make me care

 

The art of storytelling is as old as the spoken word. It entertains, informs, and connects mankind across culture, race, and creed. It has the power to heal, and in medicine, it can be a life-saving skill.

Most people enjoy reading or listening to stories at their leisure. The health care provider, on the other hand, listens to stories all day long because it's part of his job. This is how he obtains the "history of the present illness," perhaps better described as the "story of the present illness." It forms the basis of all that follows: performing the physical examination, tracking down the diagnosis, and formulating a treatment plan.

The clinical encounter begins when the health care provider takes the patient's history. He listens for specific details that lead him to the diagnosis. If the problem is pain, the provider wants to know where it's located, and whether it's sharp or dull, steady or throbbing, constant or intermittent. He wants to know how long the patient has had the pain--for a day? For a month? For years? What makes it better? What makes it worse? These details guide him through a maze of possibilities.

"The shortest distance

between a human being and the truth

is a story."

~Anthony de Mello~

The problem is that patients don't know what the provider needs to hear. They don't arrive at the office prepared to rattle off a list of relevant signs and symptoms. It's the provider's job to ask about them, but he only has so much time to get to the bottom of the patient's problem. Nowadays, the written or dictated clinical note has been largely replaced by the electronic medical record (EMR), so rather than listen to the patient's history, the provider navigates his medical record with a series of clicks that pull up an array of bulleted lists, complicated charts, and sketchy details. This is intended to expedite what has been ruthlessly abridged to a ten-minute office visit.

Because time is limited, doctors often redirect the patient who appears to be getting off track or is slow coming up with answers. In fact, one frequently quoted study found that physicians interrupt and redirect the patient when they are as few as 18 seconds into the interview. Frequent redirection leads the patient to believe that what he wants to say isn't important or relevant, so details go missing.

This is a problem. Healing, or failing to heal, occurs in the context of a person's relationships with his family and friends, his surroundings, expectations, and perceptions, as well as his emotional, psychological, and spiritual life. If the patient is denied the opportunity to tell his whole story, part of him may never heal.

"Healing yourself is connected to

healing others."

~Yoko Ono~

Let's say, for example, that the patient presents with abdominal pain. He answers all of his doctor's questions. The pain has been present for four days. He describes it as constant. It started in his upper abdomen, but now it radiates into his back. Eating makes it worse. In fact, the patient says he hasn't been able to keep anything down for the past twenty-four hours. After a focused physical exam and a few tests, the physician correctly diagnoses the problem as acute pancreatitis. But that doesn't explain why the patient develops a headache, has trouble keeping his balance, and becomes confused the day after he is admitted to the hospital.

What the doctor doesn't know is that the patient has been drinking heavily because his wife walked out on him recently. In fact, he blacked out a couple of days ago and woke up on the floor next to his bed. He didn't mention it because he was busy answering the doctor's questions about his abdominal pain. So, the doctor missed the small subdural bleed his patient sustained in the fall until days later when he had his first seizure.

This scenario highlights an important problem. Obtaining an accurate and thorough medical history takes time. Given the imperative to see more patients faster, the provider may have little time to explore the details of the medical history with every patient. Perhaps he's running behind schedule, or an emergency interrupts him. In some cases, the patient can't bear to disclose the sorrow, or fear, or shame that underlies his symptoms, so he doesn't mention it. It takes time to invite, enable, and encourage some patients to share the story that brings them to the office in the first place.

"Storytelling is the essential human activity.

The harder the situation, 

the more essential it is."

~Tim O'Brien~

When the patient is constantly redirected in order to satisfy the provider's agenda, important parts of the story may be overlooked. This reinforces the importance of hearing the patient's full narrative. When we reach into their cholesterol laden hearts to understand why they are poisoning themselves with food, we need to know more than what they are putting into their mouths. When a patient is noncompliant, we need to consider what he is afraid of, or angry about, or grieving over. When we allow the patient to speak, we may discover that the 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.

"The greatest story commandment is:

Make me care."

~Andrew Stanton~

jan

bipolar tendencies

If you weren't downright bipolar before the November election, you might be tending in that direction now, torn, as we are, between fear, dread, and uncertainty...and the bravery it takes just to make it through the day. Between periods of chaos, and moments of peace. Between utter despair, and a faint glimmer of hope. Between anger and gratitude. Sorrow and surrender.

"I'm not bipolar.

I've just had a bipolar life

foisted upon me."

~www.healthyplace.com~

We are only a few weeks into this, and there is no end in sight. How will we make it through? And who will we be when we come out on the other side?

"Life can be like an emotional roller coaster

with its ups and downs.

What matters is whether you are keeping

your eyes open or closed

during the ride..."

~Ana Ortega~

Like our eyes, it is important to discern whether our hearts are open or closed to this journey. How are we coping? In Buddhism there are four fundamental practices that are designed to open the heart: lovingkindness, compassion, empathetic joy, and EQUANIMITY:

"Equanimity: 

mental calmness, composure, and

evenness of temper,

especially in a difficult situation."

~from word-struck~

As Jack Kornfield puts it, "Equanimity arises when we accept the way things are." He doesn't suggest we give up in the face of adversity, or we passively embrace or simply succumb to whatever comes our way in life. He doesn't encourage denial, or indifference, or surrender. He means we acknowledge reality, and reflect deeply on the truth. Then we act out of lovingkindness, rather than giving way to our habitual tendency to judge, blame, retaliate, or cling to resentment and anger. This is not an function of the intellect, a decision we make, or a promise we commit to. It is a practice. A process. A way of life.

"When you find your center

you will not be drawn to someone else's storm.

Instead they will be drawn

to your peace."

~Becky Bro~ 

What if you could find a way to get off the emotional roller coaster that takes you nowhere? Wouldn't you gladly abandon the path that leads you in circles, up the same steep hills, down the same scary slopes, around the same predictable curves, again and again?

Imagine what it would feel like to escape the anger, fear, and confusion that habitually repeat themselves in your life. To tear up the ticket that gets you through the gate to envy, shame, and despair as we head into our uncertain future.

What if, instead, you could be steadfast and strong? Peaceful and calm. Wise and reflective. What if you could bring the whole bipolar ride to a grinding halt? 

How would you do that? What would it take? Who will you become?

Remember this: Teachers abound. You can begin now.

As Poe put it:

"Deep into that darkness peering,

long I stood there,

wondering, fearing, doubting, dreaming,

dreams no mortal being

ever dared to dream before."

~Edgar Allan Poe~

jan

why you should take up writing

 

I often find myself encouraging my family, friends and even random acquaintances to take up writing. I may have heard their stories over a glass of wine or a cup of good strong coffee, on a hike in the woods or on the beach, so I know they can do it. I nag them because I know someone who needs to hear their story. Someone recently diagnosed with cancer needs to hear from a person who has been through it. They need to know the diagnosis was devastating, the treatment grueling, the recovery painstaking, the victory glorious. If you're a caretaker for someone who isn't doing well, or you're battling illness yourself, it helps to know how difficult it is for others in the same situation. How they cope. How they keep their spirits up.

"If you want to change the world,

(...and don't we all?)

pick up your pen and write."

~Martin Luther~

I encourage people to write even though I know how hard it can be to get words on the page. To stick with it. To go back to it again and again. Like meditation, it can be hard to quiet your mind while sitting alone, in silence. Our minds like to be busy, thinking back on things that have happened, thinking ahead to what awaits us, guessing, planning, judging, fretting, when our goal is to stay focused on the work at hand.

In meditation, when our minds wander, we are encouraged simply to acknowledge the interruption and refocus, not to chastise ourselves for getting distracted, or berate ourselves for letting our attention wander. When unbidden thoughts arise, we label them "just thoughts" or "just thinking," and we move our attention back to the breath--in, out, in, out. Letting go of intrusive thoughts helps mitigate the impact of negative emotions such as anger, anxiety, bitterness, and resentment that may have a stranglehold on us.

"You should sit in meditation

for twenty minutes a day, 

unless you're too busy;

then you should sit for an hour."

~Old Zen Saying~

This, I believe, is a practice writers should embrace. We are accustomed to labeling our own negative thoughts as "voices" we hear. It's an interesting metaphor. We are advised not to pay attention to the voices of negativity that discourage our creative efforts. Voices that insist we're wasting our time, that we have no talent for this kind of thing, that we have no hope of success. Voices that make us feel inferior, or guilty for indulging in something we enjoy when others are so hard at real work.

"Tell the negative committee

that meets inside your head

to sit down and shut up."

~Ann Bradford~

The point is those negative voices are just thoughts. Just echoes from the past, not worth arguing about. They are opinions, and they do not have your best interests at heart. Banish them! Return to the breath. Or take a walk. Or call up a friend, someone who encourages you, and supports your dream. Someone who understands how hard this is, and respects you for trying. Someone whose friendship isn't invested in your wealth or fame. 

Do whatever it takes to stay on the optimistic side. Do whatever it takes to tell your story. Turn your attention to the truth:   

"People start to heal

the moment they feel heard."

~Cheryl Richardson~

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