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Medical Boundaries: Which Are Necessary?

AsklepiosPrize

Did you hear the one about the doctor who went fishing with his patient?

Neither had I until a friend told us about a trip he’d taken with his doctor to go fly fishing.

I wondered if he always went fishing with his doctor and he said, “No, if I have to take off my pants we meet at his office.”

This set me to thinking, as usual. In my training as a social worker, boundaries were—if you can imagine this—simultaneously rigid and blurry. They were rigid when it came to three basic things:

  1. Whatever is done must be done for the benefit of the patient. Period.
  2. No sexual relations whatsoever—implied, verbal, or physical—with any patient even when that patient has been terminated from treatment.
  3. No manipulation of the patient for personal gain, e.g., getting particularly close so you can meet his Hollywood producer cousin.

After that, however, the rules are fuzzier. In social work, the office is not the only place treatment takes place—it happens in the home, on the street, in homeless shelters, domestic violence advocacy centers, in schools, and just about anywhere else people get hurt or feel unhappy or need help. It is one of the few schools of psychotherapy that accounts for the person in situ—that we are more than a conglomerate of neural impulses or internal motivations. We live, breath, and move in an environment. We are driven not only by our own minds but by the currents that surround us. Interventions, then, must not only take those forces/currents into account, but deal with them. Sometimes that means that we move the office outside into the patient’s life.

But what about being—rather, more specifically, would I become friends with a patient? Or, conversely, would you be friends with your doctor?

Personally, there’s something about the idea that makes me nostalgic. There was a time, not that long ago, that a doctor was not a deity surrounded by the impermeable membrane of incomprehensible technology. A doctor was just another member of the community. He raised children that went to school with our children. He went to religious services with (or near) us. He got sick, took walks, bought food, and went fishing just like everyone else. We knew his first name. He knew all of ours.

Healing was not some private province. It was part of the large, bumpy wheel of living and dying.

If I’ve told you all this story before, forgive me, but it’s one of my favorites. My father is a doctor. Retired for 15 or so years, he still goes to Grand Rounds at 91 years old to learn and talk shop. Besides my mother, his only true love was and still is medicine. After he served on an army hospital ship in the South Pacific, he opened a small office in the Bronx.

Most of his patients came and went like they do in most physicians’ offices. One couple was different.  Harry was a strapping Scots-Irish trucker who was as easy-going as a man could be and as hardy as an oak tree; his wife, Irene, was as delicate as a porcelain tea cup and a consummate worrier. They came in for physicals or those occasional minor complaints that fill a family practice, until one day he came down with a fever of unknown origin. (There were far more of those fevers then than there are now.)

They called my father’s answering service in the middle of the night. The phone rang in our home and my father ran out with his medicine bag (he still has it) at 1 or 2 in the morning. He stayed there with them, holding Irene’s hand and doing whatever doctors did for mysterious and dangerous fevers until it broke. It was hours and hours.

The point of the story is not just that Harry got well or that Irene was happy. They became friends. They stopped at my father’s office to say hello, to bring pastries, to help with odds and ends. They started coming to the house for birthday parties and holidays. We called them Uncle Harry and Aunt Irene. And they still went to my father for medical care until the day they moved into a retirement village hundreds of miles away. And even then, they did nothing without consulting my father first.

How would that fare today? I honestly don’t know how most medical doctors would handle it. I suspect that most would avoid it for a number of reasons, not the least of them being liability anxiety. In social work, it is a bit easier to go out on a limb for a patient, to step out of the office for a moment. I have done it more than once—gone to graduations of clients whose families were far away, attended baptisms, stood quietly at memorial services, and walked frightened patients into health care centers when they wouldn’t (or couldn’t) go alone. It sits well with me. And it seems to have been good for them, which is how I measure it. I mind the basics (those three rigid rules) scrupulously, but I leave liability to the side, where it belongs.

Maybe I shouldn’t be so carefree about it, but I believe that proper (meaning spiritual rather than romantic) love—more than technique—is the source of cure. Especially in my work. Maybe not so much in the emergency room…but even there I think a point could be made for it.

I occasionally meet with one M.D., who is also a classical homeopath,  to discuss cases. He has been a teacher and a friend over the last few years. I’ve watched him work and he seems to feel the same way about medical boundaries. I don’t think he walks his patients into advocacy centers, but I’ve seen him attend his patients in his home office with a compassion and warmth that is unique in the business today. He dresses casually. He listens. He offers water or tea. He makes himself available both in terms of time and emotion. I don’t think he frets too much about liability either.

I guess people just have to do what they are comfortable with. If they are afraid of being sued, then perhaps they should take the precautions they need to avoid it. I don’t know if that makes it better or worse. They say we draw in what we fear most. I do know one thing. Harry and Irene lived a long time and they loved my father till the day they died.

 

 

Why Is Death So Shocking?

In Memorium: Bugsy 1996-2012Bugsy and Dave near Sandia

You would think after the supposed millions of years we have been “evolving” or adapting that we would be as surprised by death as we are by eating and elimination. You would think that if it were just another natural process that it would be as shocking as summer following spring, as stunning as another morning coffee. Why do we accept the brittle decay of maple leaves with such ease, yet when it comes to ourselves, to our friends, families, and pets, we are benumbed with grief, baffled by the finality of something that, by all scientific accounts, should be normal?

You would think after the supposed millions of years we have been “evolving” or adapting that we would be as surprised by death as we are by eating and elimination. You would think that if it were just another natural process that it would be as shocking as summer following spring, as stunning as another morning coffee. Why do we accept the brittle decay of maple leaves with such ease, yet when it comes to ourselves, to our friends, families, and pets, we are benumbed with grief, baffled by the finality of something that, by all scientific accounts, should be normal?

I have been told by very wise people that I have to make friends with Death. I believe they are right. But I have not yet been able.

Today, at 7:15 a.m., my husband’s dog, Bugsy, died after an old-fashioned Western, three year stand-off with cancer. Diagnosed with sarcoma in August of 2009, he was given about a month to live. Like the time he got his teeth wrapped around the edge of a flank steak, he took that to the track and he just kept going.

This is not an article about what we did to prolong his time with us or give him what we hoped was a beautiful quality of life. We did a lot of things—raw diet, classical homeopathy, at the very, very end steroids and antibiotics. We did whatever we could reasonably do without putting him through endless procedures or making him uncomfortable. We didn’t spend a lot of money. We didn’t go crazy. We took it one day at a time.

Which brings us to the point of this article: We had three years to prepare.

But as we knelt beside him and the doctor delivered the final injection, even though we knew exactly what was going to happen, we could not fathom it. When he took his last breath, we held ours, too. Were we waiting? To see if he would somehow defy the odds yet again?  Despite all our knowledge and all the obvious evidence, we could not believe he was gone. We stood looking at his little body and wondered where he went.

How is that?

How can we not believe it? How can I be in shock about Bugsy’s death any more than I’m in shock when the sun goes down or a breeze pushes back my hair? How can I say, “I can’t believe he’s not here!” when I’ve seen death in full frontal form with family members, friends and other pets.

But I was in shock. Again.

Maybe it has something to do with the kind of dog he was, with the kind of presence he had, with the way some people said, “He’s like a person.”

I thought if he had been a person, he would have been a Keystone Cop and he would not have been acting. He was cantankerous, funny, loving, protective, goofy, and he was my husband’s Guardian Angel. He was the dog that saved his life.

It was the night after Christmas. He’d been playing at a private party. At 4 a.m., he got a call from a friend saying they’d found a dog frozen to the street. He was about 4 to 6 weeks old, no more than that. His step-son, Stephen, had been asking for a dog for months, so he went to look at him. When he picked him up, he crawled up his chest. “I thought he was going to lick my face, but he jumped off my shoulder.” That was the beginning of a 16 year story of near-death adventures.

He had worms, a heart murmur, a gimpy leg from being frozen or possibly broken early on, he hadn’t been weaned and was not socialized. His was a slippery slope from the very beginning and raising him took work and attention but his crowning achievement was learning how to catch and crack pistachios, eat the meat, and spit out the shell.

Years passed and my husband suffered through several major disappointments—“rough times and hard drinking,” as he calls it. What saved him was knowing that Bugsy not only loved him, but needed him.  He had to stay alive, no matter how he felt. “He kept me coming home and he kept me waking up. He stared me down, waiting for me to wake up, some days, but I did, because he was there.”

When he was struggling with getting sober, he committed himself to a daily ritual with Bugsy: they would wrestle and play until they were both exhausted.

One day, he had given Bugsy a bath. It was his custom to dry him off with a towel then Bugsy would run through the house. But on this occasion, he jumped out completely wet, shook the suds off on the tile floor, and shot into the kitchen, where he waited behind a wall. Dave ran after him, flew up feet first, landed on his arse—hard—and Bugsy poked his head out, smiled (literally), and laughed, “HAH!”

He was a dog’s dog, a man’s dog, and eventually, he became a pack dog and a family dog when he became a part of our larger home life. He was the most adaptable dog I’ve ever encountered. There were incidents (one in which he was held by the nape of the neck by one of our bigger dogs until he squealed “uncle”), but he found his place and his peace.

When I told my mother about Bugsy’s passing, I started crying again. And as soon as I wept, she did, too. In between our sniffing and sobbing, I somehow managed to rail at the universe again, to be shocked again, to wonder again—how, why, what the heck was all this about, anyway? I told her, “I’m so sick of death.”

And she said to me, “You know, that’s the problem. You can’t stop it. You’re not eternal. No one’s eternal.”

And I remembered what Peter Kreeft had to say about that: Maybe the problem is the other way. Maybe we are eternal. Maybe we are continually shocked by death because it represents the antithesis to our highest natures, to our spirits. I may be wrong and if I am, I guess I won’t know it anyway. It’ll just all be gone and over, nothing. If I’m right, though, I’ll be kneeling down with Bugsy behind that wall, waiting to see Dave slide across a sudsy floor and we’ll both go, “HAH.”

 

Trending Now: Prescription Addiction

pill-manIs the medical profession finally catching on? I recently saw signs of hope.

In the February 22/29th edition of Jama (*1), the editors described a report issued by the CDC in a splendidly titled tome, Morbidity and Mortality Weekly Report.

Throughout the dryly presented data were intertwined subtle sirens of alarm: The rate of unintentional drug overdose deaths in the United States has risen over 600% in the years between 1997 and 2007.

We are not talking about heroin or methamphetamine or crack. We’re talking about prescribed analgesics. Prescribed. According to the CDC, “drug distribution through the pharmaceutical supply chain was the equivalent of 96 mg. of morphine per person in 1997 and approximately 700 mg. per person in 2007,” a dose high enough for everyone in this country to take a standard 5 mg dose every 4 hours for 3 weeks.(*2)

The report continues its assessment and finally makes this stunning observation: “Prescription drug abuse is the fastest growing drug problem in the United States…and has been driven by a class of prescription drugs called opioid analgesics.”

It goes on: “For every unintentional overdose death…nine persons are admitted for substance abuse treatment, 35 visit emergency departments, 161 report drug abuse or dependence and 461 report non-medical uses of opioid analgesics.”

Why? How could this be? Are these drugs being stolen? Manufactured by thugs in a trailer in the desert? Sold by wayward pharmacists? Smuggled from Canada? Hardly that dramatic. In fact, we are being addicted by the people we trust the most: “In an attempt to treat patient pain better, practitioners have greatly increased their rate of opioid prescribing over the past decade.”

Did someone say there was a war on drugs?

Allow me to share a more personal and human rendition of these statistics. One was a patient (name and details changed) whose situation was far too common, and one was a personal experience I had after a back injury.

The patient came to me with minor anxieties and some depression in large part due to unresolved grief. She was in her mid-thirties, a nurse, without major medical complications. Almost all her complaints centered on her fear of abandonment in relationships. Early on in treatment, she slipped at work (trying to move a large man from bed to a wheel chair) and injured her shoulder. After MRI’s and doctor visits that lasted months, they finally determined that she had some injured tendons. They put her on Vicodin. They refused her any other form of treatment.

That was 15 years ago. Needless to say her doses increased dramatically over the years as did her anxiety, her depression, and finally she was able to witness the abandonment she so feared. Her marriage fell apart. She was so addicted to the Vicodin that the withdrawal was more frightening than the dissolution of her family.

I have seen this scenario in different forms at least a hundred times. I have made phone calls begging physicians to please reconsider their choice of medication and allow for other medical solutions: acupuncture, physical therapy, massage, homeopathy, mindfulness meditation, hypnosis. With the exception of a few truly open-minded practitioners, the answer was a uniform “no.”

Why would anyone object to an alternative treatment if it brought relief at lower cost and without the risk of addiction and all the associated medical risks?

I found this out for myself personally not more than a few years ago. I fell (hard) and twisted my back. When it happened, I was more embarrassed than in pain and told myself (and everyone else watching), “Oh, I’ll be fine. It’s fine.” Within the time it took for my adrenal glands to stop pumping, the pain became intolerable. I could not walk. My husband took me to urgent care and they told me it was a muscle sprain because there was nothing on the x-ray. They urged me (I mean this literally) to take pain killers.

I said, “No, thank you.”

The doctor on staff looked at me cross-eyed and said, “What do you mean, ‘no, thank you?’”

I said, “I mean no. I don’t want them. How about some aspirin or ibuprofen or something like that?”

He reluctantly gave in and wrote the prescription but not without saying, “You’re going to be sorry.”

The pain was not going away as quickly as I’d hoped but I had seen what opioid analgesics could do and was determined to do whatever I had to do to avoid it. After putting up a fight with the insurance company that lasted two months, I finally went for an MRI where they found the bulging disc that was impinging on my sciatic nerve.

I found a physical therapist who was a hands-on genius and she relieved the pain with a combination of deep tissue massage and abdominal strengthening. We also used guided meditation. She used to tell me to “imagine the butter melting” as she focused on releasing the Iliopsoas, particularly Psoas Major which is the muscle that connects the hip to the spine. It was miraculous and immediate joy.

It was getting better. I was still in pain and not as limber as I used to be, but it was moving in a good direction. And I was willing to work hard to get better. That is, until the insurance company insisted on a new doctor. He looked over my chart and said, “You’re going to need Vicodin.”

I said, “No.”

Once again, that same look: “What do you mean, ‘no?’”

I said, “I don’t want dope. The massage and exercise works. Why can’t we continue that and forget the drugs?”

“Because you’re at maximum improvement. You can get the drugs but not the therapy.”

It was my turn to look at him cross-eyed and I said, much to the amusement of the nurse in the room with us,
“Are you crazy? Who are you working for?”

“According to the insurance company, this is medical standard now.”

I wanted to ask him when the insurance companies and bureaucrats became the arbiters of medical ethics and practice. It became clear to me that because of the structure of medical care today, people who would have otherwise had options and been good doctors, were being led in another direction, a new “standard” set by insurance companies and pharmaceutical interests.

Instead, I just said, “What about your oath?”

“I’m sorry.”

I looked at him and said, “Yes, you are,” and that was that. I walked out. No therapy and no Vicodin. And I had to pay for my own massages and take responsibility for my own recovery. And perhaps this is simultaneously the crux of the problem <em>and </em>the solution. Taking charge of my own healing instead of laying it on the doctor’s shoulders and demanding an immediate pain solution was not easy. In fact, it is an ongoing decision because I still have days with spine-shivering pain. But it has been infinitely better than what I’ve seen with my patients, people who had been struggling with aches and pains or broken hearts turned into addicts with broken homes, empty pockets, and symptoms so wildly erratic they were sometimes mistakenly diagnosed as bipolar instead of addicted. So rather than getting them off the opioids, they were given ever-increasing doses of medication that eventually made reaching–or treating–them impossible.

So, this war on drugs we’re waging? Maybe we should start in the doctor’s office. And it seems to be up to us in more ways than one. I don’t see the pharmaceutical companies leading the battle. Do you?

*1.    CDC Grand Rounds: Prescription Drug Overdoses–a U.S. Epidemic, MMWR, 2012;61:10-13, cited in The Journal of the American Medical Association, February 22/29/20120, Vol. 307, No. 8, page 774
*2.     Ibid.

Verbal First Aid and Motorcycles!

Biking Article
Montana Cross RiverUsing Your Head After A Crash.

It’s dusk in the desert and you’re relishing the open space and the glorious solitude. The sun hangs heavy as it bursts into shards of color across New Mexico skies. It’s been a perfect ride. You and your riding companion come around a tight turn as you head down into a canyon, thinking only of where you’re going to have dinner, when the lead rider hits a patch of sand and high sides into a wall of granite.

You manage to stop in time, but your friend’s bike tumbled over an embankment and while he is thankfully still on the road, he is not moving. His leg is bent at an angle not meant for human bone. He is conscious but in shock.

You’re alone. It’s nearing dark. What do you do?

If you’ve managed to reach 911 and they’re on the way, what do you say when every moment and every word counts?

This is an all-too familiar scenario for riders. It happens in the country, in the city and all parts in between. Some people, mostly those who have been specially trained to handle critical events, have the skills to approach a situation like the one above with great calm, self-assurance and compassion. Most of us, on the other hand, slip into emotional shock along with the one who is injured. There’s an old wisdom about target fixation: Never watch someone go down, because that’s where you’ll wind up. It is true on a number of levels.
But, even when there’s nothing you can do besides wait for the ambulance, there are things you can say—and ways to say them—that can help your friend survive. Words, when used strategically, can be a most powerful medicine, helping us to lower blood pressure, reduce inflammation, or stop bleeding.

Lt. Samuels (*name changed, story true) sat behind a large, conspicuously clean desk at a Westchester, N.Y.  police station. He was cool, composed, and seemed as uncluttered mentally as he was physically. The awards on his book cases and certificates on the wall attested to a long, successful career. “I paid my dues,” he smiled as he scanned the room and the work it represented. As he saw it, however, his career really started in Vietnam when he was only a teenager serving in the U.S. Army. It was there, assigned to an armored car division sent deep into the jungle, that he learned what it took to survive physically, mentally, and emotionally.

He was on a mission in the Delta, it was summer and the temperature outside had reached upwards of 115 degrees Fahrenheit before noon. Inside the tank it was at best unbearable under normal conditions. On one particular day he still remembers with stunning clarity, it was life-threatening.

“It must have been 130 or more inside. It was hot in a way I had never experienced before. I couldn’t stop sweating, couldn’t drink enough, couldn’t just get up and go to the bathroom. I was burning up. I don’t mean that metaphorically. I was literally burning up and I had to lower my body temperature somehow or I was going to die.  Funny how it didn’t scare me. It was just as clear to me as the coffee in front of me now. It was a fact. I had no air conditioning. I couldn’t get out of the tank. There was nowhere to go except a POW camp, if I was lucky enough to get caught and not killed right away. I remember thinking that I should have been panicking. Instead, I was utterly, crystal clear. It was in the space of such a small moment that I realized it was completely up to me. Whether I survived or not was between me and my own mind.” The lieutenant sat forward, his body compressed with the intensity of the experience, still vivid in him.

“For some reason, I thought about something I’d heard about some monks in the Himalayas, how they went outside in sub-zero temperatures and howling winds to meditate and never suffered any ill effects. They raised their own thermostats. And I figured if they could do it that way, I could lower it. To this day I don’t know exactly what I did or how I did it, but I imagined cool water inside me and around me, like I was dunking myself into a cooler filled with ice or skinny dipping in the lake back home. And hell if it didn’t work. I’m here. I never forgot that,” he sat back. “This,” he pointed to his head, “was my greatest weapon of all. And it has served me ever since, no matter what or where the battle.”

What he used without knowing it at the time is a simple protocol called Verbal First Aid. It is based on the simple notion that the images we hold in our minds are held in our bodies as well. What we think is what we are. What we feel determines how we heal.  Dr. Larry Dossey, one of the foremost proponents of mind/body medicine, has written, “Images create bodily changes—just as if the experience were really happening. For example, if you imagine yourself lying on a beach in the sun, you become relaxed, your peripheral blood vessels dilate, and your hands become warm, as in the real thing.”

If this is even partially true, it is an astonishing statement.

The case to definitively establish the link between mind and body was opened almost 1,500 years ago when Hippocrates wrote that a person might yet recover from his or her belief in the goodness of the physician. It was continued in 1912 when one doctor reported that tuberculosis patients who had previously been on the mend, when given bad news (e.g., that a relative had passed away) took sudden turns for the worse and died. And today the data supporting the connection between thoughts and health, indeed between mental images and survival, are mounting.

Brain scans have shown that when we imagine an event, our thoughts “light up” the areas of the brain that are triggered during the actual event. Sports psychologists conducted one study in which skiers were wired to EMG machines and monitored for electrical impulses sent to the muscles as they mentally rehearsed their downhill runs. The skiers’ brains sent the Bille instructions to their bodies whether they were doing a jump or just thinking about it.

What does this mean for a person out riding in the mountains who suddenly finds himself stuck in a downpour and unable to get out before dark when the temperature is expected to fall nearly 40 degrees? How does this help someone with an asthma attack in the middle of a lake or a rider with a broken leg one hour from the nearest town?

What some people claim is that it can mean the difference between life and death because the words we say (to ourselves and to one another) do matter, especially when we are afraid, in pain, or in shock. By saying the right words in the right way we are able to speak directly to the body, reduce an inflammatory response, help to slow down or stop bleeding, change the way an event is interpreted so that it is experienced differently IN the body.

What Can We Do, What Can We Say: Verbal First Aid in Real Life

According to medical experts, anxiety (or fear) and pain are inextricably woven together for the vast majority of people. A great deal of human discomfort comes from our anticipation of it and our perception of it. Unfortunately, there is nothing marketed as vigorously in this country as is fear. If we’re not scared to death by a headline, it’s a radio report, a movie, a video game, or a television show. We’re literally bombarded by images and ideas that promote fear. We are propelled by it and sold by it.

If the science is correct, the good news is that we can change it on every level—from the conscious to the autonomic. When we alter our thoughts, are soothed by a kind authority, or are assured that we are in good hands, we can begin to feel the changes in our bodies—the softening of muscle fiber, the opening of bronchial tubes, the quieting of pain, the start of healing. This is why so much of Verbal First Aid in the field is directed to the alleviation of anxiety through the development and utilization of rapport. In rapport, a person will feel, “She understands me.” “He is going to help me.” “I’m safe, now.” When we feel understood, our anxiety is reduced. And when anxiety is reduced, pain is relieved. Even if we are entirely alone, clinicians and scientists agree that what we say to ourselves matters and we can direct our thoughts so that our chances for survival are enhanced.

Whether you’re speaking to yourself or to someone else on the trail, how you approach someone mentally and emotionally is at least as important as the medical expertise you have, according to Winnie Maggiore, former Asst. Chief of Placitas Volunteer Fire Brigade, paramedic, former Asst. D.A., and now a malpractice defense attorney. “We saw the Bille things in the wilderness that we saw locally—snake bites, mountain bike wrecks, breaks, falls, cardiac conditions—but the injuries in the wilderness feel worse to the patient in that he’s away from familiar surroundings. Most of what we had to do in rescues was anxiety management. The first step is to let the person know you have the expertise to help. This conviction allowed us to say ‘do this’ in a way that motivated compliance.”

The other major ingredient in dealing with crises, according to Maggiore, is giving people some sort of control over what is happening to them. “When we were just learning emergency medicine, we were given a course in hypnosis so it could be used in pain control, because it could be all we’d have to work with out there. The worst part for patients was being out of control so put them back in control as much as we could, gave them something positive to focus on. Panic is a patient’s worst enemy.”

People normally want to reassure with blanket statements, e.g., “you’re fine.” When this is obviously untrue, it’s the sort of statement that breaks rapport. It’s better to say, according to the experts, that the worst is over and you’re there to help. Your caring presence is the cornerstone of the healing process. If you don’t know what to say, say nothing and listen as you wait for help or do standard first aid. Your care can do more than you might imagine.

The following are just two examples of ways we can talk to someone in distress so that they are calmed, their pain is reduced, and they are moved steadily towards healing.

Asthma Attack .

Bill and his son, Jake, went for a dirt bike ride up a trail that was almost never used. Bill was sure his son had his inhaler with him. Jake was sure dad had it with him.

It was a rugged trail that required more physical exertion than either had expected. When they finally made it up to the first crest, Jake was starting to panic from the tightness in his chest. When they realized they’d forgotten it, Bill was smart enough to take a deep breath himself so that when he turned to his son he was calm, focused, and sure-footed.

Bill:                 Jake, I can see you’re breathing but that it’s a little tight?

Jake:                (Nods, but can’t speak.)

Bill:                 Sit with me here and lean forward like this. Put your head forward like this so your bronchial tubes can open and smooth out. [At this point, Bill’s voice drops in pitch and slows down so that it’s soothing and controlled. He “paces” his son’s breath with his own, carefully so as not to hyperventilate, just enough so that there is a joint rhythm. As he speaks to his son, his breathing slows down just a little bit at a time, “leading” his son back to normal breathing.) And as you do, you can remember very clearly how your inhaler feels when you take a puff on it, a little cool, a little tingly and how it opens you up pretty quickly, you can remember how it feels when it’s working…a little more open now…a little more open, a little cooler, until you can get a really good deep, slow, even breath…

 

A High Side at Five

When we get a whiff of twisting and turning mountain roads, open vistas and the winds of freedom that fill us, it’s easy to take off on an impulse and forget basics: water, first aid kit, cell phone.

Manny and Janice took off on an early Sunday morning, the first of spring. It had been a long winter and while they remembered to charge their batteries, they forgot just about everything else. Manny and Janice pointed their bikes west, Janice leading, and kept going until a deer ran in front of Manny. Reflexively jamming on his front break, he went head over hind end until he wound up in an intimate embrace with a hundred year old oak.

When he was finally able to gather his wits, he saw Janice standing over him. Even though neither had a first aid kit, Janice knew Verbal First Aid.

Manny:            How’s my bike?

Janice:             It’s fine. It’s just taking a nap. That was some acrobatic act.

Manny:            Did you get it on video?

Janice:             Yeah, with the camera in the back of my head.  (She smiled.) I’m going to help you    now, Manny. I can see that you’re talking and thinking just fine.  Let me see  how the rest of you is.

When he stood up, though, they realized he had a deep laceration from a piece of metal

That had been left on the side of the road and blood was pouring down his leg.

Manny:            Damn it! It’s really bleeding.

Janice:             It is and that’s actually a really good thing so that it cleans out the wound. As soon as you’ve cleaned it through enough, you can stop [Janice emphasizes “stop”] the bleeding.

Manny:            Damn it. That was so stupid.

Janice:             It happens to everyone. I know you’ve gotten cut before and you’ve stopped the bleeding before just like you’re stopping it  right now. [She wraps her bandana around it and applies pressure.] You can hold it tight like this. Y’know even as we’re sitting here, it’s already starting to heal and the bleeding has slowed to a stop.

Manny:            Damned if it hasn’t!

Janice:              So… we can either wait for a car to pass or you can sit on the back of my bike…and we’ll ride into town.

Manny:            I’ll hitch.

Mental survival—regardless of where a person is, whether that’s in the extremes of battle or a cross-country ride—is often a matter of recalling or being made aware of the resources one already has. As Lt. Samuels learned the hard way, the mind is the greatest weapon of all.

 

 

 

Can We Just Call it Homesickness?

refugee tornadoSince 1935, when Dupont adopted the slogan “Better Living Through Chemistry,” we have been a culture pummeled by polymers and overly impressed by the new and shiny. Their advertising not only changed how we thought about the rush of chemicals being delivered to us (through medicine, in our water, in our foods), but reflected a new age of humanity in which biochemistry became a cruel and indifferent king. No longer were people thought of as “heartbroken.” They were thought of as chemically imbalanced.

Most people don’t know that diagnoses vary and move along social currents. Because of the authority with which words like “clinical depression” or “bipolar” are used in modern conversation, they are given the impression that those words have a permanence and solidity they do not actually have.

For instance, what we now commonly call PTSD has only been recognized as a formal disorder since 1980. During the American Civil War, soldiers returning from battle with inexplicable symptoms were said to have “Soldier’s Heart.” In World War I it was referred to as “War Malaise” or “Shell Shock,” in World War II, “Combat Fatigue,” in Korea “Gross Stress Reaction” and after Vietnam, it was cleverly called “Post-Vietnam Syndrome.”

Does it matter what we call it?

Some think it matters a great deal because names often determine approach or treatment. It makes sense. If someone is called “Your Highness” we are sure to approach him or her quite differently than if he or she were called “dear.” Similarly, if we call a state of mind a chemical imbalance, than we are very likely to approach (or treat) that state with chemicals, often many. If, on the other hand, we call it a broken heart or loneliness or arrogance or self-pity, we take a rather different tack.

This comes up because of something a patient said to me the other day. She also recently moved east from New Mexico when her husband was made a corporate offer he couldn’t refuse. She came from an old family in Santa Fe with a history that went back almost 400 years to the Spanish Conquest. She had grown up with open vistas, nearly eternally clear skies, and a community in which everyone knew one another. To say hers was a shocking uprooting would be an understatement.

She came in complaining of inexplicable and free-floating anxiety, lethargy, a tendency to weepiness over trifles, an inability to sleep through the night because of dreams and restlessness. Her first question after she elaborated on her symptom picture was: “Do you think I’m depressed?” The as yet unspoken question underneath was: Did she need medication?

Instead of answering either of those questions, I asked her about her dreams, when these symptoms started, what she’d been doing since she moved here and how well (or poorly) she was getting acclimated to a new environment and culture.

As it turned out, her symptoms began about a month after arriving, shortly after the last box had been unpacked and recycled. Suddenly, there was nothing to do. Her husband was going to his new job. Her two young children were in school. She was at home, sans friends, sans work, sans family. In New Mexico, she had not only been working, she had an extended family that occupied a great deal of her time with social engagements and care-taking elderly members. People stopped into one another’s homes fairly regularly. She had a church she loved. Here, she was alone. Worse, she was lonely.

Could someone call that depression? I imagine they could find support for it in the diagnostics and standards manual. But I’d rather call it homesickness. Not only because it is more precise, but because it gives her a way out.

Of course she misses her home. Of course she feels lonely. Of course she’s bored and restless. Of course she longs for friends and relatives. Who wouldn’t in her situation? There’s no pathology in that.

What needed to be changed were not those feelings, but what she was doing all day with them. First prescription: Volunteer. Second prescription: Find a church with her husband. Third prescription: Join a club (in her case she agreed to a yoga class).

It took about a month for her symptoms to abate.  While she still missed friends and family (and bright, endless blue skies), she was no longer as lonely, bored or restless. She slept better because her energy was redirected and expended during the day. She began to make new friends and feel a part of something bigger than her own heartbeat in a large, empty house.

The more I think about her case, the more I am inclined to think of PTSD as Soldier’s Heart. I think it more clearly sums up what we are looking at: A wound of war that breaks a heart, not a chemistry problem.

 

A Personal Case for Classical Homeopathy

Samuel_Hahnemann

 

Part 1 of a 2-Part Series on How To Explain (or Not) Classical Homeopathy

 

The American Sound Bite

Out of nowhere, my husband turned to me and said, “I wish you’d tell me what you do so I can tell other people. They ask me what you do and I can’t explain it.”

“I’m a psychotherapist and a consultant in classical homeopathy,” I stared at him. “You know what I do.”

“But I can never explain it quickly enough. I tell them ‘rebalancing,’ ‘rewiring,’ ‘peeling the skin off onions,’ but then I lose myself. I can’t come up with a simple way to describe it.”

This is the worst problem for a homeopath. How do we explain an exquisitely subtle and complex process in a simple way? Take something so important and put it in a sound bite?

I remember a long time ago having to try to explain Verbal First Aid in five seconds or less for a three minute TV news interview. I totally blew it. I’m not very good at sound bites.

But that is what we want in this country—drive through information, fast-food for the mind. If we can’t eat it in the time it takes to reach for the remote, the opportunity to communicate is lost.

But there is hope, because we do like stories. So, I thought that perhaps the best way to communicate what I do is to share with you a few cases. The first one is my own. The others (in Part II of this article) are patients with their identities protected. I have never shared my own story before, but I do so because I believe its dramatic nature will help you to understand what classical homeopathy can do and why some people are so passionate about it.

The Mysterious Case of the Disappearing Mass

Many years ago, I suddenly developed abdominal pain. I had not been sick in any other way and had no idea what was happening. I went for a gynecological exam and was told I was fine. The pain continued. I went back and after numerous exams was sent from the table to the couch. The psychiatrist sent me right back to the doctor. After about a year of bouncing back and forth with increasingly intense (searing, stabbing) pain, they finally “discovered” a mass several centimeters in width in the area of my left ovary.

At this point, the surgeons were called in. I was scheduled for an emergency laparotomy. As they wheeled me in, the surgeon said to my mother, “It could be cancer.” I was 26.

After surgery, as soon as I stopped vomiting, the doctor told me that it was not cancer. My mother wept. He said it was a streptococcal infection (Strep B) that had created adhesions and that I could forget about having children. He proudly went on to inform us that they had “scraped me clean” and that I’d be on antibiotics for about a month.

I did as I was told. I was raised by a doctor, surrounded by doctors, and had complete faith in the system.

Within a short time a whole new sort of pain emerged, this time, however, deeper. It was more localized, again on the left side. I thought the infection had returned. The pain continued for quite a while. I went to the doctor, but there was no infection. After dismissing it (and me) for at least a year again, I finally wound up in hospital. A cyst had burst. This cycle recurred every few months. They recommended birth control pills, pain pills, and pills I didn’t understand. Nothing helped. By the fourth rupture and hospital visit, they recommended a full hysterectomy.

I sat silently until I could take a deep breath again. I asked if there were no other options. The doctor said, “You’ll just keep getting them and since you can’t get pregnant anyway, this is the best idea.”

I told him I would think about it. He told me not to think too long but looked at me is if I couldn’t think at all.

I called a friend who had been talking about homeopathy. She used a homeopath for herself and had located a homeopathic vet. I asked for more information. She sat with me. She loaned me books. And she gave me the name of a doctor. I decided to at least try something before I let my reproductive center be removed forever.

I told my gynecologist about it. He said, and I quote, “You can use all the weed wackers you want, it won’t help.”

I said, “We shall see.” And I meant “we.” I had no more experience in it than he did. But I wanted some option other than organ removal.

He did not escort me out. He was more than mildly annoyed.

But I was on a mission.

 

Where the Magic Begins

This is what saved me: a young doctor with a tattered copy of a repertory (the book that is used to look up symptoms and match them to different remedies) and another equally frayed Materia Medica (the book that contains full descriptions of the remedies themselves) in a basement office in New Rochelle, NY.

It was the strangest medical experience I’d ever had. He didn’t examine me the way I had expected. He talked to me. Well, actually, he talked very little. He asked me endless questions: Where is the pain? When does it come on? What happened then? What does it feel like? What makes it better? Do you have any food cravings? Do you kick your feet out of the covers? Do you like other people around you? Are you warm? Cold? What makes you afraid? Anxious? Sad?

He was relentless. Two hours of questions that could not seem more unrelated to me or to my ovaries. But honestly, it was such a relief to have someone listen to me without judgment that I suspended my own.

At the end of the interview, he went into a little closet, pulled out an amber bottle, opened the cap, poured a few pellets into the cap, tipped my head back, and said, “Open your mouth.”

He poured the little pellets under my tongue.

That was my first remedy. It was Pulsatilla, a common flower in highly diluted (potentized) form.

After that, my mood improved slightly but briefly and the physical symptoms did not go away. Instead they shifted and got worse. I’ve learned since then that this can happen when a remedy is close but not a bull’s eye. The symptoms became far more localized and presented with greater clarity. It seemed to me then that it was like a boil coming to a head, collecting the “illness” from a large area and concentrating it so it could be seen properly and discharged. We waited a very uncomfortable month.

After the second interview he gave me Thuja. After that I had a frankly rude aggravation (cystitis) which lasted about a month and the cystic pain completely disappeared. An aggravation is what homeopaths hope for as the sign that a cure is beginning. It is also precisely what allopathic doctors find wholly inconsistent with their training. They are supposed to make symptoms go away, not generate others. But because homeopaths see the human organism as a moving, dynamic system, they believe that this discharge is absolutely necessary. Aggravations are like siphons; they allow previously suppressed diseases or eruptions a way out of the system. In homeopathic philosophy, it is part of the cure.

But I didn’t know that at the time. So I called him and complained, and after he ruled out any dangerous infections, he said “Now, we wait.” I’d call him back, still annoyed, uncomfortable, and worried. And he said, again, “WAIT!”

So, I did. After a while, the “rudeness” was gone and so was all the pain. And after a year I realized so were the cysts. None of it—not the cysts or the strep or any of that pain— has ever come back. More important, perhaps, than the physical relief, was that over the next couple of years I became calmer, more centered. Much of the insecurity that had ruled my life up until that point also seemed to just not be there. I didn’t see it leaving. It was just gone when I remembered to look for it.

That was a very long time ago. All my exams are still splendidly normal and I still have my own organs in my own body.

I went on to need other remedies over time to deal with other issues and wound up with a different remedy as my “constitutional,” the one that seems to fit my overall being. But this is how it started. And it convinced me on a cognitive and cellular level that what I had experienced was more than placebo or fanciful wish-fulfillment. As far as I could see, it could not be a placebo (although that would have been just fine with me at that point), because one remedy missed the mark, but the other did not.  And as far as wish-fulfillment—if it had been up to me, I’m sure I would have wished for instant relief—sans aggravation!

In the follow up article, we’ll look at a couple of other cases to demonstrate the most important principle of homeopathy: like cures like. And hopefully discover the sound bite people need to understand what Hahnemann’s legacy has been.