the moose in the mud

 

"The clearest way into the universe is through a forest path." 

~John Muir~

I was lucky enough to have been invited to spend last week in a cabin in the Maine woods. My "bucket list" item for the trip was to spot a moose, and I did. But not in the way I had hoped.

My daughter and I set out one evening for a bog that was known by the locals as a good place to watch for moose. We pulled off the road and waited...and waited...and waited. We thought we were seeing a bird flapping its wings every so often, until we realized we were seeing the ears and tail of a moose twitching as she lay in the mud. 

We pulled up closer, and sure enough...there she was, lying in the mud, barely visible. It occurred to us that she might be sick or injured, but she wasn't struggling, or calling out. So we concluded that, like all good mamas, she just needed a little time to herself, and what better place for a moose on a hot day than in a nice cool mud bath. Still, we didn't think it was too much to ask for her to stand up and take a few steps for us, so we whistled at her, clapped our hands, called out to her, and honked at her. We pleaded with her and cajoled her...all to no avail. We gave up as darkness closed in...

"Until one has loved an animal,

a part of one's soul remains unawakened."

~Anatole France~

...but the next morning we were on the road at 5 AM to see if she was still there. Again, it was hard to make her out, but there she was! We stayed with her for an hour, but except for those twitching ears, she didn't move. 

So, we went back that evening, and we were actually relieved to see that she had moved on...that she was OK...until we pulled off the road to turn around. That's when we found her. Dead, in a clearing, with two broken legs. How she managed to get out of the mud and through the underbrush to the clearing I will never understand. The pain. The suffering. We were stunned. Heartbroken. And so, so sad for her.

"May all that have life

be delivered from suffering."

~Buddha~

Why am I sharing this story on a narrative healing blog?

I can't get her off my mind. Perhaps telling her story will help me accept it. Maybe it will serve to caution inattentive or careless drivers. Maybe it will honor her suffering, in some way. 

It makes me wonder how I will bear my own  pain when the time comes. What if I go into heart failure? Or I develop cancer? Or I fall and I can't get up? Will I bear it quietly? Courageously? Patiently? How will I prepare my family for it? 

~Ilan Shamir~

As health care providers, we all witness pain and suffering. We are trained to do whatever we can to relieve it. We all witness death. In some cases, we have time to prepare our patients for it. We are sometimes called to break the news to their families. I held my mother's hand during her last hours, and stayed with her until she took her last breath. She didn't die alone, in pain, to be discovered too late by some passerby.

It makes me wonder how, in that vast wilderness, a solitary moose and a rare passing vehicle happened upon each other that day. Why? What are we meant to learn from this disasterous stroke of synchrony?

It reminds us that we don't always know when someone is suffering. Like the moose in the mud, they may not let it show. 

We are reminded to seek them out. To be patient with them. To be kind and gentle always.

To hold space for them in our hearts when there is nothing we can do to help.

I'm pretty sure the moose just became my spirit animal.

jan

why you should question everything

As a health care provider, I'm accustomed to dispensing advice. I tell my patients how they can lower their cholesterol levels. How much exercise they should get. Why they should definitely get the Covid-19 vaccine. And colon cancer screening. Patients, even friends and relatives, expect it.

"If it's free, it's advice.

If you pay for it, it's counseling."

~Jack Adams~

Now that I'm older and wiser, I have one more piece of advice to impart:

Save your money,

and invest it wisely so you can retire early. 

Why? Because it can take a long time to unlearn what you were taught that has become obsolete, or been proven wrong, or was outright false to begin with. It isn't easy to undo all that contradicts your sense of what is compassionate, fair, and true. It isn't easy. There's a lot to do, and it takes time.

Think about it. We now have access to information we couldn't imagine when we first entered medical practice. We didn't have MRIs or PET scans. We were just learning about the applications of radioactive isotopes in diagnosis and treatment. Laparoscopic and cryosurgery weren't options. Immunotherapy wasn't even on the horizon back then.

It's disconcerting to realize that the care we thought was top-notch proved to be ineffective, or worse, harmful to our patients. We know now that we were doing CPR all wrong. We were abusing antibiotics. We didn't recognize the existence of the human biome and its role in health and illness. Our understanding of epigenetics has changed the way we view the transmission and inheritance of DNA. We dismissed the importance of the mind-body-spirit connection in illness and health. 

The fact that we know better now...that we have learned over time...is a good thing. But this is the point:

"The important thing is

never to stop questioning."

~Albert Einstein~

This pertains to everything in life...to all we have been taught, or want to believe, or have been coerced into accepting as truth...about evolution, about the natural world, about cultural norms, about religion, and about science itself.

Question everything...and then,

when you think you have it figured out,

question yourself. 

As the Buddha put it:

"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 common sense."

~Buddha~

jan

 

how to play "stop the clock"

 

I retired after thirty years practicing Family Medicine out of fear.

I didn’t leave because of the long hours, or the fact that I’d been running hopelessly behind schedule all day, every day for three decades. I didn’t leave to take an easier position or to make more money. I didn’t ask to be excused because of fatigue, or forgetfulness, or ill health.

 

What scared me was the inevitability that I would miss a critical diagnosis, and because of it, I would subject the patient to unnecessary and inappropriate testing and treatments...all because I didn't get the patient's full history. I didn't know the whole story. Who had time to listen? Who had time to search for hidden clues to the diagnosis?

 

"I think of my patients as

body AND mind;

the more I understand about both of these,

the easier it is for me to help."

~Dr. McKenzie Mescon~

 

This fear reflected, in part, the trend toward productivity requirements that link complexity with compensation. Briefly...a doctor generates more money by seeing more complicated patients in less time, and by utilizing fewer diagnostic resources in their care. This is a sure recipe for disaster.

 

Let's say a patient presents with a sore throat and fever. His health care provider checks his throat and ears, and feels around for swollen submandibular lymph nodes. A throat swab is negative for Strep. But because he's running behind schedule, and only has ten minutes to see the patient in the first place, the provider fails to palpate the enlarged supraclavicular node that would have tipped him off to the real diagnosis...the lymphoma that was simmering out of sight. The lymphoma that was causing the patient's night sweats, fatigue and weight loss that no one asked about. It has happened. 

 

"The important thing is

not to stop questioning."

~Albert Einstein~

Details go missing all the time. 

Health care providers have to deal with time constraints. There simply is not enough time in the schedule to invite every patient to elaborate on the details of his medical history or symptoms. The provider gets the basics down, but then he is left to jump to conclusions or to dismiss further input that might otherwise affect the patient's treatment and prognosis. For example, it's bad enough when a patient presents with a broken arm after falling off a ladder at work...but it gets complicated if the patient fell because he was drinking on the job. That's a whole different problem.

The provider is also tethered to a coding and reimbursement system that doesn't compensate him for the time he takes with his patients. The EMR does not reflect psychosocial, emotional, or relational complications of illness or injury, all of which affect the patient's ability to heal.

In addition, people are busy. They're in a hurry. They may have to squeeze in a quick visit to the doctor between meetings or other commitments. To save time, they may minimize or dismiss their symptoms. For example, the patient may not want to stick around while you run an EKG for what he wants to believe is a case of indigestion. If the doctor has taken the time to explore the symptom, though, he may suspect angina...it gets worse when the patient climbs a flight of stairs, or he sometimes feels it in his jaw, or it makes him dizzy. It's not just a little heartburn.

 

Another problem is the fact that the patient may not have the language to describe his symptoms. To a doctor, there is a difference between lightheadedness and dizziness, episodic pain and steady pain, fatigue and weakness. They mean different things and imply different illnesses, and that may take some sorting out.

 

"It can be argued that

the largest yet most neglected

health care resource, worldwide,

is the patient."

~WV Slack~



Patients may also withhold information out of shame, fear, or guilt. Alcohol, tobacco, and drug abuse are prime examples. STIs  are another. Any behavior, or practice, or habit that contributed to their illness, or heartbreak, or regret is part of the story that needs to be told before healing can begin.

 

It can be as much of a challenge for patients to tell their whole story as it is for physicians to ask about it. 

Some time ago I related the history of a patient who claimed her left orbital blowout fracture was the result of a fall causing her to strike the corner of her TV...when in fact, it was the result of a blow from her boyfriend's fist that required me to secure a PFA and to find safe shelter for her. That took time, but it may have saved her life.

 

Isn't that what physician productivity is really all about? Time constraints, reimbursement issues, and productivity aside...we are here to deliver high quality, compassionate, and complete health care to our patients...not to play "stop the clock" with them.

"You define what is important to you

by what you dedicate your time to."

~Vishwas Tiwari~

jan

 

the willing suspension of disbelief

If you write fiction, you know how careful you must be to include details that make your story believable. You are in charge of creating realistic characters. You have to build a world the reader can visualize and understand. What happens there must be consistent and plausible given the story line. Even so, you may be asking the reader to suspend disbelief...to accept the fact that dinosaurs can coexist with astronauts, for example, or that extinct creatures can come back to life, or that your hero's superpower is mental telepathy.

"A piece of writing has to seduce the reader.

It has to suspend disbelief and

earn the reader's trust."

~Po Bronson~

If, on the other hand, you write nonfiction, you need to focus on the facts, and communicate them with accuracy and clarity. This, too, may require the reader to suspend disbelief as you discuss new discoveries that challenge the old...for example, recent observations and speculation about the immensity and complexity of the Cosmos. How viruses mutate. How you can hear a multiplicity of sounds, including each one's volume and pitch, how you discern harmony and melody, and how you assign meaning to them, all at the same time. Beautiful music. Approaching storm. Childhood lullaby. When you pause to think about it, it's hard to believe. In fact, it's hard to believe much of what we are learning about how the human body functions.

Advances in modern medical technology have made it possible for us to observe and understand, for the first time, how the human body takes care of itself. How it fights off infection. How a bruise just fades away. How a broken bone heals. The fact that a patient recovers after a heart attack or stroke is enough to challenge anyone's concept of reality. Still, that's the easy part...

"The body is a remarkable mystery,

capable of untold feats

of self-preservation and healing."

~J. Upledger~

...because, every day, we're learning more about how the body sustains and heals itself without any conscious awareness, attention, or effort on our part. Meaning that much of what the body does to keep itself healthy, and what it takes to heal, is under subconscious control.

We have long recognized the "placebo effect": This takes place when, unbeknownst to the patient, he is "prescribed" a useless sugar pill by his physician, but he recovers just as he would had he been given a proven drug. This is believed to happen because the patient trusts his doctor, and believes he is getting a real medication that is known to work for his condition. He expects to get better. In other words, healing depends on the patient's conscious thoughts about it.

"Your body's ability to heal is greater

than anyone has permitted you to believe."

~Unknown~

But then, there's this: Diabetes has subsided, and skin lesions have disappeared under hypnosis, suggesting there is an unconscious component to healing. This has been shown to correlate with the patient's belief that healing is occurring because of the hypnotic suggestion that it is. Just the thought of it.

And this: Patients with Multiple Personality Disorder have been observed to change not only their voices and mannerisms as they morph into different personalities, but to change their eye color. Scars observed in one personality can disappear as another personality emerges. And their EEG changes, suggesting that the mind is intrinsically involved in the transformations that are observed. 

We don't know how that happens, yet...but in medicine, as in writing, it requires the willing suspension of disbelief to even imagine it.

"It is now life and not art

that requires the willing suspension

of disbelief."

~Po Bronson~

jan

the hardest thing about storytelling

 

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 heard and understood by someone we trust 

 
I hear this from people over and over again:

“I’ve always wanted to write, but…”

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

         …but I'm not good enough.         

         …but I don’t have the time for it.
         …but I don’t have anything important to say.

"All you have to do is write

one true sentence. 

Write the truest sentence that you know."

~Ernest Hemingway~

 

If opening lines come to you when you’re driving to work, or a memory sometimes 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 get started.

"The scariest moment

is always just before you start."

~Stephen King~

You know who you are. We've been over this before. Your voice has been silenced for too long. Perhaps it was the "C" you received on your term paper in seventh grade because your teacher was having a bad day. Maybe you're surrounded by cynics who insist you can't earn a living as a writer. It might be your own inner critic lying to you about how bad you are at spelling and grammar. All of them conspiring against the creative, wise, and eager writer you could be.

"The hardest thing about getting started

is getting started."

~Guy Kawasaki~

jan

what happens in the aftermath of illness

 





Here are a few things I've learned from my own experience with illness when I was a child:

• The aftermath of childhood illness can linger for a lifetime. You think you're over it when, out of nowhere, the sight of 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.

"You can spend a lifetime

trying to forget a few minutes

of your childhood."

~unknown~

• It comes back in snatches. In trivial details. In isolated moments. The sound of a call bell from somewhere down the hall. The Little Golden Books stacked on your night stand. The smell of stale urine.

• Distant memories continue to surface uninvited. Your mother in tears, your father's arm around her waist. The way you cried yourself to sleep at night. The exact moment, years later, when you made up your mind about becoming a doctor. At least, I did.

"Sometimes superheroes reside

in the hearts of small children

fighting big battles."

~unknown~

• The lasting effects of a childhood illness can send you down a path you never intended to follow.

• Illness has the power to transform you into someone you never wanted to be. It can leave you with a permanent limp or an ugly scar. A weak heart or a chronic cough. Fear. Anger. Shame.

• If you were sick as a child, or if you have a child who is ill, or if you care for sick children, it teaches you how mindful you must be when you care for them. You may not discover until it is too late that something you said, or something you did, or that something you failed to say or do, had a lasting impact on your young patient...a sometimes devastating impact.

"Caregiving often calls us to lean

into love we didn't know was possible."

~Tia Walker~

 

If you were sick as a child, what did you learn from the experience? Will you share it with us? Will you tell us your story?

 

jan

 



 

the greatest mystery

If you work in health care as a doctor, or a nurse, or a therapist in any field, it's probably safe to assume you understand how the human body functions. How the heart maintains its steady beat without any effort or awareness on your part. How the lungs manage to deliver just the right percentage of oxygen to your tissues, and how they eliminate the carbon dioxide you exhale. How an open wound closes, or a broken bone heals.

"Your body's ability to heal is greater 

than anyone has permitted you to believe."

~Roger Ford~

If the way the heart and lungs operate is something that amazes you, the way the brain works should mystify you. How it oversees and regulates every bodily function. The way it controls movement, maintains our sense of balance, orchestrates vision and hearing, enables our senses of taste, touch, and smell, and modulates the neuroendocrine system. And on and on...

If you're in health care, you studied human anatomy and physiology for years. You learned about the anatomy, physiology, biochemistry, microbiology, and cellular biology that life, as we know it, depends upon, and illness disrupts. You are familiar with the functions and processes that make healing possible. Except one.

"Your body hears everything 

your mind says."

~Naomi Judd~ 

The one thing we don't study, or dissect, or measure in preparation for patient care, which is our calling, is the nature and essence of thought. We don't examine memory under the microscope, or trace the course of creativity and imagination. We don't fully grasp the location or power of human consciousness, and we don't come close to understanding the function of the unconscious. Because no one understands it.

The hardest thing we can do is to think about our own thoughts.

"Consciousness poses the most baffling problems 

in the science of the mind.

There is nothing that we know more intimately

than conscious experience,

but there is nothing that is harder to explain."

~David Chalmers~

Interestingly, it is not so much the biologists, physiologists, pathologists, or psychiatrists who are making headway in the quest to understand consciousness, but the quantum physicists, contemporary incarnations of the likes of Einstein, Bohr, Planck, Bohm, Heisenberg, John Wheeler, and Paul Levy who are compelled to define reality without any proof of it. To understand consciousness without any image of it.

If, like me, you are in awe of the complexity, precision, and perfect timing that mark the biology and physiology of the human body, you can't help but be mystified by the brain. Sooner or later you will be led to contemplate the role of consciousness in health and disease. The benefits of meditation. The influence of mood and emotion on wellbeing, all of which should amaze you. Humble you. And naturally spiritualize you.

"Attempting to understand consciousness

with your mind

is like trying to illuminate the sun

with a candle."

~Mooji~

I just finished a book about quantum theory. It opened with an introduction, foreword, and preface, and it ended with 896 footnotes. It suggests that there is a precise, elegant, and exact parallel, down to the most minute detail, between the laws of subatomic physics and the workings of the human mind. That would be hard enough to comprehend if we understood the mathematics that proves it. The problem is we don't have a language to express it yet. And, until we do, the nature of consciousness will remain a mystery, and an untapped resource for patients and healers alike.

"If you think you understand

quantum mechanics,

you don't understand quantum mechanics."

~Dr. Richard Feynman~

jan