how storytelling reopens the wound

If you are reading this blog, you probably have some familiarity with, or curiosity about, the concept of storytelling as a healing practice. If you are a health care provider, a therapist in any field, a caregiver—or if you have ever been sick yourself—you may have an untold story wreaking havoc in the back of your mind. Perhaps it reflects a painful, sad, or frightening episode in your past…something you’d rather not resurrect. Maybe there was a time of such joy or relief or healing you can’t imagine putting it into words so you haven’t even given it a try.

"A writer is someone

for whom writing is more difficult

than it is for most people."

~Thomas Mann~

Or…perhaps you’ve started the story again and again and gotten nowhere with it. It turns into a rambling description of places, persons, and events that fails to capture the emotions that made the experience meaningful to you.

This is where a good writing prompt can be helpful. That and a supportive reader who knows how hard this is for you and heaps praise upon you just for trying.

If you need a little nudge to get you started, here a of couple of writing prompts for health care providers that might help:

·         Write about “expectations” you’ve embraced (or rejected).

·         Tell us what it feels like to work without sleep, on an empty stomach, when you have to pee, in the middle of the night.

·         What goes through your mind on the way to work in the morning…or on your way home at the end of the day.

If you are the one who was sick, or you cared for someone who was ill, try these:

·         Write about "waiting."

·         Tell us what you fear the most.

·         Tell us what you do to care for yourself.

When you begin, don’t worry about grammar, spelling, or punctuation. That’s the easy part, and it can wait until later. Instead, write about the first thing that comes to mind.

"When in doubt, tell the truth."

~Mark Twain~

Give yourself 15 minutes or so, then rest. Wait a couple of days and try again. Write until you come up against the piece that is hardest to write…a time when you were so sad or scared or angry you still hesitate to commit it to paper…or so comical or comforting or inspiring it leaves you groping for words.

"The most important things are

the hardest to say

because words diminish them."

~Stephen King~

When you write, include details even if they seem insignificant. The missing tile on the ER wall. The overflowing trash can in the visitors’ lounge. The ladybug that made its way into the OR. These familiar images connect the reader to your story. Use the senses to bring the scene to life. The sight of blood pumping out of a tiny artery after the other bleeders were all tied off. The taste of cold, black coffee in the middle of the night…and why you sometimes need it. The smell of stale urine.

"To create something exceptional,

your mindset must be relentlessly focused

on the smallest detail."

~Giorgio Armani~

An untold story can leave us with a vague sense of frustration, anxiety, or confusion that we don’t understand, and can’t dispel until we put it into words...until we set the scene, name the players, and face the feelings that have festered out of sight for so long.

Storytelling unmasks the wound so healing can begin.

"Nobody cares how much you know,

until they know how much you care."

~Theodore Roosevelt~

jan





have you had your nap today?

 

Have You Had Your Nap Today?

 

Back in the days when my priorities were somewhat skewed, writing was on the bottom of my list of the ten most important things I needed to accomplish every day. Ahead of writing…dreaming up characters, fabricating dialogue, and searching for just the right word…were:

--caring for my patients

--getting the kids out of bed, dressed, fed, and off to school

--keeping the house in reasonable order

--getting meals on the table

--staying ahead of the laundry

--managing the yardwork

--running to the bank, grocery store, post-office, dry cleaner, etc., etc.

--preventing dirty dishes from accumulating in the sink

--getting a little exercise

--staying in touch with family and friends

...all of which are honorable and necessary expressions of a civilized life, but really? How much can one person do in one day? And notice that embellishments such as enjoying a manicure or massage, meeting with friends over a cup of coffee or a glass of wine, and slowing down long enough for an afternoon nap are nowhere on the list, a sure sign that something needs to change.

"Good things happen

when you set your priorities straight."

~Scott Caan~

Now I know better. I have learned that many of the little self-imposed tasks and obligations that we stake our lives on can be organized and dispatched in a heartbeat. I know now that before we tend to them, we must first of all write…or paint or compose or sing or dance…in order to sustain momentum, to nourish and energize ourselves, to satisfy and fulfill our longings. In other words, to be creative and connected and happy. And instead of barreling through the day at warp speed in order to earn ourselves a few free minutes to write before we collapse into bed at night, we must learn to celebrate the virtues of idleness, day-dreaming, playfulness, solitude, silence, and rest. As the mind wanders, so does the imagination. And out of the imagination, who knows what might emerge? 

                                "Let's start by take 

                     a smallish nap or two."

                                            ~Winnie the Pooh~

Have you had your nap today?

jan

there's a wound out there in the shape of your words

 

I spend a lot of time encouraging people I know to tell the stories they hold tight in their hearts. To write them down, or get them onto a canvas, or put them into movement or song. As a physician, I do this because I know that storytelling is a healing practice. Why is this important? In the words of poet Sean Thomas Dougherty:

"Because right now

there is someone out there 

with a wound in the exact shape of your words."

~Sean Thomas Dougherty~

People need to know they're not alone. They need to know how you survived. That there is hope. That their story is important, too.

We hesitate to begin out of fear. We tell ourselves we don't write well enough. We don't know where or how to get started. We are sure no one could possibly be interested in what happened to us, so we make up excuses. I don't have time to write. My grammar and spelling stink. People will never believe me.

Sometimes, shame silences us. We have been conditioned to keep secrets. We blame ourselves for what happened to us. Or perhaps we're still struggling with the issue. It's too painful, or sad, or maddening to put into words.

If you're having trouble getting started with your story, if you have no confidence in your ability to tell it, or you have no time or energy to devote to one more thing...welcome to the club! This is where we all started.

The good news is that help is available. 

"When the student is ready,

the teacher will appear."

~Various Attributions~

This week, I finished "Memoir as Medicine" by Nancy Slonim Aronie. As soon as I hit the last page, I started again at the beginning. If you need just a tiny jolt of reassurance, inspiration, and encouragement to pep you up, stop whatever you're doing right this minute, and order this book. Or run out and purchase it. Do it! We'll wait. While you're at it, pick up a new notebook or journal so you can take notes. Prepare to laugh, and perhaps, to cry. Prepare to begin writing. Get ready to heal.

"Writing is medicine.

It is an appropriate antidote to injury.

It is an appropriate companion for

any difficult change."

~Julia Cameron~

Now go to the author's website at https://chilmarkwritingworkshop.com/ to learn more.

jan

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

jan

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~

*

jan

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?

jan

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~

jan