we all deserve a little "down" time

We all deserve a little "down" time now and then, don't you think? Time away from work. Time away from the news. Time to daydream. Even Mother Nature can't be at the top of her game every day of every week of every season. Which is why we're headed into October, and this week, the weather is beach worthy, hot and humid. At this rate, the pumpkins we put out will rot before Halloween. Perhaps Mother Nature just needs a little time to muster the energy it takes to move into Fall.

"I prefer winter and fall,

when you feel the bone structure

of the landscape.

Something waits beneath it.

The whole story doesn't show."

~Andrew Wyeth~

Although, to her credit, Mother Nature did share a moment of inspiration with us last week when she let loose with a few days of glorious cool, crisp autumn-like weather. Now it's back to the same old thing--the heat and humidity--just when things were looking up. It makes you wonder. Will Fall ever come to stay? Will winter ever get here? Does Mother Nature just need a little "down time"?

 

This comes to mind because that's how my writing has been going lately. I've been slogging back and forth through the last three chapters of my WIP for weeks, not making much progress. Except for a rare moment of inspiration, I have been stuck. I sometimes wonder if I'll ever move ahead. If I'll ever get to the end of it. 

 

Like Mother Nature, I think we all occasionally need a little "down time" in our writing, because, in Brenda Ueland's words:

 

"Inspiration comes very slowly and quietly...

The imagination needs moodling--long, inefficient,

happy idling, dawdling and puttering."

~Brenda Ueland~

 

Patience. Optimism. Nurturing. You can no more rush a thought into being than you can hurry the seasons along.

 

Eventually, autumn will get here. Sooner or later the story will finish itself.

 

Do you ever experience "down" time? Do you let it discourage or energize you? Are you open to what will follow?

"...it is the way you are to feel when you are writing--

happy, truthful, and free,

with that wonderful, contented absorption

of a child stringing beads.

With complete self-trust."

~Brenda Ueland~

jan



 

off topic, but worthy of reflection

"Alpabzug" or Alpine Descent in Switzerland

I met up with a friend at our favorite restaurant the other night. It's something of a joke between us because I can order her meal from memory. Steak. And she can predict what I will have. Seafood. It's as predictable as the tide. It never changes. There's a story behind it, though.

Perhaps you have already noticed this. There are certain books that leave a lasting impression on you. Others, you can't even remember having read. I picked up a copy of "The Mind Illuminated" by John Yates, PhD this week. It has been collecting dust on my bookshelf for a while now. It's a guide to meditation based on Buddhist wisdom and modern neuroscience. It sounded interesting. Imagine my surprise when I opened it up and discovered I had already read it, complete with underlining, notations, and dog ears. Obviously, though, I'd forgotten about it.

On the other hand, I read "The Jungle" by Upton Sinclair when I was in high school. The book is an expose of the greed, cruelty, and indifference Sinclair uncovered in the meat packing industry. It changed me, but I didn't respond to the horrors and cruelty he exposed right away. After all, I was still expected to eat what my mother put in front of me...meat and potatoes. Still, the images of cruel and abusive breeding and butchering of animals stuck with me until I made the transition to vegetarianism, actually pescatarianism (veggies and occasionally seafood) in my later years. Almost fifty years later.

"All animals just want to be loved."

~Anthony Douglas Williams~

I won't bore you with arguments for or against vegetarianism except to suggest you give it some thought. Or read "The Jungle" yourself, or read something by Jane Goodall, or check in with Joar Berge online at https://moustache-farmer.de/en 

'Nuff said. Pictures speak louder than words:

~Joar Berge
 @moustache_farmer~

~@thegentlebarn~

~Arik Vasquez~

~estherthewonderpig.com~

~Tatyana_tomsickova~

Consider this:

"The greatness of a nation

and its moral progress can be judged

by the way its animals are treated."

~Mahatma Gandhi~

...and not just its pets, I would add. Also, according to Darwin:

"The love for all living creatures is

the most noble attribute of man."

~Charles Darwin~

No offense intended, but if you love animals, you could consider not eating them. If you can't resist a good steak or chop once in a while, you should offer deepest reverence and gratitude to the being that offered it up for you. Or, in deference to hunters:

"Don't eat anything

you aren't willing to kill yourself."

~Lorene Lavora~

jan

 

questions we should be asking ourselves

 

If you have dedicated your life to work in the field of health care, chances are it was more than the prospect of a secure income that motivated you to spend so many additional years studying and preparing when your friends were already out in the world. Earning money. Cultivating a social life. Even starting a family. Perhaps you come from a long line of nurses or doctors and felt the pressure of expectation to continue the tradition. Maybe you were attracted by the prospect of authority and prestige. Perhaps you pursued medicine or nursing out of a heartfelt desire to do good in the world. To help people heal. Or because you felt called to this line of work.

"The two most important days in your life

are the day you are born

and the day you find out why."

~Mark Twain~

If medicine is your calling in life and you know it, good for you! But if your purpose in life is not yet clear to you, if you're not sure what you were put on Earth to do, or who to be, or why it makes any difference, you might want to start thinking about it. Otherwise, you may find yourself wandering through life without a clear path forward. Chasing after someone else's expectations for you. Investing time and effort in something that offends your sense of right and wrong. Surrendering to something that is meaningless to you or harmful to others. 

If you have been contemplating your calling in life but still feel lost, or you've been avoiding the issue because you don't know where to start, I highly recommend Stephen Cope's book, "The Dharma in Difficult Times".

In it, he illustrates the teachings of the great Hindu text, the Bhagavad Gita, through the lives of dedicated visionaries including Gandhi, Thoreau, Sojourner Truth, and Marion Anderson, among others, all of them committed to non-violent resistance/activism. How did they discern their sacred calling? What were they willing to sacrifice to achieve their goal? How did they apply the principles of non-violence to their efforts? What was the outcome?

These are questions we should all be asking ourselves at this time of political divisiveness and retribution.

Why is it important? Because we all have a sacred calling, a duty to ourselves, to others, and to the planet, whether we care to embrace it or not. Sooner or later each of us will be confronted with a dilemma that will require us to discern right from wrong, truth from untruth, whether to follow the crowd or to stand up for what we believe and value. Each of us needs to decide if this is a challenge we are willing to accept. A goal worth pursuing. A battle worth fighting. 

"Tell me,

what is it you plan to do

with your one wild and precious life."

~Mary Oliver~

I believed medicine was my sacred calling in life. I ignored the naysayers who insisted women weren't meant for it. That I would regret my decision. That I would fail at it. Instead, I made the sacrifices that were necessary to do the work I chose. Diligently and without fanfare. For over thirty years.

What about you? Where are you on your journey? To what cause do you feel a sacred duty? Cope states: 

"Sacred duty is the thing that

 if you do not do it,

you will feel a profound sense of self-betrayal."

~Stephen Cope~

 

Is it health care? Climate change? Racism? World hunger? Cruelty to animals?

All of the above?

How will you make a difference?

"Be the change you wish to see

in the world."

~Mahatma Gandhi~

jan

your untold story

 

Those of us who support the narrative medicine/narrative healing movement would like you to believe that the simple (or not so simple) act of telling your story and knowing it has been heard can bring about healing. How does that happen?

"I will soothe you and heal you.

I will bring you roses.

I, too, have been covered with thorns."

~Rumi~

Perhaps something like this has happened to you:

You wake up and it's a beautiful day. The sun is shining. Your bills are paid. The laundry is done. You pick up a good book and head out to the porch to read. But you can't concentrate. You sense a heaviness in your chest, and you can't stop sighing. You're tired, even though you haven't done much all day. You feel a certain sadness, but you don't have anything to be sad about. Your neighbor sees you and comes over to say hello. She immediately senses something is wrong. You shrug her off, and then it hits you. This is where you were sitting when you heard the screeching tires that you knew meant trouble. This is the same kind of beautiful September day you lost your dog on the street in front of your house. Seventeen years ago. 

"If you never heal from what hurt you,

you'll bleed on people who did not cut you."

~Karen Salmonsohn~

Or you go out for the mail and in it is an invitation to your friend's baby shower. You burst into tears. Because you never got to have a baby shower. You lost the baby before anyone knew you were pregnant, so you never told anyone. Or maybe you were never able to get pregnant in the first place. And your arms feel so empty.

Or maybe your story plays out like this. You didn't mean to put a dent in the fender the first time you took the car out alone when you were sixteen. Your father told you to be careful when he handed you the keys, and you promised you would. Then, a ball rolled out into the street and to avoid it, you swerved and grazed a tree in somebody's yard. You knew you'd be in trouble when you got home, but you didn't expect a beating for it. I mean, you were being careful, and it wasn't your fault. But your dad had been drinking that day, and when he saw what had happened, he hauled off and bloodied your nose and gave you a swollen black eye. In school the next day, you told the teacher you'd slipped and fallen down the basement stairs. And that was the end of it, but not really. Now your heart races and your head throbs and you break out in a sweat every time your own son takes the car out. And you don't know why.

"The scars you can't see

are the hardest to heal."

~Unknown~

If you sometimes react to situations in ways that don't make sense, or you can't explain why you feel sad, or tired, or anxious, or people often ask you what's wrong, your untold story may be hiding in the shadows, playing tricks on you. Because until you call it by name you may not know it's lurking there.

When you give your story a title, and describe how it unfolded, you may begin to understand why it still disturbs your peace after all these years. If someone you trust is listening, you may come away with an entirely fresh perspective on it. You may 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 energy may improve, your headaches may lessen, your heart may open. 

If your story has been under lock and key for years, or you've forgotten where you left it, or you can't imagine finding the words to express it, you should consider getting back to work on it. Somebody else may need to hear it.

"Just because no one can heal you 

or do your inner work for you

doesn't mean you can, or should, or need to

do it alone."

~Lisa Olivera~

jan

l

  

 

Janet Cincotta, MD

2254 Old Hollow Road

Mechanicsburg, PA 17055

drmomjfc@gmail.com

(717) 574-7357

 

Governor Gavin Newsom

1021 O Street, Suite 9000

Sacramento, CA 95814

 

Dear Governor Newsom,

 

I am writing to express my relief and gratitude for the leadership you have shown on behalf of your fellow Californians as well as Democrats across the country for the past several weeks. The current political climate is driven by greed, injustice, deceit, and fear. You have demonstrated great courage, integrity, and clarity in your efforts to counteract this blight on our democracy. I hope you have your sights set on a presidential campaign in 2028.

 

To be brief, however, I would like to suggest that you consider tempering the humor you have employed to mock and even mimic our current president’s rhetoric and buffoonery. While your satire and mockery are clever and engaging (please don’t stop), the issues at stake are grave. As such, I believe they deserve to be presented with utmost dignity and sincerity. You do not have to stoop to the inferior standards of conduct employed by your Republican colleagues to make this point. A little parody goes a long way. This is serious stuff.

 

As an aside, speaking as a physician, if you have not already done so, I would suggest you have your vocal cords checked. You sound a bit hoarse which could be caused by a polyp, which is an easy fix. I’m concerned because America needs to hear what you have to say in a clear, loud voice.

 

Thank you for your attention. Again, you have my deepest respect and hopeful anticipation for our country’s future as a democracy.

 

Yours truly,

 

 

Janet Cincotta, MD

 

how does life go on

This past week was a tough one for me. Not for me personally, but for people I know and love, for people I don't know but whose stories I've heard, and for millions of others around the world who, we all know, suffer every day.

It reminds me that my week passed quite peacefully. The sun came out, but it stayed relatively cool thanks to an arctic front that pushed through, a perfect week to get yardwork done and to get some walking in. I went to the grocery store and picked up whatever I wanted to fill my cupboards. I slept in a safe, soft bed. I got a little writing in. It was a quiet and pleasant week for me, but unfortunately, much of the rest of humanity didn't fare so well, and that disturbed me.

It started with images of skeletal children dying of starvation in Gaza, their mothers watching in horror. It continued with pictures of people shuffling through the debris in war-torn Ukraine. It reminded me of people fleeing their homes ahead of the wildfires out West and in Canada, and of those who were reinforcing sand dunes along the East coast head of a monster hurricane. I heard about an otherwise healthy teenager who presented to the Emergency Room with shortness of breath and fever suggestive of pneumonia whose chest x-ray and subsequent CT scan revealed a 15 cm. (that's almost seven inches across) mediastinal mass with lymph node involvement...and I learned about a father who found his daughter hanging close to death in her bedroom when he got home from work. 

How will life go on for them? This is their reality, now. How will the rest of us process it?

"Be kind,

for everyone you meet is fighting

a battle you know nothing about."

~Wendy Mass~

Part of the problem is the sheer magnitude of suffering in the world. Part of it is the utter sense of futility that greets us in our efforts to reach out to others. We do what we can, but it amounts to little more than a dewdrop in the ocean. With a couple of clicks on my keyboard, I donate regularly to a couple of organizations that provide food and assistance to victims of war, poverty, injustice, and natural disasters although I have no clear idea what happens to my donations. I don't know if they help anyone at all. You may do the same, or you may volunteer to pitch in when disaster strikes, or you may simply rely on the power of prayer to relieve the world's suffering, but pain and sorrow still hang heavy around us...

...as does guilt. The gratitude we feel for all we have...food, shelter, good health, and community...can amplify the heartache we harbor for those who are not so lucky. We feel guilty even though we have done nothing to deserve it. We feel guilty because we are so helpless.

"Guilt is not a weakness.

It's a reminder of our capacity to care."

~DESIQuotes.com~

Do you share my sense of futility? Of frustration? Of discouragement?

Where do you turn for solace? For Peace? For joy? How do you sustain a sound spirit of equanimity? Is it even possible?

"EQUANIMITY:

(n.) mental calmness, composure, and

evenness of temper, especially 

in a difficult situation."

~various attributions~

If this week is difficult for you, try this: Take a deep breath in and let it out slowly. Feel the pulse beating in your own wrist. Ask yourself how the universe we know to be cold, dark, and dangerous drapes itself around us in baby blue. 

Wendell Berry may have said it best:

"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~  

jan

the consequence of fear and ignorance

 

I was going to try to avoid writing about anything political this week, but I couldn't help myself. This blog is about the role storytelling plays in the practice of medicine, including the stories that describe our patients' experiences and the stories we recount as health care providers. I'm afraid the narrative is about to change, though, as we witness efforts to discontinue public health programs and dismantle medical research initiatives. Meaning that people...children...will die.

"The two public health interventions

that have had the greatest impact

on the world's health are 

clean water and vaccines."

~World Health Organization~

I've been around long enough to have celebrated the triumph of vaccination against polio, make that "paralytic polio", a disease you do not want to see, treat, or God forbid, suffer. We are already witnessing an uptick in cases globally, not because the vaccine is unavailable (yet...), but because RFK is spearheading efforts to withdraw funding from Gavi (the Vaccine Alliance, or Global Alliance for Vaccines and Immunization) whose purpose it is to fund immunization programs in underserved populations around the world. Trouble is brewing.

Closer to home, disinformation has bred skepticism and fear. Parents are hesitant to provide their children with even routine vaccines that have been proven safe and effective for many years. We have already seen an upsurge of measles cases among the unvaccinated that have claimed the lives of three otherwise healthy children.

Count yourself fortunate if you have never watched a young polio victim struggle to use crutches, much less fight to breathe in an iron lung. We thought those days were behind us. Now, we can't be sure.

The stories we have enjoyed for years may be changing. We may be going backwards.

"Universal vaccination may well be

the greatest success story

 in medical history."

~Michael Specter~

I can tell you the story of an otherwise healthy child who came home from school one day with a headache and a slight fever...and died the next day of meningococcal meningitis. That fast. Back in the days before we had a vaccine that would have prevented it.

I can tell you what it was like to treat a child with measles encephalitis and watch them die of a totally preventable disease or suffer its consequences for the rest of their lives.

I can tell you how hard it is to intubate an infant who is struggling to breathe with whooping cough or a toddler with epiglottitis, diseases we never see in vaccinated children anymore. 

Without a doubt, the stories we tell and those our patients tell will change given the present leadership of the Department of HHS. From triumph to heartbreak. From hope to despair. From success to defeat.

Trust me: you do not want your child, or grandchild...or ANY CHILD...to suffer or die from a preventable disease. You don't want ANYONE to die of a preventable disease because of skepticism, fear, or ignorance. If you agree with me, please make your thoughts known at:

Contact Us | HHS.gov

The US Department of Health and Human Services

Hubert H. Humphrey Building

200 Independence Ave., SW

Washington, DC 20201

1-877-696-6775

"To fear what you do not understand

is to mistake ignorance for safety."

~Ginn Hale~

jan

survival 101

This may not sound like a political rant, but it is. It's about surviving the news that greets us every day...coming from a man who is totally out of touch with reality, but nevertheless, has been entrusted with our nuclear codes. Scary thought. 

This is about loss of environmental protections, the eradication of public health initiatives and medical research (just when we are on the path to treatment of cancer with mRNA vaccines...), and the elimination of programs to protect the safety and purity of the water and food we have always taken for granted. It opposes gun violence. It is a call to alarm as the economy crashes, the military marches into our own cities, and human rights are dismissed with a shrug of someone's shoulders. It is a reminder that cruelty, arrogance, and greed are alive and well on Planet Earth.

"Deliberate cruelty is not forgivable.

It is the one unforgivable thing,

in my opinion."

~Tennessee Williams~

How are you coping with it? Are you worried? Scared? Disgusted? Angry? Depressed?

You could be experiencing all of those feelings...but still, you don't have to be consumed by negativity. I would recommend you try what I like to call "fierce mindfulness." It has been especially helpful to me this past week. If you already practice mindfulness meditation, you are ahead of the game. If not, this is a good time to start. You'll wish you had as the situation worsens...

For me, fierce mindfulness is an act of countercultural resistance, a refusal to succumb to the threats to our safety, well-being, and peace that are imposed on us by people who claim to be in power. Billionaires. Politicians. Liars and cheaters. You know who I mean.

I focused on mindfulness many times this past week. When the president announced his plans for a new White House ballroom. When RFK dismantled research into mRNA vaccines. When the military was deployed to the streets of Washington, DC. I could go on...

Here's how I did it. While other people fretted, or ranted, or chose to ignore the news and carry on as if nothing were wrong, I simply turned my attention to my very own senses, right where I was, in the moment. I focused on what I was seeing in the moment. What I was hearing. How the air around me felt. Which added up to something like this, most days: The sky was clear blue and cloudless. The air, warm. The breeze, gentle. I asked myself, "What more could I want? What could be better than this?" The chaos, the cruelty and injustice, the suffering of the entire world did not cause a ripple in my reality at the moment. In most of my mindful moments, in fact.

"You are the sky.

Everything else is just the weather."

~Pema Chodron~

When we surrender to worry, dread, anger, and fear we give them power over us. We bow to the enemy...but we don't have to. We can turn our attention inward. We can focus on all the ways the universe supports us. With intention, we can always find something to feel grateful for. Something that embraces beauty and peace. Something that heals us. Just a few minutes of respite from the craziness reminds us that there is hope.

"Resistance is feasible even for those 

who are not heroes by nature,

and it is an obligation, I believe,

for those who fear the consequences

and detest the reality of the attempt

to impose American hegemony."

~Noam Chomsky~

jan

how you can provide a safe harbor

 

A while back (see "take this test", November 23, 2021) I wrote about the Adverse Childhood Experience survey, something we were never taught about in medical school despite the fact that a growing body of evidence supports the link between childhood trauma and the development of physical disease and mental health disorders later in life. Childhood trauma includes physical, emotional, and sexual abuse, physical, verbal, and emotional neglect, living with a depressed, mentally ill, or addicted parent, witnessing domestic abuse, and losing a parent to separation or divorce...among others. Chronic adversities like these actually change the architecture of the child's brain, altering the expression of genes that control stress hormone output. This triggers an overactive inflammatory response that can lead to adult disease states, notably autoimmune conditions like lupus and rheumatoid arthritis, heart disease, and PTSD-like anxiety and reactivity. These long-term effects should compel all of us to take the problem of childhood trauma seriously. We should do all we can to identify it, prevent it, and mitigate it.

"You can spend a lifetime

trying to forget a few minutes

of your childhood."

~www.HealthyPlace.com~

This week, I came across another interesting issue that I was never taught about. It has to do with attachment disorders that arise in infancy and early childhood and how they affect health in adults, notably the same kind of autoimmune, cardiovascular, and psychological problems that childhood trauma does. Issues related to childhood attachment will be reflected in adult personality traits, behavior patterns, and relationship difficulties. Repression of anger is especially harmful. 

It turns out that there is a method for uncovering some of these issues in our patients. It is called the Adult Attachment Interview, or AAI, a twenty-question survey that is designed to explore how infants become attached to their parents...or not.

This is it:

Adult Attachment Interview (AAI) (George, Kaplan, and Main 1996) 

The AAI Questions:

1. To begin with, could you just help me to get a little bit oriented to your family—for example, who was in your immediate family, and where you lived?

2. Now I’d like you to try to describe your relationship with your parents as a young child, starting as far back as you can remember.

3–4. Could you give me five adjectives or phrases to describe your relationship with your mother/father during childhood? I’ll write them down, and when we have all five, I’ll ask you to tell me what memories or experiences led you to choose each one.

5. To which parent did you feel closer, and why?

6. When you were upset as a child, what did you do, and what would happen? Could you give me some specific incidents when you were upset emotionally? Physically hurt? Ill?

7. Could you describe your first separation from your parents?

8. Did you ever feel rejected as a child? What did you do, and do you think your parents realized they were rejecting you?

9. Were your parents ever threatening toward you—for discipline, or jokingly?

10. How do you think your overall early experiences have affected your adult personality? Are there any aspects you consider a setback to your development?

11. Why do you think your parents behaved as they did during your childhood?

12. Were there other adults who were close to you—like parents—as a child?

13. Did you experience the loss of a parent or other close loved one as a child, or in adulthood?

14. Other than any difficult experiences you've already described, have you had any other experiences which you should regard as potentially traumatic?

15. Were there many changes in your relationship with your parents between childhood and adulthood?

16. What is your relationship with your parents like for you currently?

17. How do you respond now, in terms of feelings, when you separate from your child / children?

18. If you had three wishes for your child twenty years from now, what would they be? I'm thinking partly of the kind of future you would like to see for your child I'll give you a minute or two to think about this one.

19. Is there any particular thing which you feel you learned, above all, from the kind of childhood you had?

20. What would you hope your child (or, your imagined child) might have learned from his/her experiences of being parented by you?

It requires some training to use this interview effectively; the questions require more than a yes or no response. It requires the provider to assess not only what the patient says, but how they express themselves, for example whether they respond fluently or haltingly, in detail or with a paucity of words, consistently or with frequent self-contradiction. 

The interesting thing about it is this: when the interview is conducted even before a person has a child, it can predict the attachment style they will develop as a parent: secure, avoidant, ambivalent, or disorganized. This, in turn, can raise concern for future problems with health and well-being as an adult, possibly paving the way for early intervention.

The point is that, as health care providers, we rarely have the time or expertise to explore these issues with our adult patients, much deal with them in treatment. How, then, can we help them heal?

"Give me your past,

all your pain,

all your anger,

all your guilt.

Release it to me and

I will be a safe harbor for the life

you need to leave behind."

~Jewel E Ann~

jan

if not now, when?

When I retired in order to begin all over again as a wannabe writer, I didn't know what I was getting myself into. I didn't know if I had any talent for this kind of thing, any hope of success, or the necessary dedication to it. Nevertheless, I put my misgivings aside, summoned whatever courage I could muster, and cleared my desk so I was ready to try.

Since then, I've learned there are certain signs that writing is a person's true passion in life. Is it yours?

"I'm one of those people

who believes you should start writing 

before you're ready."

~Joseph J. Ellis

In my experience, these are the top ten signs that you, too, may be ready to begin:

• At any one time, you carry at least five pens with you (six to ten is even better). Go ahead. Check your purse or briefcase now.

• You have enough pens with you but sometimes you forget to carry paper. Therefore, sizable chunks of your manuscript are recorded on napkins, on the back of receipts, on used envelopes, and when that fails...on the back of your hand.

• You have perfected the ability to record plot points, dialogue, and gorgeous prose whenever and wherever your muse is kind enough to share it with you...and you can get it down without taking your eyes off the road.

• Sudoku makes you cringe.

"A writer's life and work 

are not a gift to mankind.

They are its necessity."

~Toni Morrison~

• You are reluctant but willing to concede that your laptop/word processor is a convenience, but you will defend the merits of pen and paper to the end. Remember the likes of Shakespeare, Dostoyevsky, Matthew, Mark, Luke, and John?

• When you're writing, you sometimes make yourself cry.

• Sometimes you make yourself laugh.

• When you read what you've written later on, it happens again.

• You have made peace with the word "delete".

"You may not write well every day,

But you can always edit a bad page.

You can't edit a blank page."

~Jodi Picoult~

• "I wasted the whole day," is not part of your vocabulary.

• You make excuses (Oh, all right--you sometimes lie) so that you can stay home alone.

Oops. That makes eleven sure signs.

The point is that unless you begin, you will never know what you can accomplish. You will never put your passion to the test, exercise your creativity, or realize your dream.  You will miss your chance to share what you have learned. You will never know if you have what it takes, and you will always wonder about it.

When do you plan to begin?

"If not now, when?"

~Eckhart Tolle~

jan

when the body says no

 

So...it happened again. A friend just received news of his advanced stage cancer diagnosis after months of waiting for diagnostic scans to be scheduled, then waiting for the biopsy, then waiting for the results...and now waiting to schedule a PET scan to determine what treatment might still help...sending us all to our computers to research what might lie ahead for them. It makes you wonder if all the delays will affect his prognosis and outcome, but let's not go there.

"Bad news does not get better

with time."

~Mark Villareal~

Instead, let's consider a few other factors that might affect the course of his treatment.

The book I coincidentally happen to be reading is "When the Body Says No" by Gabor Mate, MD. 

In it he discusses autoimmune diseases as well as immunity against common cancers and their relationship to stress:

• Why some people appear to be more susceptible to autoimmune diseases and some cancers, while others are spared. 
• The role stress plays in the unmasking of autoimmune problems, and how coping strategies affect the course of the disease (denial, repression, anger, depression).
• How negative and positive thinking affect healing.
• Strategies that can mobilize natural immunity and promote healing.

While genetics, environment, nutrition, and lifestyle are important, stress and how we cope with it also play a role. The field of psychoneuroimmunoendocrinology takes everything into consideration, measuring hormone levels, observing changes in cellular biology, exploring personality traits, and scanning the brain in response to stress to create profiles that correlate with patient outcomes. More or less.

The problem for my friend is that he has no background in medicine and can't really understand what is happening. Denial is in play, or perhaps it's the inability to process and express the emotions that flood patients in this situation. They can feel helpless. Confused. Doomed. 

"Even miracles take a little time."

~The Fairy Godmother in Cinderella~

While his family and friends rally around him to provide support, encouragement, and comfort, the medical community mobilizes its superpowers: surgery, radiation, chemotherapy, and now, immunotherapy. It's all pretty scary.

This is the thing. Patients need to understand what is happening to them, especially when the future is uncertain. Someone needs to ask what they are thinking. What they understand. What they believe. They may need to hear that this is not their fault. That options are available. That there is hope, or that hope is running out. It involves explaining what is happening every step of the way, and the reasoning that goes into medical decision making. It means sharing our expectations for the patient. Even our fears. It means responding to theirs. If they don't process and express the feelings that flood them, they are left to flounder in a sea of confusion, fear, and despair...not a healing space around them.

"Three factors that universally lead to stress:

--uncertainty

--lack of information

--loss of control."

~Gabor Mate, MD~

This is a process that involves not just our patients, but the people who gather at their bedside because they care about them. Because they love them. When we treat patients, we treat their family and friends, as well. They need to understand what is happening and what to expect. They deserve our attention. They need our consideration, compassion, and support, too.  

The overwhelmed physician may suggest this is what we have nurses, social workers, psychologists, pastors, and family and friends for. In today's health care culture, you can get away with this. You can focus on the bulleted lists in the electronic medical record and leave the rest of it to your staff. You can apply what you know about medical and pharmaceutical technology without really knowing your patient. He will still heal. But by disengaging yourself from your patient's psychological, emotional, and spiritual life, and from his family and friends, you sacrifice your connection with him. Unless you include them in his care, you disconnect him from his support system. From his caretakers. This can leave all of them with fear, uncertainty, confusion, and dread when what they need is engagement, support, and understanding.

How do you support your patients and their families when the prognosis is poor, and the way forward is difficult? Do you know...or care...about their fear, anger, or denial and how it affects their ability to heal? What could you be doing differently?

Remember:

"Everyone you meet is fighting

a battle you know nothing about.

Be kind. Always."

~Ian MacClaren~

jan

no mud, no lotus

 

If you are a healthcare provider in any field, or the caretaker for someone you love, you are well aware of the duality that permeates every aspect of reality...the coexistence and contradiction between joy and sorrow, between kindness and cruelty, between life and death. We feel this deeply every day in some way, but never more acutely than when the people around us are suffering.

If you are writing about your experience, you may feel the push and pull of duality in your narrative.

First there's the story you have pictured in your mind...and then, there's the process of translating it into words on a page. It can take you from soaring with enthusiasm to slogging through the muck. You may find yourself stuck.

"No mud, no lotus."

~Thich Nhat Hanh~

Inspiration wanes, fatigue sets in, and the story line languishes. Self-doubt creeps in. And even though the end is in sight, like a desert mirage, it fades away the closer you get to it.

"What makes the desert beautiful

is that somewhere it hides a well."

~Antoine De Saint-Exupery~



This is a lonely place for writers. Your manuscript isn't polished yet so no one else has seen it or commented on it. Therefore, you don't get to enjoy the inspiration that comes with an exchange of ideas, weighing in on suggestions from writing partners. You need a fresh infusion of incentive, like the energy that emerges when composing a query letter or submitting to an editor or agent. But you're not there yet. This is just hard, lonely work, day after day.



How do you cope with it? 

Sometimes I'll take a little time out to dash off a piece of flash fiction, a short essay, or, like today, a blog post. It's like indulging in a little snack when you can't wait for supper.

 

Sometimes I have to tear myself away from the keyboard and polish off a few necessary chores before I can concentrate again. For example, when there's no food in the house, or I run out of clean underwear. I mean, priorities do change. Writing sometimes has to wait while life marches on. Storytelling may have to take a back seat for a while.

What can you do in the meantime?



When I'm stuck for an idea or unsure how to put one into words, I'll pick a random passage to edit and revise, backtracking a bit until I'm sure I'm on the right path again.

"Real writing begins with rewriting."

~James A. Michener~



It also helps to read something by another author on a similar topic. A couple of my go-to favorites are:

"Memoir as Medicine" by Nancy Slonim Aronie

and

"Still Writing" by Dani Shapiro

Just the process of reading beautiful writing invites the mind to get in on the action. 

Do you ever get bogged down in the middle of a project? What do you do to recharge? To move ahead? How do you get it all done?

"Many of life's failures

 are people who did not realize

how close they were to success

when they gave up."

~Thomas A Edison~

jan

the willing suspension of disbelief

...in case the heat is starting to get you down...

The stack of books-to-be-read on my nightstand, coffee table, and desk is getting out of control! 

It's not that I don't like to read. I do. It's not that I don't have time to read. I do. The problem is that one interesting thing leads to another. For example, in "Brave New Medicine", Cynthia Li, MD talks about autoimmune diseases and the role of functional medicine (traditionally known as "alternative" medicine including such practices as acupuncture, Qigong, meditation, Reiki, and other forms of energy medicine) in treatment. This leads her to a discussion of the roles of neuroplasticity, quantum theory, and epigenetics in healing and how our health is affected by our thoughts, beliefs, and intentions. It's no wonder I get distracted.

Li, a board-certified internist, traces her own journey, beginning with a bout of postpartum thyroiditis that never really goes away. She describes the devastating effect it has on her professional and personal life, and the frustration and defeat she felt when traditional allopathic medicine failed for her. She encourages the reader to explore alternative, or functional methods, when all else fails.

"When you have exhausted all possibilities

remember this:

you haven't.

~Thomas Edison~

The point is that autoimmune problems run in my family, so I know they can be notoriously difficult to diagnose, and frustrating to treat. In fact, one of us underwent surgery just last week for an autoimmune condition that has insidiously progressed over the years despite ongoing medical supervision and treatment. And I was just switched to a drug that runs over $7,000 per month which puts it totally out of reach for most of us except that Medicare, supplemental insurance, and a generous patient assistance program through the company that produces it, cover most of the cost...if you "qualify".

Autoimmune disease exacts a harsh physical, emotional, and financial toll on patients and their families. The symptoms vary. The diagnosis can be elusive. The treatment can be expensive, cumbersome, and often ineffective. Not to mention that we know so little about its causes and prevention. 

When a patient encounters a difficult diagnosis, fails to respond to traditional treatments, and gets worse despite our best efforts to help them, it may be worth looking outside the proverbial box and consider something completely different. Li invites us to "suspend disbelief" and keep an open mind to alternative practices that have a long history of success in other cultures and systems, which is how she finally healed.

"Your body's ability to heal

is greater than anyone has permitted

you to believe."

~Bruce Lipton, PhD~

jan