excuses...excuses

The healing power of storytelling emerges when four conditions are met:

• when we listen to what our body is trying to tell us
• when we feel an insistent urge to put our story into words
• when we find a safe place to share it
• when our story is received and understood by someone we trust

I hear this from people again and again:

"I've always wanted to write..."

This is usually followed by a litany of excuses for not getting started:

• ...but I wouldn't know where to begin. 

I simply tell them, "You begin in the upper left hand corner of the first blank page."

• ...but I don't have the time.

The truth is nobody has the time to write. We sometimes have to lie, cheat, and steal to carve out the time for it.

• ...but I don't have anything important to say.

Oh, really? Let's say you have a child with special needs, meaning you had to learn how to feed her through a tube, and tend to her skin, and run through a whole set of exercises with her every day. Don't you want the rest of us to know how you manage it all? Or maybe you have to go in for chemo every week, but you're still trying to hold down a job so you can afford it. Don't you want to add your voice to the outcry against health care inequality? Oh! You have something important to say, all right! Something the rest of us need to hear.

If opening lines come to you when you're driving to work, or a memory sneaks up on you while you're mowing the lawn, or snatches of dialogue come to you in the middle of the night, your story may be begging you to please, start writing. If your voice has been silenced for too long, now may be the time to begin writing as a healing practice.

"When you stand and share your story

in an empowering way, your story will heal you

and your story will heal somebody else."

~Iyanla Vanzant~

jan

a doctor's touch

 

 

 

This week, I planned to provide a few prompts for physicians and healthcare providers who are blocked for whatever reason from telling their stories, perhaps because of constraints on time and energy, self-doubt, or lack of inspiration and support. I had planned to offer words of encouragement by Julia Cameron (http://www.theartistsway.com ).

 

"Writing is medicine.

It is an appropriate antidote to injury.

It is an appropriate companion

for any difficult change."

~Julia Cameron~

 

…and by mindfulness meditation leader Jon Kabat Zinn:

 

"Cultivate wisdom and equanimity

~not passive resignation~

in the face of the full catastrophe

of the human condition."

~Jon Kabat Zinn~

  

Then a friend of mine (she knows me too well...) sent me a link to a YouTube video by Abraham Verghese, titled "A Doctor's Touch.”

 

https://www.ted.com/talks/abraham_verghese_a_doctor_s_touch/transcript

 

"The most important innovation
in medicine to come along in the next ten years:
the power of the human hand."
~Abraham Verghese~
 

Suddenly a whole new set of questions arose. This video emphasizes the therapeutic effect of the laying on of hands by the physician...the healing roles of ritual and expectation...the importance of time spent with patients. It undermines the glorification of the ten-minute office visit…the game of "Beat the Clock" that doctors are required to play in order to meet productivity quotients. Don't get me started...

 

"The life sciences contain spiritual values
which can never be explained
by the materialistic attitude
of present day science."
~Sherwin B. Nuland~
 

These trends in the practice of "modern" medicine, among others, are what led me to bow out of practice because of fear of the inevitable: that the day would arrive when I would miss something important because there simply wasn't time to do the job well.

 

These are the questions I still can’t answer:

 

--Should I have taken a stand against the system and what I perceived to be the erosion of my wisdom and authority as a physician in the care of my patients

 

--How could I have done it...without risking my job?

 

--Would it have made any difference?

 

--Is it too late now?

 

Thankfully, there are physicians like Abraham Verghese who are able to speak eloquently on our behalf while the rest of us scramble to collect our thoughts and yet fail to act on what we know to be true.
 

 "What moves men of genius,

or rather, what inspires their work

is not new ideas,

but their obsession with the idea

that what has already been said is still not enough."

~Eugene Delacroix~ 

 

 

Is there an issue you need to confront? What is holding you back? What kind of a difference can you make? When will you begin?

jan

 

 

 



wash your spirit clean

The mountains were calling...



I was lucky enough to have spent the past two weeks hiking in Sequoia and Yosemite National Parks under cloudless blue skies with people I love. It would be impossible to put such magnificent beauty and grandeur into words, so I took hundreds of pictures. When I got home, though, I realized that none of the pictures really captured what I saw or communicated what I felt out there. You have to stand on a mountain top, or hike to the base of a waterfall, or look up at a Sequoia to appreciate what that feels like and how it can affect you.

 

"I only went out for a walk, and finally concluded

to stay out till sundown, for going out,

I found, was really going in."

~John Muir~

 

 



I imagine this is what it must feel like for patients when we ask them to describe their illness. How hard it must be for them to express what they feel. To help us understand what they are experiencing and how it affects them physically, psychologically, and emotionally. All of which we need to know in order to help them heal.

 

"Between every two pine trees

there is a door leading

to a new way of life."

~John Muir~

 

 

How does the patient describe the fear he feels when his doctor pronounces the word "cancer"? What does it feel like to survive a major stroke or heart attack? What sadness blankets a parent whose child is suffering?

 

The tests we order, and the x-rays and scans we review help us make the diagnosis but they don't reveal a thing about the patient's experience. Like my pictures, they don't capture the patient's feelings or reactions to his illness. To his treatment. To his sense of helplessness, or, God forbid, his sense of hopelessness.

 

"The clearest way

into the Universe is through

a forest wilderness."

~John Muir~

 

 

 

You have to climb the mountain to see the view. You need to hike in the woods to appreciate the trees. You have to wade in the river to enjoy the water.

 

What do you think it takes to understand a patient's illness? What does it take to heal? 

 

"Keep close to Nature's heart...

and break clear away once in a while,

and climb a mountain or

spend a week in the woods.

Wash your spirit clean."

~John Muir~

 

 jan

 

tell us what you think we should know

 

 

If you are a health care provider or therapist in any discipline, you may find yourself frustrated from time to time when a patient does not respond to treatment. You find yourself questioning the diagnosis. You ask the patient about his symptoms over and over again, re-examine him, and order additional tests without getting anywhere. Something doesn’t add up. There must be a missing piece. Too often, the patient is labelled as uncooperative, difficult, or mentally ill...when you may not have heard the patient’s whole story.

"The simple yet complex act of listening is,

in and of itself,

a clinical intervention.

Listening constitutes the very heart and soul 

of the clinical encounter."

~Mary T Shannon~

Some days there just isn’t time to explore the details of his illness with every patient. Perhaps you’re running behind schedule, or an emergency interrupts you. Some patients can’t bear to disclose the sorrow or fear or shame that underlies their symptoms. Some remain in denial for reasons we don’t understand.

Rita Charon, MD pioneered the practice of “narrative medicine” almost twenty years ago as a path to help clinicians uncover the missing piece in their patients’ histories. It trains the healer to recognize the fact that the problem exists, and then to elicit the patient’s untold story—to listen, receive, interpret and apply what the patient reveals.

This is how she begins with a new patient. She simply invites the patient to "tell me what you think I should know about your situation." Then she listens to the patient without interrupting, clarifying, correcting, or taking notes. Instead, she focuses her attention on what is revealed and how it is communicated...paying attention to the patient's posture and gestures, images and metaphors, facial expressions, and the characters who play a role in the story. This approach may take more time in the beginning, but in the long haul,  it saves us from revisiting the history again and again, from ordering unnecessary tests, and from wasting time and resources on ineffective interventions because of what we have missed. 

“I am, by calling,

a dealer in words;

and words are, of course,

the most powerful drugs used by mankind.”

~Rudyard Kipling~

When we reach into our patients’ cholesterol-laden hearts to understand why they are poisoning themselves with food, we need to know more than what they putting into their mouths. When we let the patient talk, we may discover that the real reason for this one’s fatigue or that one’s intractable headache is end-stage disappointment or anger or shame that has festered for years.

 

Only then can we help them heal.

"Histories must be received, not taken."

~Sir Richard Bayliss~

jan

 

 



where does your story begin?

 

 

 

 

?? Chapter One ??

 

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 a 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 way you cried yourself to sleep at night. The jab of a needle and the dull ache that lingered 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 in order 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 upon pushing on your belly right where it hurt worst. Every last one of them.

 

Or perhaps 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 futile effort to mask its bitter taste. Maybe your favorite threadbare teddy is still packed away in a chest somewhere 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?

*

"Nothing fixes a thing

so intensely in the memory

as the wish to forget."

~Michel de Montaigne~



 

Your comments are welcome...

jan

 

 





 

 













the power to heal

The motivating principle behind the study and practice of narrative medicine is the conviction that storytelling has the power to heal, not just psychologically and emotionally, but physically, as well.

“Dancing, singing, storytelling and silence

are the four universal

healing salves.”

~Gabriella Roth~

It is easy enough to understand how an uplifting story can raise one’s spirits. Let’s say you have been diagnosed with cancer. Hearing the stories told by people who have faced the same thing and have healed can offer hope, optimism, and strength for the journey you are about to embark upon. Ok, so you feel better emotionally and psychologically. The question is, does this shift in the psyche translate into physical healing?

Consider the vast literature concerning the mind-body connection. One simple but compelling case in point: the disappearance of warts with self-hypnosis. Pretty straightforward. We are also aware of the accumulating research on neuroplasticity and the effect of meditation and visualization on the course of illness. We have learned about the neural connections that modulate the release and function of stress and growth hormones, and how those processes influence our physiology.

“The purpose of storytelling

is not to tell you how to think,

but to give you

questions to think upon.”

~Brandon Sanderson~

In addition, there’s this: the demonstration of neural coupling on functional MRIs during storytelling. Researchers scanned the brains of storytellers and their listeners before and during storytelling. While different areas of the brain were active before the story began (maybe the listener had skipped breakfast and was focused on where he would go to pick up lunch, while the storyteller was worried he might leave something out), as the listener became engaged in the story, the scans changed. They came to mirror one another. The same areas of the brain started to light up in both the storyteller and the listener…proof that the person sitting across from you has the power to affect you physically by how he engages with you mentally.

This is no great secret. We have all experienced a racing heart while watching a thriller on TV, or shed a few tears during a sad interlude at the movies. And, who hasn’t lost track of time while reading a good book? Something happened to our bodies while we were engaged with the story.

In the medical setting, the storyteller is the patient. The listener is the physician or provider. Their brains come into synch by virtue of their mutual engagement in the process of obtaining the medical history. Their physiology changes. We can measure changes in hormone levels and we can scan for changes in electrical activity in the brain. They become connected.

“There isn’t a stronger

connection between two people

than storytelling.”

~Jimmy Neil Smith~

If a story can bring us to tears…or to laughter…it doesn’t take much to imagine that it can affect our health and wellbeing…whether through a mindful change in our attitude or behavior, or a beneficial surge in certain hormones.

This is why narrative has a role in the practice of medicine. Both the patient who is telling his story and the physician who is listening to it are affected not only cognitively, but physically, as well.

“Storytelling is the essential

human activity.

The harder the situation,

the more essential it is.”

~Tim O’Brien~

jan

layer upon layer

 

Like most of you, I was horrified to awaken on Sunday morning to news of a second mass shooting in less than two days this weekend. El Paso and Dayton. As reality started to sink in, it occurred to me how many layers there are to these stories.

"Man is unique in

organizing the mass murder

of his own species."

~Aldous Huxley~

The unfathomable grief blanketing the friends and families of the victims. The shock. The anger, fear, and sorrow they will shoulder for the rest of their lives.

"No one ever told me

that grief felt so like fear."

~CS Lewis~

The aftermath of trauma the survivors face. The pain. The scars. The horror.

"I'm standing in the ashes

of who I used to be."

~Mallika Dodeja~

 

You have to wonder if the courage and resolve it took for first responders to act at the scene didn't falter just a bit. Maybe, a lot. You have to wonder how those images are carved into their psyches. Into their hearts.

 

And who doesn't want to know what drove two young men to commit mass murder in the first place? Not to excuse them or to forgive them, but to understand how something like that takes root in a human heart. To fathom what it takes to plant the seeds of hatred, violence, and dispassion in the mind of someone who was born an innocent child?

 

What about the parents and families of these two men? Mystery abounds. Speculation grows. Will we ever know the truth? Will we ever hear their stories?

 

"There is no greater agony

than bearing an untold story

inside you."

~Maya Angelou~

 

What about the nurses and doctors who dropped everything to tend to the mass influx of trauma patients on short notice. How did they get through it?
 

Does it help those of us who practice narrative medicine to tell our stories? Does anyone benefit from hearing them? What can we learn from victims and patients? What can killers teach us?

 

SUDDEN

~by Nick Flynn~

 

If it had been a heart attack, the newspaper

might have used the word massive,

as if a mountain range had opened

inside her, but instead

 

it used the word suddenly, a light coming on

 

in an empty room. The telephone

 

fell from my shoulder, a black parrot repeating

something happened, something awful

 

a sunday, dusky. If it had been

terminal, we could have cradled her

as she grew smaller, wiped her mouth,

 

said good-bye. But it was sudden,

 

how overnight we could be orphaned

& the world become a bell we'd crawl inside

& the ringing all we'd eat.

 

jan