a tribute to anyone who has ever been hospitalized

Lately it seems like an uncanny number of my friends have been hospitalized for one reason or another. One because she was in diabetic ketoacidosis. One to manage the side effects of chemotherapy. This week another one started up the mountain...from X-ray, to biopsy, to surgery, to God-knows-what.

This post, then, is a tribute to anyone who has ever been hospitalized. It's a snippet from my novel, "The Bandaged Place." In it, my protagonist, Kate Tilton, shares her thoughts about her first day post-op:

"Even when surgery goes well, it wrings you out dry. I can attest to this because yesterday, as soon as anesthesia wore off, I felt like, well, road kill. I looked like it, too. And it just keeps getting worse because today they had the nerve to let visitors loose in my room to gawk at me when I am in no mood to entertain.

The pain isn't the problem. I'm getting morphine for that. In fact, the morphine is the problem. I just feel so giddy. I can't see straight, and I'm prettty sure my speech is slurred. The last time I was awake enough to speak, Shirley, my nurse this shift, asked me about the pain. I think I said "five" when I meant to say "fine." To a med-surg nurse, "five" means the worst pain possible, so she gave me another squirt of the magic potion...which is why, now that I'm awake again, I'm in love with everybody in the whole wide world. I just haven't figured out why they can't be here in bed with me right now.

And it doesn't bother me in the least when, for the umpteenth time in eight hours, Shirley hits the switch, and I am blinded by the overhead lights while she rechecks my vital signs--blood pressure, pulse, respiratory rate, and temperature--signs that I have survived. This has been going on all night long.

Shirley has been a nurse here for twenty-some years, night shift. After she finishes checking wounds, adjusting IV's, and passing meds for the night, she fortifies herself with Oreos and Coke. Despite her weight, she is the kind of woman who seems to walk on air--easy, silent, and graceful. Her touch is gentle, and her hands are warm. She is genuinely kindhearted, so even though she has interrupted my sleep countless times all night, I don't resent her for it at all.

"Sorry to disturb you again, darlin'," she says. "I'll just be a minute here."

I roll toward her and extend my arm. I like it when people apologize even though they haven't done anything wrong. You can forgive them in an instant, and then you're endeared to one another for life. "It's not your fault. I was a cake anyway," I mumble. I'm pretty sure that doesn't come out right, but it's the best I can do right now.

She laughs as though she thinks I'm the sweetest patient she has ever cared for, and then she reassures me, "First night's always the hardest." She takes my temperature, wraps the blood pressure cuff around my arm, and feels for the pulse in my wrist.

That's the last thing I remember until six o'clock sharp when someone arrives to draw my blood for the tenth time to check my blood count, sugar, and potassium. But I'm not diabetic, I didn't hemorrhage, and there's potassium running in my IV, so why even bother?

Right on schedule, a breakfast tray is delivered to my bedside and deposited on a little table that is just out of reach. So even if I were hungry or thirsty--which I am not--I'd have to settle for the smell of food, and that turns my stomach.

Not fifteen minutes later, the lady from dietary is back. "Not hungry yet?" She smiles as though she understands completely. It's much too soon after surgery to have worked up an appetite. So she clears away the untouched tray without so much as a word of encouragement like, "Here, let me bring this a little closer. So you can reach it. You should try to eat a little something." Not that I could get a fork up to my mouth if I tried.

I could cry, but I won't, so help me God, not even when Shirley insists I get out of bed and shuffle all the way over to the bathroom and back, pulling my IV stand along behind me like a two-year old, "Come along, now. It's time to go potty." Whoa--not so fast, I'm thinking. As I roll over and sit up, ten thousand poison arrows pierce my chest. The moment I get my feet down, it feels like the floor falls away. My knees quiver. The room spins. Thankfully, Shirley has the strength to steady me.

"Take your time, now. Take it slow. We don't want you to take a tumble now, do we?"

No, we do not, I'm thinking. So can't you just bring me a bedpan or something?

Oh, my God! Did I just ask for a bedpan? Somebody please hand me a gun!"

*

If you're a healthcare provider...or if you've ever been a patient...and you're hesitant to tell your own story because you don't think anyone wants to hear it, or you don't think you write well enough, or you're having a  hard time putting it into words...

tell somebody else's story.

"There is nothing worse than thinking

you are well enough...

Don't turn your head.

Keep looking at the bandaged place."

~Rumi~

Famke

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when storytelling is an obstacle to healing

The goal of training in narrative medicine is to provide the health care provider with tools to help him uncover otherwise unspoken details that might impact diagnostic accuracy and successful treatment. 

"You'd be surprised what lengths

people will go to not to face

what is real and painful inside them."

~Various Attributions~

This is especially important given what we now know about childhood trauma and its remote influence on adult health and well-being. Most patients don't make the connection between their experiences as a child and the headaches, hypertension, IBS, anxiety, depression, and addictions that plague them as adults. 

The enduring effects of childhood trauma in its many guises--verbal/physical/sexual abuse or neglect, injury or illness, a significant loss, the stress conferred by poverty, racism, and even bullying--can be hard for patients to put into words. This is especially true if the trauma they experienced occurred pre-verbally, if it was a secret they kept, something they couldn't tell anyone about...and still can't, or if it was so severe they dissociated from it. They may have suppressed the memory of it, or lack the language to express it. 

"You can spend a lifetime

trying to forget a few minutes 

of your childhood."

~From HealthyPlace.com~

But make no mistake...they still feel it in their bodies. 

Working with these patients can be a challenge because just the process of narrating the experience can be traumatizing to them. When they are encouraged to re-tell the story, they can re-experience the trauma, and regress or shut down. In this case, exploring the patient's narrative can pose an obstacle to healing. 

You may sense this when the patient's body language shifts. His posture may change. His facial expression and the tone of his voice may change. He may start fidgeting, stiffen, or slump. Instead of asking him what he is thinking about, it may help to ask him where in his body he is feeling it. Does his neck ache? Is he aware of his heart beat? Is he shaking? Does he feel nauseated? Lightheaded? Once he understands that he is safe despite these somatic manifestations, he may be able to connect them with his traumatizing experience, and eventually with his ability to heal.

"Trauma comes back as a reaction,

not a memory."

~Bessel Van Der Kolk~

Somatic psychotherapy helps patients integrate the physical manifestations of illness with the fear, anger, grief, shame, confusion, and denial they cannot express. Suppressed memories may emerge.

When the patient understands that he is safe despite the fact that his chest aches, or his energy is drained, or his mind goes blank, the mind-body connection is strengthened, and a pathway to healing is revealed. 

Six Steps to Strengthen

Mind-Body Connection:

1. Close your eyes and

    take a deep breath

2. Scan the body

3. Be aware of any sensations,

     pleasant or unpleasant

4. Notice where the sensations

are coming from

5. Let your awareness travel

around your body

6. Follow these sensations

     until they disappear

~From Quotemaster~

*

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how civilizations heal

~Ukraine Flag~

by Setsiri Silapapsuwanchai

If, like me, you are deeply affected by the war in Ukraine, you may find it difficult to put your thoughts and feelings into words. Thankfully, others have taken a stab at it for us. They have shared inspiration and consolation with us, both with and without words:

~Tower of Mothers~

A 1937 sculpture by German artist Käthe Kollwitz that

depicts women standing in a circle to protect their children from the horrors of war.

*

The Peace of Wild Things

~Wendell Berry~

When despair for the world grows in me

and I wake in the night at the least sound

in fear of what my life and my children's lives may be,

I go and lie down where the wood drake rests

in his beauty on the water, and the great heron feeds.

I come into the peace of wild things

who do not tax their lives with forethought

of grief. I come into the presence of still water

and I feel above me the day-blind stars

waiting with their light. For a time

I rest in the grace of the world, and am free.

*

Hope springs eternal.

*

Cultivate EQUANIMITY:

mental calmness, composure, and evenness of temper,

especially in a difficult situation.

*

~I've got peace like a river~

*

Mahatma Gandhi, on nonviolence:

First they ignore you,

then they laugh at you, 

then they fight you,

then you win.

What inspires you? Where do you turn for comfort? For solace? For peace? 

How do you make sense of life as it unfolds?

"There is no time for despair,

no place for self-pity,

no need for silence,

no room for fear.

We speak, we write,

we do language. 

That is how civilizations heal."

~Toni Morrison~

How will you help?

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could you kill? would you?

 

In the field of health care, we are often confronted with ethical dilemmas. Which patient should get the life-saving liver transplant? Which Covid patient should be placed on the last ventilator? When should we discontinue life support? We are sometimes called upon to decide who lives, and who dies. 

This past week I was happy to take care of two of my grandchildren (almost two-years-old and almost five) while my daughter and her husband enjoyed a much needed and well-deserved vacation. There was just one problem. While I was trying to decide between giving the kids mac & cheese or chicken nuggets for supper, I saw hungry children and their desperate mothers walking for miles with nothing at all to eat. When I tucked my little ones into their soft, warm beds, I saw children out in the cold with nowhere to sleep. We all did. We all watched thousands of women and children flee Ukraine with nothing but what they could fit into a battered suitcase to last them...well, perhaps forever. We watched as husbands and wives bid one another goodbye...perhaps forever.

 

"Every war is a war against children."

~John Steinbeck~

 

All this transpired while one man dined extravagantly and reclined comfortably in his secure fortress, taking it all in with deep satisfaction and great pride. 

 

“All war is a symptom

of man’s failure as a thinking animal.”

~John Steinbeck~

 

The cruelty, indeed the horror, of war is crushing to witness, especially when we are helpless to intervene. It raises ethical questions we are not trained to confront. Consider, for example this iteration of a classic ethical question:

 

There is a train coming down the tracks, and ahead, five people are tied to the tracks. They are unable to free themselves, and there is nothing you can do to rescue them. If the train continues on the tracks, they will all die. However, there is a lever. If you pull the lever, the train will be directed to another track, which has ONE person tied to it. You have two choices:

 

(a) If you do nothing, five people will die.

(b) If you pull the lever five people will live, but you will have killed the other one.

 

What would you do?

 

"It is both a blessing and

a curse to feel everything so very deeply."

~David Jones~

 

Now, think of it this way: Hundreds, perhaps thousands, of men, women, and children will die trying to make their way out of Ukraine. One man holds their fate in his hands, and he refuses to act to save them. If you had a choice, what would you do? Would you do nothing and watch as hundreds die? Or would you do whatever you could to eliminate the man in charge?

 

Would you kill one person to save many?

 

Could you?

 

I've been toying with this dilemma for a few days now. I think I have my answer. Do you?

 

"The day the power of love

overrules the love of power,

the world will know peace."

~Mahatma Gandhi~

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what would you do if only you could

This week I was thrilled to learn that the Narrative Healing Workshop will be back this summer, following a two year pandemic-induced hiatus. This year, we'll be gathering in July at Omega Institute for Holistic Studies in Rhinebeck, NY. There, I will join a dedicated group of writers, seekers, and healers to explore storytelling as a healing practice. To integrate movement with reflection. To connect silence with solace. 

"Dancing, singing, storytelling, and silence

are the four healing salves."

~Gabrielle Roth~

I have to admit...there's a part of me that wishes I were a presenter at this conference. That I had the wisdom, expertise, and gumption to get up there and lead a meditation, present a topic, or tell a story. If I could, I would give a brief introduction to the practice of meditation, and ask the group to give it a try for a few minutes. With beautiful music playing. I would talk about transformative learning and the role of the "disorienting dilemma" in our lives (see my post from Feb. 6). 

"You are not going to heal

if you keep pretending

you are not hurt."

~unknown~

Then I would tell my story. Why I abandoned the practice of medicine out of fear. Why I bowed out of my marriage after forty-two years. How I lost my faith. What it was that made me question my deeply held beliefs, and the values I had always lived by. How that led me to discover my sacred calling. 

And to act on it.

"It may be that

when we no longer know what to do,

we come to our real work,

and when we no longer know which way to go,

we have begun our real journey."

~Wendell Berry~

Sooner or later, most of us will come up against a dilemma that requires us to re-evaluate our deeply held beliefs in life, to question our assumptions and opinions, and perhaps, to change our minds. Then we will be confronted with the imperative to act on what we have learned in the process, or to betray ourselves if we don't. To neglect our duty to ourselves and others.To trivialize our sacred calling. 

As Stephen Cope puts it:

"Sacred duty is the thing that

if you do not do it, you will feel

a profound sense of self-betrayal."

~Stephen Cope~

~from "The Dharma in Difficult Times"~

This, I believe, is a core concept that healers should understand, and storytellers/writers should embrace. It speaks to our search for truth, and our duty to share it. Which is why conferences like the one I'll be attending in July are so important. Among the people who will be presenting are founder Lisa Weinert, Jamia Wilson, Kim Thai, and Justin Michael Williams, whose bios can be found here .

You don't have to be a health care provider, writer, or storyteller to attend this conference. You don't have to practice yoga or meditate to participate. Think about it. It would be great to see you there!

"If we are artists--

hell, whether or not we're artists--

it is our job, our responsibility,

perhaps even our sacred calling to take

whatever life has given us and make something new, 

something that wouldn't have existed if not for the

fire, the genetic mutation, the sick baby, the accident."

~Dani Shapiro~

And there you have it.

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the downside of doctoring

 

 

One of the perks of being a physician is the fact that you get to live in a state of perpetual awe. It starts with the first pass of the scalpel on your first day in the anatomy lab. It continues as you tease out every organ, blood vessel, and nerve in the body you've been assigned to dissect. A sense of wonder punches you in the gut the first time you hear a beating human heart and realize that your own heart has been beating steadily and predictably without any effort on your part since before the day you were born.

 

"There is nothing worse than

thinking you are well enough...

Don't turn your head.

Keep looking at the bandaged place.

That's where the light enters you.

And don't believe for a minute

that you are healing yourself."

~Jelaluddin Rumi~

 

You'd have to be a toadstool not to be mystified by the anatomy, physiology, and psychology of your very own body. You'd have to believe in miracles if you understood the way a broken body heals, what it takes for an open wound to close, how a lifeless heart can pick up the beat again.

 

Don't even ask what happens during sex.



I studied medicine for seven years and practiced it for over three decades, so I understand how the body works. I know what it takes to keep it up and running. Most of the time, I know how to fix it when something goes wrong. Most people don't. They get out of bed in the morning and expect their bodies to cooperate with their plans for the day. They have to get their children off to school. They have to get to their jobs. They don't have time to be sick.

 

But what if you woke up in the morning and you couldn't move the left side of your body, and you speech was garbled so you couldn't tell anyone what had happened? What if you woke up to find the infant you rocked to sleep the night before pale and lifeless in her crib? What if everything that was familiar and predictable to you changed in a heartbeat?

 

We expect our bodies to work, but sometimes they don't. We think our children are safe, but we can't guarantee it. We take health and happiness for granted until something goes wrong. The cancer comes back. The paralysis is permanent. The depression won't lift. Sometimes the afflictions of the body go beyond its own ability to heal, and beyond the physician's ability to help.

 

What then?

 

When a patient under his care gets worse and there is nothing he can do about it, a doctor feels helpless. When he has tried everything he knows and nothing has worked, he feels like a failure. So not-God as is sometimes still expected of physicians.

 

And that's the problem. The downside of doctoring is that sometimes the patient gets worse despite your noblest efforts. The cancer spreads. The heart fails. The wound won't close. There is nothing more you can do. You concede it would take a miracle for the patient to recover. All you have left is prayer.

 

"The greatest force in the human body

is the natural drive of the body to heal itself,

but that force is not independent of belief...

What we believe is the most powerful option of all."

~Norman Cousins~



 

But what if you don't believe in miracles and you've given up on prayer? Your sense of awe comes into question. Your sense of wonder falters. Hope fades away. Where do you turn?

 

You might try this. Study the night sky. Watch for the first signs of spring. Feel the pulse in your own wrist. And teach your patients to do it, too.

 

"The human body experiences

a powerful gravitational pull

in the direction of hope."

~Norman Cousins~

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the disorienting dilemma

Unless you're an educator, you may not be familiar with the term "transformative learning". The theory of transformative learning was developed by Jack Mezirow, a sociologist and Emeritus Professor of Adult and Continuing Education at Columbia University. It refers to the ways we adjust our thinking based on the acqusition of new information. Nothing special about that, but the thing that sets transformative learning apart from, say, what we learn from reading is the fact that transformative learning always involves what is known as a "disorienting dilemma". 

 "You can't resolve a dilemma

with the very same mind

that made it."

~Albert Einstein~

A disorienting dilemma can be described as an experience that does not fit our expectations or make sense to us without a substantial change in our world view, our conditioned assumptions, our previously held beliefs, or our tightly held convictions. It leaves us stunned. Disoriented. Our dilemma forces us to ask several questions:

• What have I been thinking all this time? Why?
• What am I really committed to?
• What is important for me to accomplish?    
• What is preventing me from accomplishing what I am committed to?
• What path will I take going forward?

While Mezirow's theory was intended to reference learning in adults, it is applicable across a broad spectrum of behavior and experience. And it is especially relevant to health care providers.

A disorienting dilemma for me evolved gradually with the changes in the health care system...the erosion of the physician's authority by self-proclaimed intermediaries who had neither knowledge of nor concern for patients’ well-being...attorneys, auditors, insurers. A system whose number one priority was corporate profit rather than compassionate care. The imperative to see more patients, faster in order to generate more revenue...which I believed put patients at risk. I worried about missing a diagnosis, or bungling a procedure, or prescribing the wrong medication in my rush to stay on schedule...in my efforts to appease corporate administrators, while struggling with an oppositional-defiant electronic medical record system, a baffling coding and reimbursement system, and the ever-present threat of litigation. It scared me.

Medicine was my passion, but my sacred duty was to patient well-being and safety, hence, my dilemma: Should I stay and fight the system? Did I have a duty to engage in that battle? Or should I go? 

"Sometimes you change your mind...

sometimes your mind changes you."

~Binyomin Scheiman~

Long story, short: I abandoned the practice of medicine. After thirty years in Family Medicine, I told my patients and colleagues I was retiring…when I meant I was quitting. 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 my dilemma for years. My decision had nothing whatsoever to do with my patients. Caring for them was my passion. Nor was I defeated by the perpetually long hours. Nor was I 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. That wasn't the problem.

I simply deferred to what I considered to be my sacred duty, my true calling...and I did what was necessary to honor it.

"Sacred duty is the thing that

if you do not do it, you will feel

a profound sense of self-betrayal."

~Stephen Cope~

Sooner or later, most of us will come up against a dilemma that requires us to re-evaluate our deeply held beliefs in life, to question our assumptions and opinions, and perhaps, to change our minds. Then we will be confronted with the imperative to act on what we have learned in the process, or to betray ourselves.

The important plot points in our lives tend to involve disorienting dilemmas. They punctuate our professional narratives as well as our personal lives. And they unfold among our patients. For example, whether or not to terminate an unplanned pregnancy. Whether or not to place Mom in an extended care facility. When and if to discontinue life support.

Are you facing a life-changing decision? Are you ready to learn? Are you prepared to act?

"Two roads diverged in a wood

and I--I took the one less travelled..."

~Robert Frost~

jan