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Posts Tagged ‘medicine’

Sometimes (quite often actually), I wake up with a word or phrase in my head. This morning it was “heart of the universe”. The particular word or phrase can set off all kinds of different thoughts and where this one quickly went was “It’s 2013. It’s 40 years since I dissected a human heart. Second year, Medical School, Edinburgh University. That year we learned Anatomy and Physiology. I was amazed at the structure of the heart. It’s four chambers, the valves, the specialised heart muscle cells which each had their own rhythm, the conduction pathways from the “AV node” which carried the co-ordinating electrical beat to produce the two, opposite states of the heart – systole and asystole.

It was two years later before they told us to put on white coats, buy a good quality stethoscope, and led us on ward rounds, to stand collectively around patients’ beds, and one by one, place our shiny new stethoscopes on their chests to listen for the “lub dub” of the “normal” heart, and listen carefully for the clicks and sounds which filled the silences and revealed the disorders of the valves.

Over the years as a GP, I prescribed the drugs to slow hearts down, to regulate disordered rhythms, and to improve the blood supply to get the oxygen to the cells starved by blocked arteries and causing angina. I also found people presenting with pain, flutters and skipped beats of the heart whose investigation results showed no obvious pathologies. What were we to do with them? And where was the explanation for their symptoms? If their symptoms weren’t signposts to pathology, then what were they?

Gradually, I became aware of how we use heart in our language, as people told me about “broken hearts”, “heart ache”, “longings of the heart”, “an emptiness in my heart”, “getting to the heart of the problem”, “filling my heart with joy”. Of course, from early years I became familiar with the shape of a heart as we would draw it to communicate love. We see that shape everywhere.

three leaves

cafe love

tree

wishes

Why the heart? Why not the liver, or the pancreas, or the spleen? Why not the kidneys?

I knew there were intimate connections between the brain and the heart, mainly channeled through the “autonomic nervous system”. Then only in the last few years did I learn we’ve discovered that there is a neural network around the heart and associated with that is the production of neuropeptides (the small proteins which act on the brain) within the heart and its neural network. So, the links are more intimate than I realised, and, most importantly, more two way than I realised – the brain acts on the heart, but the heart also acts on the brain. In fact, it seems we do some of our mental processing using these neurones around the heart. (That dismissive phrase which I never liked – “it’s all in your head” – turns out to be even more stupid than I always thought it was)

And as time passed, and I experienced encounters with more patients, I began to see that sometimes (not always but often enough to always consider), there were direct links between “heart issues”, “heart language” and “heart symptoms”, irrespective of the presence or absence of pathologies.

So, here’s something to consider as you think ahead into 2013. How about building your “heart intelligence”? That’s a concept that means somewhat different things to different people, but let’s just use it as it is, without detailed definition.

Try the Heartmath technique. Sit quietly, focus on your heart area, take three deep, slow heart breaths, then recreate for yourself a heart feeling (you can find the details here). In this state of “coherence”, ask your heart a question, and wait to see what answer appears. Write it down.

What does your heart tell you about 2013?

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There was an amazing story recently in the NY Times about a Greek man living in the US. He was diagnosed with lung cancer in his mid 60s and given the prognosis of 9 months to live. He decided that instead expensive treatments and a costly funeral in the US, he would return to his native Greek island of Ikaria.

He moved back in with his parents and went to bed to be cared for by his wife and mother. But he started to feel strong enough to go out so reconnected with childhood friends and re-established his Sunday trips to church.

As the months passed he felt strong enough to do some gardening (a common activity on the island) and planted vegetables thinking he might not live to enjoy them, but he would enjoy growing them. Not only did he live to enjoy them but with his regular routines now of plenty of sleep, regular walks up the hill, spending time in the garden and in the evenings with his friends at the bar, and his weekly visits to the church he began to feel well enough to tackle the old, neglected family vineyard.

Three and a half decades on he is now 97, producing 400 gallons of wine a year from his vineyard and seems to be cancer free.

What can we learn from this inspirational story? Well, the author of the story in the NY Times concludes this –

If you pay careful attention to the way Ikarians have lived their lives, it appears that a dozen subtly powerful, mutually enhancing and pervasive factors are at work. It’s easy to get enough rest if no one else wakes up early and the village goes dead during afternoon naptime. It helps that the cheapest, most accessible foods are also the most healthful — and that your ancestors have spent centuries developing ways to make them taste good. It’s hard to get through the day in Ikaria without walking up 20 hills. You’re not likely to ever feel the existential pain of not belonging or even the simple stress of arriving late. Your community makes sure you’ll always have something to eat, but peer pressure will get you to contribute something too. You’re going to grow a garden, because that’s what your parents did, and that’s what your neighbors are doing. You’re less likely to be a victim of crime because everyone at once is a busybody and feels as if he’s being watched. At day’s end, you’ll share a cup of the seasonal herbal tea with your neighbor because that’s what he’s serving. Several glasses of wine may follow the tea, but you’ll drink them in the company of good friends. On Sunday, you’ll attend church, and you’ll fast before Orthodox feast days. Even if you’re antisocial, you’ll never be entirely alone. Your neighbors will cajole you out of your house for the village festival to eat your portion of goat meat

 

Those are probably reasonable conclusions but what inspires me most about this this story is the series of simple, pragmatic choices this man made. He didn’t set off to “beat cancer”, or to find the elusive magical cure. No, what he did was chose, moment by moment, day by day, to live. He might have died in his bed within days of returning to Ikaria. He would have had the death he chose, if that were the case. But he was not at any point focused on trying to determine the detailed outcomes.

Here is what inspires me about this story – at each stage he was focused on how he would live today and at no point did he think how to escape death.

Read the whole article here.

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The Scottish Storytelling Centre in Edinburgh hosted the International Storytelling Festival last week and I participated in a series of workshops entitled “Stories and Cures”. What a fantastic, stimulating, rich experience with a diverse range of nationalities and disciplines taking part. Right at the start of the week I heard something I’d never heard before.

Back in the 18th and early 19th centuries throughout Europe when a person wished to consult with a doctor, there was a practice of letter writing. Someone would write a letter to the doctor whose advised they wished to receive. The letters were typically the person’s story, in their own words, describing what they were experiencing and the contexts of those experiences. In other words, the letters weren’t just lists of symptoms, and certainly weren’t tables of figures or readings, but, rather, they were highly personal, unique life stories.

The doctor would then write back, commenting on parts of the person’s story and giving a range of advice , often touching on issues of morals, hygiene or spiritual life. This was the beginning of a conversation which might be followed up with further exchanges of letters and/or with meeting up for face to face consultations.

Joanna Geyer-Kordesch, whose research as a Professor of the History of Medicine was the basis for this series, has read hundreds of such letters in English, German and French.

I didn’t know such a practice had ever existed.

Just think for a moment how different this practice was from our current doctor-patient relationships.

First of all, the record of the person’s illness is now created and held by the doctor. The stories have been turned into case notes and typically it would be extremely difficult to gain any understanding of who the person is if you were to read these notes. Doctors notes (I don’t think they usually could be stretched to be considered as stories) are mainly lists of symptoms, physical findings and results of investigations, then diagnostic labels based on pathology. The advice recorded certainly isn’t in the form of a conversation or exchange with the patients. In fact advice is more likely to have been replaced by a list of drugs prescribed.

What are the consequences of this change?

There has been a shift in power – from the person to the doctor, or the institution. This shift in power is so great that the words recorded are much more likely to be the doctor’s words and his or her interpretations of the person’s experience, rather than any record at all of the story the person has told (it’s not like that where I work because we have a tradition of writing down the patient’s actual words as much as we can – however, it’s still the doctor making and holding the record, not the person whose life it is)

There has been a shift in focus – from the person to the pathology. As Eric Cassell so beautifully describes in his “The Healer’s Art”, and “The Nature of Suffering”, illness is what the person goes to the doctor with and disease is what he comes home with.

It seems to me we’ve lost sight of the human being in the process. By reducing someone to a mere physical body to measured and imaged, we have dehumanised Medicine. The PERSON has been lost. How do we get the PERSON back into the centre of the stage? How do we get the individual’s agenda back at the heart of the medical engagement? How do we regain the truth of the uniqueness of every single human being and move away from the mass production processes of reducing people to diseases, diseases to “managed”, rather that people to be healed?

A good starting place would be to enable people to tell their stories – in their words, in their order of priority, in their own style – to reveal not just their sensations and experiences, but also their choices, their values and their beliefs (and what about the creation of the record? How and where would you create the record of your illness and your healing?)

Maybe valuing each individual’s story would begin to let us re-humanise Medicine?

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