who are the real superheroes?

This is not a picture of me, but it could be. The ward I was in looked exactly like this.
The bed is the same, and it is in exactly the same spot as mine was. This could be the little boy who was in the bed next to me. 
It is uncanny. 
I wept when I first came across this picture.

Truth:

An ugly scar. A permanent limp. A weak heart. The aftermath of childhood illness can last a lifetime. You think you’re over it when the sight of a little blood or the thought of getting a shot catapults you back in time to a place you’d rather forget. One moment you’re a fully functioning adult. The next, you’re a sobbing three-year-old.  Like a stain you can’t get out, like fog that never lifts, it stays with you.

Trivial details rise up out of nowhere with perfect clarity. An aide unloading the lunch cart. The “No Smoking” sign by the door. The pile of Little Golden Books stacked on your nightstand. 

Moments you’d rather not remember surface uninvited. Your mother in tears at your bedside. The mingling smell of antiseptic and stale urine. The jab of a needle and the dull ache that lasted until the next shot was due. You still feel it.

Even if you recovered completely, memories of the ordeal can shadow you all your life. Perhaps as an adult you still use a night light to dispel the fear you felt when visiting hours ended and the nurses turned down the lights in the children’s ward. Maybe you struggle with asthma because of the way the nurses held you down to draw your blood. Smothering you. Maybe your gut still cramps up the way it did when the doctors lined up around your bed and insisted on pushing on your belly right where it hurt worst. Every last one of them.

Or, maybe you still have trouble swallowing pills because you were too young to get them down when you were sick. Instead your mother crushed them and slipped the powder into applesauce or pudding in a failed attempt to mask its bitter taste. Maybe your favorite threadbare teddy is still packed away in a chest in the attic. All visceral reminders of the ordeal you endured as a child.

Traumatic memories can release an outpouring of emotions that can stop you in your tracks. Something as simple as getting your flu shot, or having your blood pressure taken, or hearing an ambulance in the distance with its siren wailing can set the whole thing off again. Palms sweating. Heart racing. Hands shaking.

I was three years old when I went into the hospital. How is it I remember the exact arrangement of the beds in the children’s ward? The pattern of the afternoon sunlight reflected across the wall? The name of the girl in traction across the room from me? Alice. Ten-years old.

How does it all come back to me in technicolor detail when some days I can’t remember what I ate for breakfast?

*

"Sometimes real superheroes live in the hearts

of small children fighting big battles."

~unknown~

jan

the cure for new year's resolutions

I'm not a fan of making New Year's Resolutions. It's a time-consuming process that smacks of self-discipline, grim determination, and Herculean effort...and it often ends in failure. I prefer to think of it as wishful thinking. This has a more optimistic ring to it. It suggests we believe...or hope...that the new year holds limitless possibility for us...the possibility that good will come to us, that our burdens will be lifted, that help is available. It enables us to envision a world at peace, to imagine an end to poverty and hunger, to hope for an elusive cure, to pray for an end to suffering. 

"Now is the accepted time 

to make your annual good resolutions.

Next week you can begin paving Hell with them."

~Mark Twain~

Last year, I resolved to embrace practices that are said to raise cellular telomerase levels. Telomerase is the enzyme whose function is to lengthen telomeres. Long story short, telomeres are stretches of DNA that prevent the double helix from unraveling so the entire length of the helix can be duplicated prior to cell division. This increases the vitality and reproducibility of stem cells, enhances health, and extends life. Meaning, you want your telomerase levels to be as high as possible if you hope to live a good long life!

"Bad news: A lot can change in a year.

Good news: A lot can change in a year."

~Rohit Hooda~

The bad news is that telomerase activity can be inhibited by common environmental stressors such as exposure to adverse prenatal conditions, childhood abuse/neglect, domestic violence, PTSD, nutritional deficiencies, and isolation or lack of love. 

The good news is that certain practices can raise telomerase levels. Good nutrition, exercise, meditation, yoga, a positive outlook on life, dwelling in happiness and gratitude, serving others, and love, especially self-love, all enhance telomerase activity. Telomerase lengthens telomeres, and long telomeres promote a long and healthy life, so that's what I worked on all year long.

The problem is there's no way for me to know if I succeeded. Unless you're a cell biologist, you can't simply measure your telomerase levels to see if they're improving. I have, however, been told that I seem to be happier and more peaceful, so something must be working.

This year, in keeping with my pro-telomerase practice of mindfulness meditation, I have decided not to look back at the year that has passed, with its shortcomings, goof-ups, and defeats...that lead me, inevitably, to feelings of inadequacy, shame, and sadness.  

"Don't look back.

You're not going that way."

~Mary Englebreit~

Likewise, I am not looking ahead. I won't be inviting frustration and failure with broken promises, misguided intentions, or impossible goals...meaning, I won't be making New Year's Resolutions this year.

Instead, in keeping with my mindfulness practice, this year I plan to focus on the present. What it feels like to be in the moment. Literally. If you're interested, the meditation goes something like this:

Begin by bringing the breath into focus.You may close your eyes or keep them open. Because I tend to hold tension in the abdomen and throat, I make sure I'm breathing correctly, inhaling with a soft belly, and feeling it tighten on the out-breath. I relax my tongue and throat until I can feel the in-breath all the way into my upper airway. I do a quick body scan to acknowledge any areas of discomfort. 

"I think this is how 

we're supposed to be in this world.

Present and in awe."

~Anne Lamott~

When you are ready, turn your attention to the space around you. Notice the temperature. If you're outside, is the air still, or is there a breeze? Take note of the light around you. What do you hear? The birds outside? The TV downstairs? Thunder in the distance? What do you smell? Coffee brewing in the kitchen? Fresh cut grass? Wood smoke? Don't forget to visualize what is behind you and overhead. Fully immerse yourself in the moment. If your mind starts to wander--and it will--return your attention to the breath.

Oh! You caught yourself starting your grocery list? Good for you! Return to the breath.

Oh! You just now remembered where you left the book you've been looking for? Good for you! Return to the breath.

If emotions arise--and they will--simply acknowledge them, and turn your attention back to the breath. Perhaps tears well up. Maybe your heart starts racing. Perhaps your breathing quickens, or your throat tightens. Welcome whatever comes up without judgement, shame, or rejection...then let it go. Return to the breath, to the space you're in, to the sound of it, to the light around you, to its bouquet.    

Training in mindfulness reminds us to let go of our regrets about the past with its frustrations, disaapointments, and defeats. It asks us to release our grip on the future, and to allow it to unfold as it will. It is a sure cure for New Year's Resolutions.

"Whatever is good for your soul,

do that."

~Unknown~

jan

the part of you that never gets to go home

Go ahead. Help yourself.

Imagine that tonight is Christmas eve. 

Outside, the sun is setting under a sky that could pass for cotton candy. The air is frigid but still. The street is busy with people hurrying home to begin celebrating the holiday. You, yourself, are looking forward to getting home to a crackling fire on the hearth and a traditional Christmas eve meal. The kids are home from college. Their gifts are wrapped and arranged under the tree. You breathe a sigh of relief and gratitude.

"I will honor Christmas in my heart

and try to keep it all the year."

~Charles Dickens~

It was a busy day. Among the patients you admitted through the emergency room were a child with asthma complicated by fever and pneumonia, an elderly gentleman who fractured his hip when he slipped on the ice outside his garage, an OD, and an out-of-state trucker with chest pain and an abnormal EKG. Orders have been written, tests scheduled, and rounds finished. Your patients are settled for the night. Your job for the day is done. It’s time to go home.

Except that part of you never goes home.

You can't forget the expression on the child’s face when he learned he would be spending Christmas in the hospital. He’d asked for a blue bicycle and he couldn’t stop crying because he wouldn’t be there to get it…and he wasn’t well enough to ride it, anyway.

You recall discussing her husband’s injury with the elderly man’s wife. She would be alone for Christmas now, and for weeks to follow. She couldn’t imagine how she would manage by herself.

The OD was not accidental. You are reminded of the most recent studies debunking the long-perpetuated myth that suicide rates peak around the holidays. In fact, suicides reach a statistical nadir in December. Still, opioid contamination keeps no schedule and leaves no clues. It will be a long vigil for this victim’s family overnight.

You learn that the trucker’s family is stuck at Chicago’s O’Hare International Airport because of an unexpected blizzard. They wonder if he will survive this latest heart attack. Will they get to his bedside in time?

It’s Christmas eve. You get to go home. Your patients don’t.

"When you're sick, 

it's nice to know there are people

who await your recovery

as they might a holiday."

~Anton Chekhov~

This is a bi-polar time of the year, a time that highlights the irreconcilable discrepancies, emotional extremes, and divergent realities that prevent some people from celebrating the spirit of the holidays. There is poverty in contrast to wealth, sorrow instead of joy, cruelty as opposed to compassion, and of course, illness instead of health.

For those of us in the medical field who are taking our patients’ medical histories, exploring their symptoms, and fielding their pain when the rest of the world is celebrating joy and peace, it is a bittersweet season. Many of our patients will experience pain rather than comfort, grief instead gratitude, anger as opposed to joy, and anguish instead of peace. It won’t be merry or bright at all. They will be stuck with it…and in many ways, so will we.

Dickens wasn't referring to Christmas, but he could have been when, in “A Tale of Two Cities", he wrote :

"It was the best of times,

it was the worst of times...

it was the season of light,

it was the season of darkness,

it was the spring of hope,

it was the winter of despair."

~Charles Dickens~

He was writing in the 1800s, but he could have been writing today. This is the beauty of narrative...the concept and context of great storytelling endure across generations. Common themes repeat themselves. We realize we are connected in our joy and sorrow, victory and defeat, pleasure and pain with the rest of humanity all across time and space. And that is a sacred gift...a gift to each of us.

A Gift To Bring You

~Rumi~

You have no idea how hard I've looked

for a gift to bring you.

Nothing seemed right.

What's the point of bringing gold to the gold mine,

or water to the ocean?

Everything I came up with

was like taking spices to the Orient.

It's no good giving my heart and soul

because you already have these.

So I've brought you a mirror.

Look at yourself and remember me."

*

This Christmas, I wish you enough.

 

jan

 

 

how healing begins

 

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. 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 may see things a little differently. You see it wasn't your fault your friend found life unbearable. Perhaps you didn't miss the warning signs because there were none. A layer of guilt falls away...

...and healing begins.

"Guilt is to the spirit

what pain is to the body."

~David A. Bednar~

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 do for her, no clue how to help her. Then you pick up a book 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...

...so that healing can begin. 

It may be a bit harder to grasp the idea that telling or writing your own story can also be a healing practice, but it is.

 

Maybe for you, anger sometimes erupts without any provocation. Perhaps you feel anxious even when life is going well. Maybe despair blankets everything you do for reasons you don't understand. Or a particular song always brings you to tears. You can't help it. Why?

 

"We don't write what we know.

We write what we wonder about."

~Richard Peck~

 

Intrusive thoughts and feelings are the shadows of traumatic memories. Remember the time your father hit your mother in a fit of rage? You were so angry you wanted to hit him back. You never knew when the front door would open and your father would come home drunk, and even if you were already in bed, he'd find you there.You were so scared, you didn't dare move, and you couldn't run away. You felt helpless as a child, and now you feel worthless as an adult.

Or perhaps a song comes on. It's the one you listened to so you didn't have to hear your parents argue, the one that still makes you cry.  

 

Your anger, or sadness, or fear needs to find a time, or a place, or a name to explain it. You need to know its identity, its source, and its setting in order to renegotiate your relationship with it.

 

Telling your story puts you in control. It helps you think about what happened. It helps you understand why. You get to decide how it ends. And that can help you heal.

 



 "At any given moment
you have the power to say,
'This is not how my story is going to end.'"
~Christine Mason Miller~

jan

close encounters of the hardest kind

 

 

 

This was a fairly average week for me as I moved in and around my community. I ran into three women I know who have lost children, one of them to suicide. I spotted a patient of mine at the mall who is losing her fight against cancer, and another one who is still waiting for her test results. I spent an evening with a friend who donated a kidney to save her brother’s life.

 

Because I practiced medicine in my community for over thirty years, I have a unique vantage point when it comes to knowing who is in pain. I run into patients on the street, at the post office, and in the sub shop in town. I know who just had open heart surgery, whose marriage is in trouble, and who is battling addiction. Still, I don’t think these encounters are unique to physicians.

Whether we realize it or not, we all live among people who have endured heartache and suffering that would bring Job to tears. We encounter them wherever we go. The problem is we don’t always recognize them.

"It may take a doctor
to diagnose someone's disease,
but it takes a friend
to recognize someone's suffering."
~www. WishesMessages.com~

You can’t always tell by looking at a person what they’re up against—that divorce is in the air, or that a coworker’s cancer came back. It’s hard to know when someone is contemplating suicide. They don’t want anyone to know so they do what they can to hide it.

Many people who are in pain get out of bed in the morning just like the rest of us. There is nothing strange or special about the way they dress. They get their children off to school, and spend time tending to the house or they go to their jobs. They are right there behind us in the checkout line at the grocery store, on the treadmill next to us at the gym, or on the cushion next to us in meditation. We can’t see their broken hearts or crushed spirits so it can be hard to pick them out of the crowd. 

"The moment you change your perspective
is the moment you rewrite the chemistry
of your body."
~Bruce Lipton, Ph.D.~

This means a couple of things. First of all, if we don’t know their stories, we can’t help people heal. When we meet them on the street, we can comment on the weather, or commiserate over the sad state of politics in our country, or chat about the grandchildren, but we are prevented from expressing our concern for them, or sharing words of comfort and encouragement. In our offices, we ask about the onset, severity, and timing of their symptoms, but our questions dance around the underlying pain that is eating them alive. As health care providers, therapists, and caretakers, as neighbors and friends, as co-workers and acquaintances, we are helpless unless we know the whole story. The true story.

But enough about us.

Untold illness narratives have a way of hiding out in the subconscious while wreaking havoc with the body. They play tricks on people. As Rita Charon puts it, in her ground-breaking book, "Narrative Medicine--Honoring the Stories of Illness": “The body and the self keep secrets from one another.” The body may experience chest pain, when the problem is despair. The patient may see a physical therapist for a back injury when the cause of his pain is anger. People may turn to opiates for relief when their pain arises out of fear.

"The healing process begins
when patients tell of symptoms
or even fears of illness--
first to themselves, then to loved ones,
And finally, to health professionals."
~Rita Charon, M.D., Ph.D.~

Unless we seek out and explore the anger, or despair, or fear that is at the root of their pain, nothing we say or do will relieve the cause of suffering. All the medication in the world will not solve the problem.

“The shortest distance between
truth and a human being
is a story.”
~Anthony de Mello~

jan





take this test

 

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

"A facility that asks you to fill out

a health screening form is a sign of one

that really cares about its members."

~Kathi Davis~

Back when I was in practice, we didn't use screening questionnaires like these very much, but now they're considered an important part of the patient's medical record...which makes me wonder why the ACE (Adverse Childhood Experiences) Survey is not included in the paper work we submit to our health care providers. This questionnaire addresses childhood trauma and its effect on the development of chronic disease in adulthood.  

A growing body of evidence supports the link between childhood adversity and the development of physical disease and mental health disorders later in life. Childhood tauma 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 leads to adult disease states, notably autoimmune conditions like lupus and rheumatoid arthritis, heart disease, and PTSD-like anxiety and reactivity.

You can take the quiz here. Answer yes or no:

Before your 18th birthday:

1.      Did a parent or other adult in the household often or very often swear at you, insult you, put you down, or humiliate you, or act in a way that made you afraid that you might be physically hurt?

2.      Did a parent or other adult in the household often or very often push, grab, slap, or throw something at you, or ever hit you so hard that you had marks or were injured?

3.      Did an adult or person at least 5 years older than you ever touch or fondle you or have you touch their body in a sexual way, or attempt or actually have oral, anal, or vaginal intercourse with you?

4.      Did you often or very often feel that no one in your family loved you or thought you were important or special, or that your family didn’t look out for each other, feel close to each other, or support each other?

5.      Did you often or very often feel that you didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you, or that your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

6.      Were your parents ever separated or divorced?

7.      Was your mother or stepmother often or very often pushed, grabbed, slapped, or had something thrown at her, or sometimes, often, or very often kicked, bitten, hit with a fist, or hit with something hard, or ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

8.      Did you live with anyone who was a problem drinker or alcoholic, or who used street drugs?

9.      Was a household member depressed or mentally ill, or did a household member attempt suicide?

10.  Did a household member go to prison?

Add up your "yes" answers. This is your ACE score. If yours is greater than 0, you should be concerned.

The bad news is that the higher your ACE score, the more likely it is that your health and well-being are under assault. People with an ACE score of 4 are twice as likely to be diagnosed with cancer than someone with a score of 0. Each "yes" response increases the likelihood of hospitalization for an autoimmune disease by 20%. Someone with an ACE score of 4 is 460% more likely to face depression as an adult than someone with a score of 0. An ACE score of 6 or higher shortens an individual's life-span by almost twenty years. This is a big deal. 

The good news is that these early changes in the brain, and their subsequent effect on inflammation and the immune system can be mitigated. Epigenetic changes are reversible. There is a path to healing. 

Some of the practices that have been shown to promote epigenetic healing include:

• writing to heal
• drawing
• mindfulness and loving-kindness meditation
• tai chi, qigong, and yoga (moving meditation)
• dietary changes to promote a healthy microbiome in the gut
• guided imagery
• hypnosis
• neurofeedback
• EMDR

The problem is that childhood trauma is notoriously shrouded in secrecy, and very few healthcare providers are aware of these associations so they don't ask about them. Most physicians see several patients with high ACE scores every day, but all too often the underlying trauma that plays a role in the patient's illness goes unidentified. The opportunity to intervene therapeutically is, therefore, lost.

If you're interested in the relationship between adverse childhood experiences and their effect on health outcomes in adults, I would recommend you check out the book, "Childhood Disrupted" by Donna Jackson Nakazawa, or visit her blog online at www.donnajacksonnakazawa.com.

If you're curious about the role of epigenetics in illness and healing, check out  "The Biology of Belief" by Bruce H. Lipton, PhD.

Next on my list is "The Body Keeps Score" by Bessel van der Kolk, M.D.

"As the ACE study has shown,

child abuse and neglect is the single most common

cause of drug and alcohol abuse,

and a significant contributor

to leading causes of death such as

diabetes, heart disease, cancer, stroke, and suicide."

~Bessel van der Kolk, M.D.~

It is a shame to withhold this vast body of knowledge from patients when it offers an effective pathway to healing that has, so far, been largely ignored.

jan

finding a way forward, without a map

 

Last weekend I was speaking to a friend of mine who is thinking about retiring from medical practice... prematurely, like I did. Not because he can no longer keep up with the demands of patient care or the new technology. Not because of ill-health, or exhaustion, or forgetfulness. The problem is a health care system that subscribes...alas, surrenders...to the demand for power, speed, and profit at the expense of excellence, compassion, and human connection.

"America's health care system

is neither healthy, caring, nor a system."

~Walter Cronkite~

When I gave up after thirty years in Family Medicine, I told my patients and colleagues I was retiring…when I meant I was quitting. (Don't get me started.)

I didn’t put it quite that way, of course. It wasn’t as though I simply got fed up with things, turned in my stethoscope and tongue blades, and slammed the door on my way out of the office. I wasn’t impulsive about it at all. I agonized over the decision for years.

"You can quit your job,

but you can't quit your calling."

~Lissa Rankin~

It had nothing whatsoever to do with my patients. Caring for them was my passion. I wasn't defeated by the perpetually long hours, nor discouraged by the fact that I’d been running behind schedule all day, every day for thirty years with no chance I’d ever catch up.

No. What finally got to me was the erosion of my authority as a physician by self-proclaimed intermediaries who had neither knowledge of nor concern for my patients’ well-being. When I started out in medicine, the problem was oppressive paperwork; now-a-days it’s an oppositional defiant electronic medical record system. A baffling coding and reimbursement system. The ever-present threat of litigation. A pharmaceutical industry that invests as heavily in marketing as it does in service. A health insurance industry whose number one priority is corporate profit…not compassionate care. Aggravations that follow physicians through life like a swarm of angry bees.

In my friend's situation, mismanagement stoked by poor judgement and lack of foresight had propelled his department to the brink of disaster. They were understaffed. Plagued by scheduling errors. Preoccupied with plans to expand into something bigger, faster, and more profitable while they were mired in confusion and frustration...all problems he could have remedied if he'd had the go-ahead from leadership. Instead, his concerns and suggestions were met with disregard. He felt he had no choice but to resign. To explore a different path forward. Without a map.

"You are never too old to set

 another goal or to dream a new dream."

~C. S. Lewis~

Reflecting on his predicament, I put a series of rhetorical questions to him:

• What happened to the drive for excellence in health care? 
• What actually constitutes excellent patient care?
• When did our priorities as providers shift in favor of speed, power, and profit?
• Is it possible to restore the sanctity of the doctor-patient relationship?
• Is there any role for compassion, communication, and mutual respect in patient care?  

He met my gaze with a blank stare.

Health care providers and patients alike should be worried. I'm afraid we are lost, some of us forever.

"The best way to find yourself is

to lose yourself in the service of others."

~Mahatma Gandhi~

Don't you think it's time we restored rightful autonomy and authority to physicians and health care providers…to men and women who have dedicated their lives to delivering compassionate and capable health care to their patients? To clinicians who are not derailed by the promise of wealth or power? To healers who still believe they have a sacred duty and calling?

"We touch heaven when we lay our hands

on a human body."

~Novalis~

jan