submersed

 

If you are a health care provider or a caretaker you may have attended a patient who was dying. I sat with my mother for fourteen hours the day she died, hoping my voice...my simple presence...would bring her some comfort that day. Perhaps it allayed her fear, eased her sorrow, or brought her some sense of peace. I do not recall her suffering. She did not appear to be short of breath. She never cried out in pain. And then...with her last breath...she was gone.

"Tomorrow I will be gone.

I will be a flower or a leaf...

I will be very happy."

~Thich Nhat Hanh~

Thich Nhat Hanh taught us we fear death because we believe that in the end, our life amounts to nothing. We are filled with fear of annihilation. I disagree. I believe we fear death because we fear the suffering we will endure...and cause our loved ones...during the process. Regardless of what we believe comes afterward.

*

I spent last week with a couple of my grandchildren. I never tuned in to the news or commentary I usually follow so I was not aware of the unfolding drama aboard the Submersible Titan until it became clear that the men on board were running out of oxygen, helplessly facing suffocation even as massive rescue efforts were underway

Imagine what that must be like.

If you hold your breath long enough, your body will crave oxygen. Thankfully, your nervous system is wired to override your efforts. You will eventually take that needed breath. Gasp! But what if there were no oxygen in the air you inhaled? You would suffer, desperate for relief until you passed out. Until you died. 

I couldn't shake off the horror of the fate of the five men on board the Titan. The slow suffocation. The certainty they would die. Watching as the others succumbed one by one.

"All beings tremble before violence.

All love life.

All fear death.

See yourself in others. 

Then, whom can you hurt?"

~Buddha~

Hanh taught that the most important task we face in life is to make peace with death. To accept the fact that everything is impermanent. To fully embrace what we believe follows. This is something we must all reconcile for ourselves. It has to be something that makes sense to each of us personally, because no one knows what comes after death. Some believe it is never ending peace and joy in Heaven. Hopefully, not an eternity spent in Hell. Others believe in rebirth, giving us time to learn the lessons and embrace the sacred practices we missed or rejected the first time around. I prefer the idea of a green burial, and the re-animation of my DNA in an apple tree, a flower, or a ladybug. Embracing the possibility of a meaningful and joyful afterlife is a great help. 

I also take comfort from accounts of the near-death experiences of people who have, for example, survived cardiac arrest. The white light. The visions of angels and glimpses of heaven. The utter absence of pain and suffering that make some who survive wish they hadn't. Suggesting that the moment of death is both painless and transcendent.

Yesterday we learned of the violent implosion that destroyed the Titan and took its five passengers to their deaths. Now I'm trying to process that...

"In the depths of your hopes and desires

lies your silent knowledge of the beyond;

And like seeds dreaming beneath the snow

your heart dreams of spring.

Trust the dreams, for in them is hidden

the gate to eternity."

~Kahlil Gibran~

jan

why we wander and where we go

Rocky Mountain National Park

June 2023

~Andrea Gashinski~

There is no question that writing, or storytelling in any of its iterations for that matter, has the power to heal. Hence, my interest in narrative medicine. Most of us would also agree that music has the ability to affect our mood. That art can bring us to awe.

But what about time spent in nature? In the wilderness? In solitude?

"Morning has broken like the first morning."

~Cat Stevens~

\

"I am at home among the trees."

~JRR Tolkien~

"Still waters run deep."

~various attributions~

"Nature is my religion. The earth is my temple."

~Nidhi Bhatt~

"Of all the paths you take in life,

make sure a few of them are dirt."

~John Muir~

As Tolkien put it:

"Not all who wander are lost."

Some of us wander because we are suffering. Some are healing. Others are grieving. Some of us are in search of peace. Others, courage. Still others, wisdom. Even joy. 

If you sometimes feel lost...and don't we all at times?...remember to:

"Keep close to nature's heart...

break clear away once in a while and

 climb a mountain or spend a week in the woods.

Wash your spirit clean."

~John Muir~

You'll feel better.

jan

 

"the mind illuminated"

 

I'll be off the grid, so to speak, for the next week or so...heading out to Estes, Colorado to explore the park with a few of my favorite people. This is the reward I promised my new right knee if she kept up with her PT and proved she could hike a bit without complaining about it. She's eager to see if she measures up, and so am I. Of course, there are some activities we will have to pass on, like rock climbing and white water rafting...

...meaning I will need a couple of good books to enjoy poolside while the younger generation puts their lives at risk.

"Books are a uniquely

portable magic."

~Stephen King~

Most people I know like to read a good mystery or thriller, a romance, or fantasy when they are on vacation. Not me, though. I disappeared down the consciousness studies hole again a few weeks ago, chasing a few references from the book I was loving, "Science, Being, & Becoming: The Spiritual Lives of Scientists" by Paul J. Mills, Ph.D. 

Among the titles that attracted me were "Physics of Consciousness" at 304 pages, "Song of the Cell" at 496 pgs., "The Science of Consciousness" at 514 pgs., and, on a lighter note, "Braiding Sweetgrass" at 408 pgs., and "The Immense World" at 464 pgs....none of which I wanted to haul all the way cross country. (I know, I know...I should have a Kindle, and I do have one, somewhere...).

"I like big books

and I cannot lie."

~attribution unknown~

So I turned to Amazon and came up with two short, light-weight paperbacks I thought would suffice: "When the Trees Say Nothing" by Thomas Merton, and "The Confession Club" by my favorite novelist, Elizabeth Berg. That order went in before I landed on this:

The problem is I couldn't resist opening it, and now I can't put it down. The good news is it comes in at 430 pages so I won't be able to finish it before I leave. The bad news is it weighs in at 2 lbs., and I'm definitely hauling it to Colorado!

This is the most detailed, reader-friendly instruction in meditation I have come across yet, no offense to Pema Chodron, Jack Kornfield, or Sharon Salzburg, among other great teachers. 

If you are curious about the practice of meditation and its benefits, this book is a practical and inclusive guide. If you are skeptical about what you have been taught or have read about meditation, the author, in addition to his credentials as a Buddhist meditation master, is also a neuroscientist. He understands both sides of the equation. If, like me, you have a regular meditation practice but you want to take it to the next level, this book will show you the way. If you're ready to give up because nothing seems to be happening or you find the practice difficult, don't walk away just yet. Again and again, the author touches on an issue that resonates with me, and I've been meditating regularly for years. He goes into obstacles to effective meditation, the sense of failure we all experience as beginners, and the reasons we fail to progress. Then, step by step, he shows us the way forward. 

Meditation is good for you, and for the world. You don't have to take my word for it though. Discover it for yourself.

"Believe nothing

no matter where you read it or

who has said it,

not even if I have said it,

unless it agrees with your own reason

and your own logic."

~Siddhartha Gautama~ 

(The Buddha)

jan

when the truth is pure fiction

 

One of the goals in narrative medicine is to unearth the patient's whole story, including missing details that point to the correct diagnosis and lead to an effective treatment plan. These details are easy to overlook when time is short. When the health care provider is staring down the barrel of the proverbial productivity gun and is under pressure to get on with it. When his own anxiety propels him through the day. It takes time to elicit the patient's story, to understand the real source of his pain, to recognize the oscillations between identification and detachment, between truth and denial...and to act on the patient's behalf out of sincere empathy and compassion. The provider's job is tricky and difficult under the best of circumstances.

 

In addition to the productivity conundrum, there is this: patients sometimes lie. Yes, they do. They don't always mean to be misleading, but it happens.

 

"The most dangerous lies

are the ones we tell ourselves."

~Honey Sanaa~



Let's say the patient has been sitting in the waiting room for almost an hour and is running late to pick up the kids from school. When she finally gets in to see the doctor for her checkup, and he says, "How have you been?", she replies, "Fine. Things are good." This lets him off the hook. He breathes a sigh of relief. Never mind the fact that she has been exceptionally tired lately. That she gets winded carting the groceries into the house. That she feels a little lightheaded when she stands up too fast. She doesn't have time to go into all that today.

 

Never mind the fact that she looks so pale, and her blood pressure is running low. She says she feels fine, and that's all the doctor has time for today, anyway. 

 

Never mind the leukemia that already has a head start but could have been stopped in its tracks if only there had been enough time that day. Enough time for the doctor to mention her BP, to comment on her pallor, and to ask if she was feeling tired or weak...which might have led him to order the blood count that might have saved her life.

 

"The greatest obstacle

to discovering the truth is

being convinced that you already know it."

~Ashleigh Brilliant~

 

Besides the ever present problem of time constraints, patients may lie out of shame. They're not likely to admit to the sexual encounter that left them with a rash or discharge. They'll tell you they tripped over the dog and ended up with a broken wrist, but they won't mention that it happened after night of heavy drinking.

 

Out of a sense of guilt. They'll try to convince you that the infant with the fractured femur fell off the changing table in the split second it took to fetch a clean diaper.

 

Out of denial. They blame their chest pain on indigestion or a muscle strain even though they know better. Their cholesterol is out of control and their BP is sky high.

 

"A diagnosis is burden enough

without being burdened by secrecy and shame."

~Jane Pauley~

 

So...even though the goal of narrative medicine is to get to the truth, sometimes it will inevitably be pure fiction. 



 jan

 

 



the difference between caring for our patients and caring about them

Today

~How is it, I wonder, that the universe we know to be cold, dark, and dangerous

drapes itself around us in shades of baby blue?~

The motivating principle behind the practice of narrative medicine is the conviction that, in clinical medicine, storytelling is a healing practice. The concept of training health care professionals in narrative medicine originated under the direction of Rita Charon, M.D. at Columbia University. She recognized the fact that patients need to be encouraged to tell their whole story in order for the clinician to come to an accurate diagnosis and to develop an effective treatment plan. A complete medical history reveals not just what symptoms patients are experiencing, but how their illness affects them emotionally, how it impacts the people they love and care for, what fears they harbor, and what expectations they hold.

"Everyone has a story that

will break your heart.

And, if you're really paying attention, 

most people have a story

that will bring you to your knees."

~Brene Brown~

hey learned the skills necessary to elicit and interpret the patient's history, to pick-up on missing details, and to understand the patient's illness in the context of his life and community. As a result, patients under their care felt as if someone was finally listening to them. That someone cared. When they felt heard, they did better. They coped more effectively. They were more receptive to therapeutic intervention.

Did they heal because of it? That, of course, depends upon how you define healing.

 

"Your pain will transform you.

Your story will enliven the world.

Your truths will magnetize your tribe."

~Tanya Markul~



The motivating principle behind the practice of narrative medicine is the conviction that, in clinical medicine, storytelling is a healing practice. The concept of training health care professionals in narrative medicine originated under the direction of Rita Charon, M.D. at Columbia University. She recognized the fact that patients need to be encouraged to tell their whole story in order for the clinician to come to an accurate diagnosis and to develop an effective treatment plan. A complete medical history reveals not just what symptoms patients are experiencing, but how their illness affects them emotionally, how it impacts the people they love and care for, what fears they harbor, and what expectations they hold.

It might be a stretch to say that a narrative approach to patient care speeds wound closure or prevents the spread of cancer. Antibiotics are probably a better choice for pneumonia. You need surgery if you have appendicitis.

 

Nevertheless, the empathetic connection that develops between the physician and the patient when the patient is heard in a caring, receptive and holistic manner can improve his prognosis.  

 

No illness is free of emotional fallout. Fear. Shame. Anger. Heartache...none of which the patient may want to admit or express. These feelings may, however, be the most amenable to the healing power of storytelling in the clinical setting. Only if the patient is encouraged to express his frustration, fear, and sense of loss can we know what kind of support he needs. Perhaps he simply needs facts to help him understand and embrace his treatment plan. Maybe he needs constant reassurance and encouragement. Maybe she needs assistance arranging for help at home. Some patients welcome prayer at the bedside. Others may not. 

We can't know what the patient needs unless we ask. Then, it is up to us to respond empathetically.

 

"It is more important to know

what sort of person has a disease 

than to know what sort of disease 

a person has."

~Hippocrates~

For those of us involved in patient care, the operative word is "care." This involves more than tending to the tasks required to treat our patients. It means caring about them. Caring enough to frame the impact of their illness on their emotional and psychological wellbeing, and its impact on their family and friends. On their futures. On their souls. All the hidden places pain lingers.

 

"Cure sometimes.

Relieve often.

Comfort always."

~Hippocrates~  

jan

 

the happiest day of the year...or the saddest

 

Happy Mother's Day

A couple of years ago, a childless friend of mine stopped me after Mass on Mother's Day. She confided to me about how sad she was because she couldn't stand up in church to receive the special Mother's Day blessing. 

So...this post is for her, and for YOU...if you are a mother or hope to become a mother some day.

This is also for you if you have been unable to become a mother, or if you have decided that motherhood is not right for you.

This is for you is you have lost a child through illness or injury, an act of gun violence...or, God forbid, because of a drug overdose or by suicide.

If you are a mother who has been entrusted with the care of a child with special needs, this is for you.

If you have suffered a miscarriage...or opted for an abortion...this is for you, too.

If you are estranged from your children...if you wish you had done better...if your maternal heart is broken, this is definitely for you.

If you are trying to do it alone, this is for you.

"Behind every great kid is a mom 

who's pretty sure she's screwing it up."

~attribution unknown~

This is for all the meals you prepared, all the laundry you washed, all the miles you drove, all the sleep you lost.

~Anne Taintor magnets~

If you are a woman, this post is for the comfort, encouragement, patience, kindness, and love you have shown for any child, anywhere, ever...

It's for the frustration, worry, sorrow, anger, and sacrifice you have borne just trying...because Mother's Day may be the happiest day of the year for you...or the saddest.

www.scientificchicago.com

*

Remember:

"Treat Mom to a bottle of wine

this Mother's Day.

Remember: You're the reason she drinks."

~From "Your Lighter Side"~

jan

protect kids, not guns

 Here are the facts:

Firearm-related injuries 

are the leading cause of death among

children and adolescents in this country.

~https://www.nejm.org/doi/full/10.1056/NEJMc2201761~

~https://www.cnn.com/2023/03/29/health/us-children-gun-deaths-dg/index.html~

This is a public health crisis. A societal and cultural tragedy. A monumental failure to protect the health and well-being of our children.

Those of us who are in healthcare can justifiably celebrate the gains we have made over the years in the successful treatment of other killers...childhood cancer, congenital heart disease, infectious diseases, and diabetes, among others. For this, we can thank the well-funded research programs and the men and women who dedicate their lives to the pursuit of elusive cures. 

When it comes to gun violence, though, it seems all we have to offer are thoughts and prayers which, so far, haven't worked very well. And never will. The same can be said for marching in the streets to protest the failure of elected officials to act on behalf of the innocent victims of gun violence, and it holds true for those of us who write to our representatives and senators for help. It hasn't worked. It never will.

"It takes a monster to kill children.

But to watch monsters

kill children again and again and do nothing

isn't just insanity--it's inhumanity."

~Amanda Gorman~

Interestingly, right-leaning politicians and their supporters who understand and defend the right to life of the unborn apparently do not apply the same standard to toddlers, preschoolers, or school age children. They don't seem to understand the connection between easy, and often illegal, access to firearms and the loss of young lives. Instead of citing the role of firearms in these deaths, they assign blame elsewhere. They place responsibility on a failed mental health system, or with lawless immigrants. And they can't be convinced otherwise.

Which leaves us in a bind. Those of us who recognize the horror and the urgency of this crisis feel an aching imperative to act. A sacred duty to act. But...what can we do? Our leaders have nothing to suggest. Our priests and pastors have nothing to add. We are left with little more than wishful thinking.

"Maybe this is crazy,

but I think the right to own a gun 

is trumped but the right not to be

shot by one."

~Andy Borowitz~

Death by gunshot is an agonizing process. Imagine it. Go ahead. Try. Imagine the bullet tearing through your flesh, into your lung, or your gut, or your brain. Bleeding out. Suffocating for lack of oxygen. Now take a moment to imagine your child or grandchild suffering like that. No...no, you can't. It is unthinkable. Unbearable. Impossible. 

Unless you are able to somehow acquiesce to the loss of your own child's life by gunshot, you must take a stand against it no matter which side of the political spectrum you favor. You must speak out. You must act to pass strict gun control laws. To disempower the NRA. To prioritize mental health services. You must put your own guns down. To ignore or deny or vindicate this problem is to invite disaster into your own life and the lives of those you love.

"Protect kids, not guns."

~attribution unknown~

jan