an invitation to heal

 

Listening is a critical skill for health care providers--for doctors, nurses, and therapists in every field. All day long we listen to patients as they tell us their stories...their symptoms, and the timing, severity, and course of their illness. We organize and record the facts in order to arrive at an accurate diagnosis and formulate a treatment plan. 

Deep listening adds another layer of connection with our patients. It involves more than just getting the facts down. It requires us to remain open-hearted, receptive, attentive, and nonjudgmental in each and every patient encounter. It is the key to accurate diagnosis and to healing. It is not, however, an easy skill to acquire or to sustain.

"In deep listening, we listen

with the sole purpose of helping

the other person feel heard and accepted."

~Thich Nhat Hanh~ 

 

In his book, "The Road Home," Ethan Nichtern describes some similarities between deep listening and mindfulness meditation. Deep listening involves sustained awareness, intention, patience, and compassion. As such, the deep listener encounters some of the same obstacles that trip us up during meditation: 

• DISTRACTION: Attention is difficult to sustain because we are distracted much of the time. Linda Stone ("The Attention Project" at https://lindastone.net/) coined the phrase "continuous partial attention" to describe the difficulty we have sustaining focus. Our minds are constantly darting from task to task, from issue to issue, from patient to patient, or simply drifting from one thought to another. We divide our attention between the story the patient in front of us is telling while worrying about the next difficult case, or the results of the tests we ordered on the last patient we saw. Not to mention the emails and text messages that are waiting for a response. Just as we do during meditation, we need to acknowledge the fact that our attention has wandered and return to the present moment.

• FEAR: Another obstacle is the anxiety that can arise during the patient encounter. We worry about getting behind schedule. We worry about making a mistake or missing the diagnosis. The patient's story may trigger a memory from our own experience that reminds us of a painful ordeal we thought we'd put behind us. Suddenly, our hands are shaking and our heart is racing.

• INTERJECTING OUR OWN STORY: In an effort to identify with the patient, we may be tempted to interject our own story into the conversation. Perhaps, like the person sitting in front of us, we, too, have lost a child or struggled through chemo and radiation. We want to share our experience with her--what helped us get through it, where we turned for support, how we coped with side effects. This attempt to create connection and identification can backfire if our story is not what the patient wants to hear, if he is not ready to hear it, or our experience does not accurately reflect his story.

• OFFERING ADVICE: This, of course, is what we do all day long. We order tests, prescribe medication, recommend diets and exercise programs, and make plans for follow-up. The sooner we get to this, the sooner we can move on to the next patient. The problem is that we run the risk of intervening too soon, before we understand the patient's whole story, or worse, before the patient is ready to listen to us.

"The biggest communication problem

is we do not listen to understand.

We listen to reply."

~Stephen Covey~ 



When the patient tells us his story ("the history of the present illness"), he offers us a glimpse into his most private thoughts and feelings. He makes himself vulnerable...literally and figuratively naked before us. We elevate and dignify his presence when we receive his story with an open and non-judgmental heart, when we are attentive and responsive to his needs, and when we respect and welcome his offering.

"The most precious gift

we can offer anyone

is our attention."

~Thich Nhat Hanh~

Deep listening embodies compassion, empathy, and equanimity. It relieves suffering by providing the storyteller with a safe, nonjudgmental, receptive listener. It is an invitation to heal.

jan



how to know when you need help

 

If you are a healthcare provider in any field, or a caretaker for someone...because it is your profession, or because you offered to help out, or because circumstances forced you into the role...you know how hard this kind of work can be. You know what it feels like to do your job when you're exhausted, hungry, scared, unsure. You know how stressful it can be when you're running behind schedule, or you're asked to work an extra shift. It can be hard to make time for your family and friends with everything your work requires. You sometimes miss your kids' games and recitals. You miss family celebrations and holiday gatherings. You do your job even though you're not feeling well or you're in pain. Or when your bladder is full.

"You must find the place inside yourself

where nothing is impossible."

~Deepak Chopra~

We all understand this. We accept it, and we choose it. It is hard at times, but this is what I think is harder. It is harder for me when someone I care about, someone I love, is struggling, and I can't be with them to lend a hand.

"I cannot do all the good the world needs,

but the world needs all the good I can do."

~Jana Stanfield~

I was reminded of this last week when my brother went into the hospital for some pretty scary tests because of a complicated assortment of medical conditions. I couldn't be there with him because he lives far, far away. Which left his wife to manage by herself.

A long time friend is navigating treatment for cancer on her own. Also, far away.

My son's dog ran out of steam this week, leaving us with broken hearts. 

Impotent: how you feel when you are kept from providing care, or support, or encouragement to someone you love, when they need it most. You feel powerless. Helpless. Empty.

"We can't help everyone,

but everyone can help someone."

~Ronald Reagan~

Which is why we need helpers. This week I had to take a step back and turn the care I longed to offer over to other people. My brother's wife stayed with him in the hospital day and night all week long. An old friend of hers stayed at my friend's side during chemo and stood by to offer whatever support she needed at home. My son's girlfriend stood by him with comfort and compassion.

I called. I sent cards. Flowers. Whatever I could. Nothing, really.

"Do all the good you can,

by all the means you can,

in all the ways you can,

at all the times you can,

to all the people you can,

as long as ever you can."

~John Wesley~

This is a reminder to accept all the help you are offered.

jan

the difference between fiction and nonfiction

 

True story.

I used to live in the country, and I loved to walk out there. An afternoon stroll "around the block" was a good four or five mile hike, no matter which route I took.

But there was one road that used to spook me out.

The trees and vines had overtaken a ramshackle trailer settled askew a few yards off the road.

www.2.tbo.com
 It looked something like this.

A pile of old tires spilled up against a dilapidated shed where a muddied pickup truck was parked.

www.flicker .com

You get the picture...it was the kind of place meant for stereotyping. The kind of place you'd expect to find some redneck, beer-swigging, abusive boor with his toothless girlfriend and ragamuffin kids. Or, perhaps some psycho loner with his stash of semi-automatic weapons, his shortwave radio, and a fully stocked bunker somewhere out back.

www.ar15.com

Or, on a more empathetic note...an elderly couple living in poverty who could barely afford their medication, much less the upkeep on their place. I used to cross to the other side of the road whenever I passed the place. It was that spooky.

Then...one fine summer day as I passed, the front door opened and out stepped the lady of the house, a fiftyish woman in a flowered house dress and fuzzy slippers (I kid you not). She waved and called me over. I'm thinking, "This is not happening!" But I crossed the road, worried she might be sick. Maybe she needed help. She stood on the stoop and this is what she said:

"I see you walking by every so often. Do you have any books you could bring me?"

 

True story.

 

I walked away laughing to myself. Books?? When I got home, I put together a bag of old paperbacks and castoffs...and the next time I passed her place, I put it in the mailbox for her.

 

 

 

Not long after that, the place went empty. Gradually, bushes and vines overran the place, and then one day it was gone. The trailer--gone. The shed--gone. The truck and tires--gone. Today there is nothing left of it...just the woods, as though they'd never been disturbed.

 

www.flicker.com

Nothing spooky about it at all.

The end. 

"The difference between fiction and nonfiction

is that fiction has to be absolutely believable."

~Mark Twain~

Epilogue: I never saw the woman again. I have no idea who she was or where she ended up. And I still sometimes wonder what happened to those books. 

 

If books are made of stories, I guess stories can be made of books.

jan

 

you can't make this stuff up

Don’t let the term “narrative medicine” intimidate you. This is a broad and inclusive writing niche. You don’t have to be a physician or a health care provider to practice it. You don't have to be a nurse, an aide, or a therapist. In fact, you don't need to have direct contact with patients at all.

"Everybody has a story to tell."

~Joe Strummer~

Maybe you work in the hospital laundry, and one day, a half-smoked joint falls out of the pocket of a pair of surgical scrubs you're folding. Which bleary eyed surgeon did that come from? Or, imagine you’re a janitor called to fix a leaky faucet in the middle of the night. When you walk into the room, the patient is breathing quietly. Then you hear a groan and his breathing stops. Tell us about it.

Perhaps you've been a patient. Tell us what went through your mind the day you started having chest pain. What worried you about it? Why didn’t you go to the ER sooner? 

Maybe you can tell us what it was like to wait in the ER for hours before someone came to set your child's broken wrist. What did you see there? An angry drunk in handcuffs escorted by the police? Drops of blood drying on the floor? The surreptitious pinch the doctor gave the receptionist on her behind when he thought no one was looking? You have a story to tell.

What is it we like to say? You can’t make this stuff up.

"Everybody walks past

a thousand story ideas every day.

The good writers are the ones

who see five or six of them.

Most people don't see any."

~Orson Scott Card~

Now, let’s add another plot twist.

What if the surgeon who is scheduled to replace your aortic valve in the morning was up all night because that afternoon his son totaled the car on his way home from school? What about the ICU nurse who found the cigarette burn on the shirt her ten year-old wore to school yesterday? What about the single mother who works in food service with the dull ache in her low back and unpaid bills collecting on her kitchen counter? What do you think their stories are?

What is yours?

"Tell your story with your whole heart."

~Brene Brown~

jan

how to change the way you think

 

The news this past week was discouraging. The fires in Maui, and now in Washington State. The approach of hurricane Hilary. The war in Ukraine. The oppression of women in Afghanistan. The threats posed by climate change. The ongoing political nonsense here in the US. Etc., etc...

If, like me, you sometimes just don't know what to think anymore, it may be time to change the way you think. To question what you have come to believe because of what you were taught, what you have observed, or what you have experienced in your life. To pause for a moment to reconsider your customary or conditioned response to whatever it is you're up against this time. To explore the feelings that emerge unbidden, as if on cue. Anger, hatred, fear, greed, shame. Not a healthy emotion among them. 

"If we could see the miracle of a flower,

our whole life would change."

~Buddha~

If you are looking for a way to push through fear, grief, anger, or shame, this could be your guidebook. It helped me a lot:

The author is a senior teacher in the Shambala Buddhist tradition and founder of the Interdependence Project in NYC.

Ethan Nichtern

This is not a textbook about Buddhist psychology or practice. It is not intended to promote spiritual conversion, or coercion. It is an invitation to consider looking at life from a different perspective. To examine our choices in life. To question our values. To explore our relationships. The author demonstrates how ancient Buddhist teachings can bring equanimity, connection, even peace when the life we know is chaotic, confusing, and often painful. He lives in Manhattan, so he would know.

I decided to re-read this book--this week--because I needed a good healthy dose of wisdom. I learned that a friend I thought was on the road to recovery...actually, is not. His cancer has spread. Another friend starts chemo this week. She lives alone. Another is facing a future of slow memory loss and progressive frailty punctuated by confusion. It was a bit overwhelming to contemplate.

I needed to hear about interdependence again. About loving-kindness and mindfulness. About what is true and what is deceptive. What is real and what is illusory. I needed to re-examine my response to the painful transitions my friends and family are facing...and to think about how I can be helpful to them.

"It may be that when we no longer know 

what to do, we have come to our real work,

and when we no longer know the way to go,

we have begun our real journey."

~Wendell Berry~

If the news is getting you down...if you feel powerless, victimized, or somehow blameworthy, or if the twists and turns that mark your own path through life are confusing and sometimes scary, consider this:

"The simple act of caring

is heroic."

~Edward Albert~

Caring gives you something to reach for. Something to build upon. Something to offer. 

Ask yourself, "What am I called to do in this life?" 

"What difference do I want to make in the world?"

"How will I proceed?"

"People change for two main reasons:

either their minds have been opened or

their hearts have been broken."

~Steve Aitchison~

jan

 

what we all need-to-know

 

Burlington, Vt

If you are curious about the healing power of storytelling but you haven't started writing yet, I understand. I had a hard time getting started, too. I convinced myself I lacked the skills and talent and dedication required to line up words on the page, one after another...and then, to rearrange them, over and over again until they sounded right. Until they made sense. Until they rang true.

"Words are sacred. They deserve respect.
If you get the right ones,
in the right order,
you can nudge the world a little."
~Tom Stoddard~


It's hard to know how to begin, but instead of worrying about spelling, grammar, and punctuation...instead of fretting over literary style...or judging yourself before you even begin, you might start by asking yourself a couple of questions:

What about my story does the reader need to hear?

Why?

   

The reader needs to know he's not alone. It helps to know how someone else felt when the doctor pronounced the word "cancer" for the first time. What went through his mind? How did he cope? Where did he find the courage to go on?

 

Or maybe one of your readers needs to know how you helped your daughter when she suffered a miscarriage...and how you got through it. What did you say to her? What did you do to provide relief, or comfort, or solace to her? Where did you find yours?

 

"Write about what disturbs you, what you fear,

what you have not been willing

to speak about.

Be willing to be split open."

~Natalie Goldberg~



People need to know it's OK to cry. To rage. To rest. To ask for help, and to embrace it when it's offered.

People need to know there's hope, and when hope fails, it helps to know where others turn for comfort, consolation, and support.

Where do you turn? What story can you tell? Someone, somewhere needs to hear it. When will you begin?

"The healing that can grow

out of the simple act of telling our stories

is often quite remarkable."

~Susan Wittig Albert~

jan

 





 



what are you afraid of?

If you are a healthcare provider, a caregiver, or worse, if you are the patient...you're probably all too familiar with the word "fear."

"It is both a blessing and a curse

to feel everything so deeply."

~Noah Weiss~

Patients probably bear the brunt of it. When they have to wait for the test results they know will determine their fate. When they face a painful or risky procedure. When the phone rings in the middle of the night, and it's the ER calling. They bolt out of bed and they are on their way. Fear can alert you to danger. It can deliver a jolt of adrenaline. It can be a great energizer, a motivating force. 

Fear is also fertile soil for avoidance and denial. For procrastination. For the imagination. Take the case of the middle-aged man who presents to your office with chest discomfort he describes as "indigestion"...because he's afraid to admit it could be his heart. So he fails to mention that the pain gets worse when he walks uphill. That it radiates into his neck when he lifts something heavy. That antacids haven't helped. He's afraid, all right.

Imagine the fear a parent feels when his child is rushed to the hospital because of an illness, injury, or overdose. 

What is it like for a woman in labor if she lost her last newborn because of a heart condition or some other unforeseen complication? What could be scarier?

"Be brave my heart.

Have courage my soul."

~attribution unknown~

As ordinary human beings trying to orchestrate our personal lives outside of the office or hospital, healthcare providers are prone to some of the same fears. I take good care of myself so I don't worry unnecessarily about my health. But I will admit to a twinge of anxiety when I was asked to return for additional views on my mammogram this year. 

I wasn't worried when my PCP picked up a few irregular heart beats on my physical and ordered an echocardiogram. I drink a lot of coffee, so what did he expect? I wasn't worried until the tech started spreading the goop all over my chest. Suddenly, I was a bit anxious about what they might find. I had rheumatic fever as a child, by the way.

Once, when I was in medical school and my mother was out of town on business, I called my Dad just to say hello. He picked up the phone and greeted me, clearly pleased to hear my voice. Then the line suddenly went silent and I heard the receiver fall to the floor. Nothing. I knew he was alone and I was a three hour drive away. Panicked, I called a neighbor of his to check on him and to call for help. Fortunately, he'd experienced a simple fainting spell when he stood up to answer the phone. As it turned out, he was fine...but I feared for his life.

There's that...and then there's the fear that stalks us through the work day. Who hasn't felt it on the way to a "code"? Will the patient need to be intubated? Will I remember the dose of bicarb or atropine to give, and when to give it? Will we be able to save this life? Fear is never far away.

"The greatest mistake we make

is living in constant fear that

we will make one."

~John C. Maxwell~

What about the patient who shows up unannounced at the office with a bad laceration? Fear kicks in. Will I get the layers right when I sew it up? Will it look OK when it heals? What if it gets infected? 

Will the delivery go smoothly? Will the baby be okay?

Will the Narcan work in time?

"Do what you can,

with what you have,

where you are."

~Theodore Roosevelt~

Patients would probably be surprised to know how fearful we can be. Deciding which tests to order and how to interpret them. Afraid of making the slightest mistake. Worried we might miss a diagnosis.

Fear is like a shadow on a cloudy day. It follows us through the day, unseen. Patients don't know it's there, but it is. It might reveal itself as frustration, impatience, or disengagement. It can cause headaches, rapid pulse, nausea, sweaty palms, or shakiness. Even in doctors. Like everybody else.

"Great fear is concealed

under daring."

~Lucan~

What are you afraid of? What will you do about it?

jan