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