't be there. Not that I would play any role in his surgery or treatment, but I believe in the healing grace of presence. So, I feel totally helpless.

"When you love someone,

the best thing you can offer

is your presence."

~Thich Nhat Hanh~

Then I received word that a friend's husband passed away unexpectedly over the weekend...while they were travelling out West with their two dogs in their brand-spanking new RV...leaving her alone somewhere in Texas to find her way home. Without him. Without hope. Which leaves those of us who love her fraught with worry and sorrow, unable to be there for her. Unable to help at all.

"At some point

you are going to want to give up.

Consider this a reminder:

don't you dare."

~Karen Salmansohn~

Not only my little speck of the world, but the entire planet appears to be blanketed with fear, pain, dread, and sorrow. Punctuated by cruelty, indifference, hatred, and greed. Littered with broken bodies, broken hearts, and broken lives. With no end in sight. It has frustrated us by making us feel helpless. It has discouraged us with loss of hope. 

But make no mistake about it. Both the suffering we witness around us and the pain we experience in our own lives are wellsprings of deep compassion. They invite us to come together and to remain present for one another. They train us to acknowledge what is real and true in our lives, and by doing so, to embrace equanimity:

"EQUANIMITY:

mental calmness, composure, and

evenness of temper,

especially in a difficult situation."

~multiple attributions~

Compassion, surrender, and equanimity are the three healing forces that teach us what is precious and tender about this life we share. They train us to feel deeply. They teach us what we need to do in order to heal.

"It is both a blessing

and a curse

to feel everything so very deeply."

~David Jones~

jan

why stories go untold

 

When we refer to the healing power of storytelling, what do we mean? Is there anything to it? How does it work? What happens between us when we share our personal stories, and why is it important that we do?

This interests me because I’m a family physician. I practiced medicine for over thirty years…until I retired because my other passion in life is writing…and, you know, sometimes you have to make tough choices.

Plus…I had a story in me that I really wanted to tell. 

"Tell your story

with your whole heart."

~Brene Brown~

The point is that we ALL have a story to tell, but most of us ever get around to sharing it. Instead, we make up excuses. We tell ourselves we don’t have time to write. We don’t know where to begin, or how to put it into words. We tell ourselves that what we have to say isn’t important. That no one will care. Sometimes shame silences us. We blame ourselves for what happened to us. We have been conditioned to keep secrets. It’s too painful, or sad, or maddening to put into words.

 "You'd be surprised

what lengths people will go to
not to face what's real and painful inside them."
~attribution unknown~

So…our stories go untold…and as such, I’m telling you…they wreak havoc on our bodies. The anger we keep bottled up, the sorrow we can't express, the shame we keep under lock and key all take a toll on us. They increase levels of stress hormones and inflammatory chemicals in our bodies that raise the heart rate, elevate BP, and raise blood sugar levels. This can lead to all kinds of problems in adulthood--hypertension, heart disease, diabetes, and autoimmune problems like lupus and RA. Not to mention anxiety and depression.

There is, in fact, some science to support the idea that telling our stories can help us heal. We know that storytelling can lower levels of inflammatory hormones in the body, because we can measure them. In studies where subjects were asked to write about a traumatic episode they experienced vs a neutral topic like the weather or a favorite food…heart rate, BP, and sugar levels fell in the first group as compared to the neutral group. In another study, participants underwent a small skin biopsy. They were then assigned to write about a traumatic episode or a neutral topic. The open wounds healed faster in the cohort that wrote about trauma.

When the listener is engaged with the story the teller is sharing, functional MRI scans of their brains demonstrate synchronization in electrical activity between the storyteller and listener. EEGs demonstrate the ways their brain waves change. 

Think of it. If we had a pill that could lower our blood pressure, control our blood sugar levels, and elevate our mood, we would all be buying stock in that company. So…why not invest in storytelling?

"Because right now
there is someone out there 
with a wound in the exact shape of your words."
~Sean Thomas Dougherty~

Unless we explore the anger, or despair, or confusion that is at the root of our pain, nothing anyone says or does will touch the cause of suffering. All the medication in the world will not solve the problem.

The point is that telling our stories affects us in ways we can actually measure and observe. When you give your story a title, describe how it unfolded, and name the characters that populate it, you may begin to understand why it still disturbs your peace so many years later. If someone you trust is listening, you may come away with an entirely fresh perspective on it. You may finally 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 BP and sugar levels may come down. Anxiety and depression may improve. All pathways to healing.

As a physician, I listened to patients’ stories all day long. The history, or story, of the present illness. The past medical history, or story. The patient’s family history, or story. But that was back in the days when I could scan my schedule for the day and envision every patient, I knew them that well. With a quick glance at the schedule, I knew who was getting ready to start chemo, who had just welcomed their first grandchild into the world, whose mother was recently transferred to the dementia unit. I knew because I had asked about it, the patient told me the story, and I made a note of it in the chart.

Nowadays, rather than dictating a note about the clinical encounter (a.k.a. narrating the patient’s story), you open an electronic medical record (EMR) that presents you with a confusing array of bulleted items, complicated charts, and abbreviated details. You can easily pick out a list of symptoms that were problematic at the patient’s last visit, when they started, how often they occurred, and how long they lasted. You know what tests you ordered and how you treated him, but you might not remember anything else about the patient because nothing else 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 get that part of the story. 

"The most important part of a story
is the piece of it you don't know."
~Barbara Kingsolver~

If you’re a healthcare provider, it’s easy to understand how missing details can make it hard to come up with the right diagnosis. You miss the fact that your patient’s headaches started the day she discovered the cigarette burn on the sleeve of the sweater her ten-year old wore to school that day. You have no way of knowing that the patient’s heartburn and indigestion have been a problem because of the pile of unpaid bills that are collecting on the kitchen counter. Or that your patient has insomnia because he is headed for divorce...

…unless, of course, you ask about it.

"There isn't
a stronger connection between people
than storytelling."
~Jimmy Neil Smith~

Sharing our stories helps us heal. It is built into healthcare. It can’t be ignored. The stories we share in the back of an ambulance, or in the examination room, or at the bedside describe who we are. They help us process what happens to us. They embody our unspoken fears, our deepest sorrows, and our greatest regrets…

…which is why we don’t tell them. It’s hard to put them into words.

 It took me fifty years to get mine down.

 Now is your chance to get started on yours.

"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~

 jan

 

how to be a better human

We're already well into March. January and February have come and gone...and with them, perhaps, the resolutions we embraced with such conviction at the start of the new year. To lose a few pounds. To ramp up our exercise routine. To simplify our lives. All worthy goals. All honorable intentions. All admirable yearnings.

Most of us would probably agree that it takes some combination of burning desire, fierce determination, and unrelenting self-discipline...whatever it takes...to make change happen. 

Perhaps your goals for this year are even loftier than usual at this stage of your life. To find happiness. To embrace equanimity. To cultivate inner peace and extend it to others. To heal the wounds that cause people to suffer...which, I believe, is what we are called to do with this one transcendent life of ours. To help people heal.

The bad news is that these are difficult goals to achieve under the best of circumstances, even with tireless effort. Harder even than dieting and exercising. 

The good news is that help is available. Wisdom abounds. Why, in just the past week, the following brilliant nuggets popped up among my e-mails:

~How to make the best of life

~How to master a life transition

~How to be perfect

~How to reprogram your subconscious mind

~How to access superhuman abilities

~How to reprogram your brain for healing

~And my personal favorite: "The Secret to Finishing Your Book."

I could go on. It's all out there. How to be a better human. Words of advice for whatever you want to achieve...complete with instructions...from people who claim to know it all. This should be easy, right? Plenty of people claim to have attained transcendence. They offer us an easy path forward. Don't fall for it, though. Before you surrender to someone else's authority, before you give away your own power, consider the Buddha's advice:

"Believe nothing,

no matter where you read it

or who has said it,

not even if I have said it,

unless it agrees with your own reason

and your own common sense."

~Buddha~

Or, as Einstein put it:

"The important thing is to

never stop questioning"

~Albert Einstein~

...to which I would add, when you think you have it all figured out, think again. Question yourself, especially if, at this stage in your life...in the world we now inhabit...you feel a need for correction, redirection, or redemption. If you feel a need to rediscover, reinvent, or recreate your true Self. This is the perfect time to reconnect...

...which is why these words of artist Emily McDowell, from "EM & Friends", resonate so authentically with me:

"Finding yourself is not really how it works. You are not lost. Your true self is right there, buried under cultural conditioning, other people's opinions, and inaccurate conclusions you drew as a kid that became your beliefs about who you are. Finding yourself is actually returning to yourself, an unearthing, a remembering who you were before the world got its hands on you."

The conclusions we draw about who we are include a litany of disempowering, disheartening, and discouraging misconceptions we embraced as children and endured as adults that continue to cast long shadows over us as we age. No matter who we're with. No matter where we go. No matter what we accomplish. These include the never-good-enough, never-smart-enough, never-funny-enough, never thin enough, never-worthy-of-anything judgements that serve to camouflage wounds that have been festering untended, out of sight, our entire lives.

How can we ever expect to heal?

The answer is to question everything. Question everyone...your parents, friends, teachers, mentors, and every stranger you meet. Question your doctor. Ask your pastor, priest, or rabbi why they worship the way they do. See if makes sense to you.

If what you were trained to do, or taught to believe, or expected to accept leave you feeling uneasy, question them. Beware of guilt and shame. Pay attention when you feel a twinge of heartache or the pull of compassion. Stand up to injustice and cruelty in all their guises...poverty, war, homelessness, and hunger. Abuse and neglect. Tend to the ill and grieving when you can. Take care of the animals. Speak up for the planet. Challenge the politics.

"The cost of not following your heart

is spending the rest of your life

wishing you had."

~Attribution Unknown~

Spend a little time exploring who you were before the world got its hands on you.

You'll find a better human there. 

When you wake up in the morning, instead of asking yourself what you need to do that day, consider asking yourself this question:

Who do I want to BE today?

And always remember this:

"You're braver than you believe,

stronger than you seem,

and smarter than you think."

~Winnie the Pooh~

jan

why writing is an act of raw courage

 

Over the years, I’ve listened to a lot of stories…from my patients, among my friends, and in my own family. So, I spend a lot of time urging people I know to get their stories down…to enter them into a journal, or to confide in someone they trust. I beg them to write them down, to get them onto a canvas, or translate them into song or dance. (There’s more than one way to tell a story.) I do this because I know that storytelling can be a healing practice. In the words of poet Sean Thomas Dougherty, this is important because, as he puts it:

 “Right now, there is someone out there

with a wound in the exact shape of your words.”

~Sean Thomas Dougherty~

The story you share will help you make sense of your own experience…and, trust me, someone else, somewhere, needs to hear what you have to say. When people are struggling, they need to know that someone else has been through the same ordeal. They need to know where you turned for support, for strength, for comfort. They need to know how you survived. How you emerged victorious. Hearing your story may be just what they need to begin healing themselves.

It doesn’t take a stretch of the imagination to understand how hearing or reading just the right story at just the right time can help with healing.

"It may take a doctor to diagnose

someone's illness,

but it takes a friend to recognize

someone's suffering."

~attribution unknown~

For example, you might gain a new perspective on an issue that has been troubling you. Perhaps you’ve been struggling with guilt after a friend committed suicide. You pick up a book like “The Ticking Is the Bomb” by Nick Flynn whose mother took her own life. His story looks at suicide differently. He considers the inevitability of it given the course of his mother’s life. After reading it, you might see things a little differently, too. It wasn’t your fault your friend found life unbearable. Perhaps you didn’t miss the clues because there were none. A layer of guilt falls away. 

Healing.

Or maybe your friend has been diagnosed with cancer, and it doesn’t look good for her. You have no idea what to say or to do for her. You have no clue how to help. Then you pick up a novel like “Talk Before Sleep” by Elizabeth Berg, and you learn all the ways you can comfort and encourage her, and even bring a touch of humor to the situation.

Healing.

The process of telling your story may teach you something, too. Writing my childhood narrative taught me something I should have known. It taught me how mindful you must be when you care for people who are sick…especially children. You might not discover until it is too late that something you said or did, or that something you failed to say or do, had a devastating impact on your patient. The bitter aftermath of your life saving efforts might stalk him through life: fear, dread, despair.

Telling my story taught me the most important lesson of all: when you care for people who are sick, you need to anticipate their unspoken fears, to explain what is happening to them, and what they can expect. They need to know how to heal. They need to believe that healing is possible. 

The question is: do you believe it?

Let’s find out. 

Here's a prompt to get you started:

Write for about ten minutes about a time you remember "WAITING..."

Waiting for...

Waiting to...

Waiting until...

If that doesn’t resonate with you, write about something else. Whatever comes to mind. If just the thought of writing off the top of your head strikes fear and dread into your heart…maybe you can tell us why. The point is to write the first thing that comes up for you. Set a timer. When you're finished, read over what you have written. Better yet, read it out loud. To someone you trust.

Then, congratulate yourself. Why?

First of all, you wrote which, in and of itself, is an act of raw courage.

Second, you were willing to share your first unedited effort which is a mark of sheer humility and deep generosity.

Remember this: 

The story you share might be just what someone else needs to hear to begin healing.

"We read to learn about the world.

We write to change the world.

~Lori Jamison Rog~

jan

 

story healing

 

In a couple of months I'll be presenting my first ever workshop on the healing power of sharing our stories. 

"One of the most valuable things

we can do to heal one another 

is to listen to each other's stories."

~Rebecca Falls~

Here is some of what I'll be covering:

Today we’re going to talk about what I like to refer to as the healing power of storytelling, and what that means. Is there anything to it? How does it work? What happens between us when we share our personal stories, and why it’s important that we do.

This fascinates me because, for those of you who don’t know me, I’m a family physician. I practiced medicine for over thirty years…until I retired because my other passion in life is writing…and, you know, sometimes you have to make tough choices.

Plus…I had a story in me that I really wanted to tell.

Anybody else??

"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~

The point is that we ALL have a story to tell, but most of us never get around to sharing it. Instead, we make up excuses. We tell ourselves we don’t have time to write. We don’t know where to begin, or how to put it into words. We tell ourselves that what we have to say isn’t important. That no one else will care about it. Sometimes shame silences us. We blame ourselves for what happened to us. We have been conditioned to keep secrets. Perhaps it's just too painful, or sad, or maddening to revisit.

So…our stories go untold…and as such, I’m telling you…they wreak havoc on our bodies. The anger we bottle up, the sorrow that never fades, the shame we keep under lock and key all take a toll on us. They raise levels of stress hormones and inflammatory chemicals in our bodies that raise the heart rate, elevate BP, and raise blood sugar levels. This can lead to all kinds of problems in adulthood--hypertension, heart disease, diabetes, and autoimmune problems like lupus and RA. Not to mention anxiety and depression.

Think of it. If someone produced a pill that could lower your blood pressure, control your blood sugar levels, and elevate your mood, we would all buy stock in it, wouldn't we? So…why not invest some time and effort into storytelling? Unless we explore the anger, or despair, or confusion that is at the root of our pain, nothing anyone says or does will touch the cause of our suffering. All the medication in the world will not solve the problem.

"Your body's ability to heal

is greater than anyone

had permitted you to believe."

~multiple attributions~

There is, in fact, science to support the idea that telling our stories can help us heal. We know that storytelling can lower levels of inflammatory hormones in the body, because we can measure them. In studies where half the subjects were asked to write about a traumatic episode they had experienced and half wrote about a neutral topic like the weather or a favorite food…heart rate, BP, and sugar levels fell in the first group as compared to the neutral group. Their brain waves actually changed. Functional MRI scans of their brains demonstrated synchronization in electrical activity between the storyteller and listener. We don’t have time today to go into the science behind storytelling as a healing practice, but I’ll be around all weekend, so stop me if you’re interested.

The point is that telling our stories affects us in ways we can measure and observe. When you give your story a title, describe how it unfolded, and name the characters that populate it, you may begin to understand why it still disturbs your peace so many years later. If someone you trust is listening, you may come away with an entirely fresh perspective on it. You may finally 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 BP and sugar levels may come down. Anxiety and depression may improve.

"The healing that can grow out of

the simple act of telling our stories

is often quite remarkable."

~Susan Wittig Albert~

As a physician, I listened to patients’ stories all day long. The history, or story, of the present illness. The past medical history, or story. The patient’s family history, or story.

That, of course, was back in the days when I could scan my schedule for the day and envision every patient, I knew them that well. With a quick glance at the schedule, I knew who was getting ready to start chemo, who had just welcomed their first grandchild into the world, whose mother was recently transferred to the dementia unit. I knew because I had asked about it, the patient told me the story, and I made a note of it in the chart.

Nowadays, rather than dictating a note about the clinical encounter (a.k.a. narrating the patient’s story), you open an electronic medical record (EMR) that presents you with a confusing array of bulleted items, complicated charts, and abbreviated details. You can easily pick out a list of symptoms that were problematic at the patient’s last visit, when they started, how often they occurred, and how long they lasted. You know what tests you ordered and how you treated him, but you might not remember anything else about the patient because nothing else 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 get that part of the story. 

 "The most important part of the story

is the piece of it you don't know."

~Barbara Kingsolver~

If you’re a healthcare provider, it's easy to understand how missing details can make it hard to come up with the correct diagnosis. You miss the fact that your patient’s headaches started the day she discovered a pack of condoms in the back of her daughter’s dresser drawer. You have no way of knowing that the patient’s heartburn and indigestion have been a problem because of the pile of unpaid bills that are collecting on the kitchen counter. Or that your patient has insomnia because he is headed for a divorce.

Sharing our stories helps us heal. It is built into healthcare. It can’t be ignored.

The stories we share in the back of an ambulance, or in the examination room, or at the bedside are the same stories we share with our families and our best friends. They make us who we are. They help us process what happens to us. They embody our unspoken fears, our deepest sorrows, our greatest regrets…which is why we don’t tell them. It’s hard to put them into words.

It took me fifty years to get mine down on paper.

How long will it take you?

"Can you tell me about a moment

that was big for you...

a moment when

you saw things differently from then on...

Not a sensational moment--

you won ten-thousand dollars in the lottery,

you were lost in the woods alone with no food--

but a quiet moment when your whole awareness shifted?"

~Natalie Goldberg~

That's the one.

Tell us about that.

jan

tell me your story, show me your wounds

When we refer to the healing power of storytelling, we're not talking about some kind of magical cure. It won't restore the strength to your arm or leg after a stroke. It won't shorten the course of chemotherapy if you have cancer. It can't speed up wound closure or prevent infection. So how does it work?

Illness can leave us feeling fearful, angry, ashamed, or depressed...not a healthy emotion among them. Telling our story forces us to reflect on an experience we'd rather forget, or deny, or pretend never happened. Which is what makes it so difficult. We tell ourselves no one would be interested in hearing about it. We avoid talking about it because it still brings us to tears, or makes our hearts race, or embarrasses us. We don't want people to see us like that, so we order our memories, our feelings, our pain into lockdown. Then we wonder why we're getting headaches. Why we feel anxious all the time for no good reason. Why we can't relax without a couple of good stiff drinks at the end of the day. The aftermath of illness and trauma takes a toll on us in ways we don't always recognize.

The thing to remember is that writing is a safe haven for difficult problems.

"A day will come when

the story inside you will want

to breathe on its own.

That's when you'll start writing."

~Sarah Noffke~

 

If all you do is jot your thoughts down in a private journal, it will help. There, you can take your time searching for the right words to describe your experience and your feelings about it. There is no wrong way to begin. No one needs to see it. Even if you decide to take a torch to it later on, you will have learned something about your SELF. Where you're stuck and why. What helps and what doesn't. What you need to do in order to heal, and what you need to avoid.

"It's important that we share

our experiences with other people.

Your story will heal you and

your story will heal somebody else."

~Ilyana Vanzant~

The day will come when you're ready to share what you've learned. When you realize you need help and you're ready to reach out for it, you'll be able to share your story with the rest of us. Some of us have been through the same thing. We'll be there for you...to comfort and encourage you, to hold you up, to hear you out.

Some of us may not be as far along in the process as you are. We need to know how you survived. Where you turned for strength and comfort. How you ever managed to smile again. Tell us so we can heal, too.

"Tell me your story,

show me your wounds

and I'll how you what loves sees

when love looks at you.

Hand me the pieces,

broken and bruised,

and I'll show you what love sees

 when loves sees you."

~lyrics from The Story~

jan



how to beat the winter blues

A lot of people I know are experiencing the winter blues right now, given our recent cold spell and its accompanying snowfall, the threat of impending war, our country's political shenanigans, etc. Has winter got you down? Are you tired of dealing with drifting snow and sooty slush? Then you might want to try this:

• Peruse this spring's seed catalogs. They should be arriving in the mail any time now. If you start early, you'll have plenty of time to plan out the lush, perfectly groomed flower beds and foundation plantings that will have your neighbors wide-eyed with envy. This way, when it's 90 degrees outside, and you're weeding and edging and trimming away, you'll be reminded how lovely it was in the winter when all you had to do was spread a little Ice Melt every couple of days.

www.summercottage.co.uk

• Start your search for the perfect beach house to rent for your vacation. Think about all the money you'll save if you go in the off-season this year, say in March rather than July--during peak hurricane season, which is an altogether different kind of adventure.

www.thehouseplanshop.com

• Check out the fashions that will be all the rage this summer. If the thought of appearing in public in a swimsuit is more than you can bear, instead of a house on the beach this summer, consider renting a cabin in the woods where denim and hiking boots are always in style. 

www.debbiesellsredding.com

• Take a walk. If the thermometer inches up over 30 degrees, and you dress for it, you should be able to embrace the outdoors without risk of frostbite or hypothermia. Feel some compassion for the birds and squirrels and the deer who are stuck out in the cold day and night without recourse to a warm meal or a soft warm bed. And don't forget to enjoy the beauty.

www.iamcamjr.blogspot.com

If that doesn't appeal to you, you can always brew a cup of good strong coffee, add a splash of Baileys or three, wrap yourself in a nice warm blanket, and settle yourself next to the fireplace where you can read a good book... 

~www.depositphotos.com~

...or write one.

*

To paraphrase my favorite poet:

www.fineartamerica.com

"The woods are lovely, dark, and deep,

but I have promises to keep,

and pages to write before I sleep. 

And pages to write before I sleep."

jan

can you hear me now?

If you are interested in, or for that matter, even if you're a bit skeptical about the concept of narrative as an instrument of healing, you should run right out and pick up a copy of “What Patients Say, What Doctors Hear” by Danielle Ofri, M.D. If you harbor any cynicism about the relevance of narrative medicine as a healing practice, you should read this book. Then, lend it to a friend, or two, or three.

Among the topics she tackles are:

• Obstacles to effective communication including time constraints, over-booked schedules, and individual productivity quotients that have nothing to do with improving patient care.
• The importance of listening patiently when obtaining the patient’s medical history, and how our body language and facial expression can intimidate or discourage the patient from sharing important parts of his story.
• The role our own back story plays, and how it affects our expectations and interactions with patients.
• How the use of jargon reflects our attitudes towards patients, for example, referring to the disease rather than the person who has the disease (the diabetic, the epileptic, the asthmatic) or labelling the patient who fails to respond to treatment as a “difficult” or “noncompliant”.
• The influence of gender identity, race, culture, socioeconomics, and religion on communication.
• How to break bad news to the patient and his family.
• The correlation between poor communication skills and malpractice claims, and the pros and cons of disclosing medical errors.
• How effective communication influences the perception of pain, and how this affects healing. 

I often hear from people about the fragmented and impersonal relationship they have with their healthcare provider. They feel as though they aren’t being heard or understood. Issues that are important to them are dismissed or left untouched by physicians who appear hurried, distracted, or disinterested in their problem.

“Listen. People start to heal

the moment they feel heard.”

~Cheryl Richardson~ 

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 that doesn’t work for him. He has to navigate a baffling coding and reimbursement system, and he is tethered to his very own productivity quotient, a.k.a. how much income he is expected to generate.

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

On the other hand, physicians who are trained to practice narrative medicine learn skills that help them elicit and interpret the patient’s history, to seek missing details, and to understand the patient’s illness in the context of his life and his community. As a result, patients under their care feel as if someone is finally listening to them. That someone cares. When they feel heard, they do better. They cope better. They are more receptive to therapeutic intervention.

Do they heal because of it?

That, of course, depends upon how you define healing.

“You are so brave and quiet

I forget you are suffering.”

~Ernest Hemingway~

It might take a stretch of the imagination to say that a narrative approach to patient care speeds wound closure (although some studies have demonstrated this phenomenon), or that it prevents the spread of cancer. Antibiotics would be a better choice for pneumonia. You need surgery if you have appendicitis. Nevertheless, the empathetic resonance that develops between the physician and the patient when the patient is heard in a caring, receptive, and nonjudgmental manner can improve his prognosis.

No illness is free of emotional fallout. Fear. Anger. Shame. Heartache. None of which the patient may want to admit or be able to express. These feelings may, however, be the most amenable to the healing power of storytelling in the clinical setting. Only if the patient is encouraged to express his frustration, fear, and sense of loss can we know what kind of support he needs. Perhaps he just needs facts to help him understand and embrace his treatment plan. Maybe he needs constant reassurance and encouragement. A glimmer of hope. Maybe she needs assistance arranging for help at home. Some patients may welcome prayer at the bedside. All of which can help the patient heal.

For those of us involved in patient care, the operative word is “care”. This involves more than tending to the tasks required to treat our patients. It implies caring about them. Caring enough to explore the impact of their illness on their emotional and psychological well-being, and its impact on their family and friends. On their future. On their souls. All the hidden places pain lingers.

"The healing that can grow

out of the simple act of telling our stories

is often quite remarkable."

~Susan Wittig Albert~

Training in narrative medicine empowers the physician to elicit, interpret, and respond to the stories that patients tell us about their illnesses. In addition to exploring the occurrence and progression of their symptoms, it encourages the physician to consider 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 affect patient outcomes.

The overwhelmed health care provider may suggest that this is what we have nurses, social workers, 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, his sense of empathy. With loss of empathy, morale suffers, and when morale suffers, physicians tend to burn out.

Storytelling is one of the many art forms that enables people to explore and to process the full scope of illness and recovery. It is 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)”, as though an epic novel is about to unfold.

Storytelling is a useful tool for the patient himself as a means of exploring the cause, effect, and meaning of his own illness. He needs more than a diagnosis, a referral, or a prescription. For healing to proceed, he needs to know that his provider cares about what he has to say, understands him, and addresses all the ways he is suffering.

“The most precious gift

we can offer anyone

is our attention.”

~Thich Nhat Hanh~

jan