“Notes from a Healer”—Too Close for Comfort

When is a clinician more than just a clinician?

Readers can ponder this question while perusing my latest “Notes from a Healer” column — Too Close for Comfort — in the Yale Journal for Humanities in Medicine.

The Yale Journal for Humanities in Medicine acts as an online clearinghouse for manuscripts dealing with the humanities and medicine.

Striking a Chord

At our recent Cell2Soul conference, therapeutic harpist Anne Bewley described the technique she uses when playing for patients in the hospital setting.

“I try to find a note or chord on the harp that seems to resonate with the patient’s state,” Bewley explained. “Many times I improvise while watching the patient’s response. I can tell when we’ve connected—the patient begins to calm down and become less agitated.”

Bewley described how she can manipulate a cardiac patient’s heart rate, dropping it down from 130 to 90 beats per minute. “The only time it didn’t work, I found out afterwards that the patient had a pacemaker.”

I asked Anne Bewley if she knew of any studies that had been done on colicky babies, where attempts were made to soothe them through therapeutic music. Although she knew of none, she did tell me that she had used similar techniques to calm crying infants in the hospital nursery.

It occurred to me that when we empathize with others, we cue into their mood and mirror that mood through our body language, facial expression and verbal response. In short, we strive to meet them where they are; we attempt to connect with them, and then bring them to where they need to be—to a better place.

The psychologist Dan Gottlieb has said that perhaps what human beings desire most of all—more than love—is to be understood.

When we realize that we are understood, we know that we are not alone—another person has connected with us in an intimate way.

Therapeutic music and empathetic understanding may turn out to be two sides of the same coin.

Morning Light

It had cooled considerably after two days of warm rain.  Finally the leaves were beginning to turn.

I camped out on the white wicker chair in the corner of our front porch with a copy of Jack Kerouac’s On the Road in my lap.  The crisp morning air stung my nostrils and made ephemeral ghosts as it periodically slipped out through my mouth. 

Morning light sifted through bare branches of the massive walnut tree across the street and filtered onto our porch, brightening the blue shakes of the house.  High above the street fire-tinged leaves blazed on the tall maples, red-orange in the sunlight. 

My wife’s begonia spilled over the edge of the cobalt blue pot where it sat behind the white porch baluster.  The yellow-orange flowers faced the morning sun.  One convoluted stalk had ventured out too far, dipping down almost to the fir flooring.  The flower at its apex poked under the railing in search of the morning light. 

In the far corner, sunflowers stood erect in a large plastic pot among full green leaves, perfect in appearance.  Plastic and artificial, oblivious to their surroundings, they had not changed their inclination. 

I looked down at the book in my lap.  A small black spider had thrown out a filament from the edge of my coffee cup to the porch railing and was in process of making its way along the strand.  Bathed in the light, it paused to rest, glistening in the morning sun. 

A slight breeze broke the morning stillness, rustling the remnant leaves between the long brown stems of the mock orange bush.  Chickadees called from low-lying shrub trees across the street. 

Again I looked at the begonia, reaching toward the light.  Phototropism; luxphilia.  Unlike the plastic sunflower plant, soon the begonia and the small black spider would succumb to autumnal frosts.  Yet on this crisp fall morning, they both reveled in the warm brightness of the sun.

Infinite Reflections

“Down, boy; down!” I said in a firm voice, pushing the dog’s head away from my chest.

“Loki, down,” Avery coughed softly from the recliner. The dog persisted in his attempts to climb into my lap.

“Loki—crate!” Avery’s wife yelled from the doorway, pointing to the large wire framed cage in the center of the parlor. Immediately the dog dropped his head and sulked off into the crate, where he laid down and whimpered fretfully. “That dog is so bad.”

“No, he’s not,” Avery said. “He’s got too much energy. It’s not his fault. I haven’t been able to take him out for those three hour walks in the woods since I got sick. Actually, he’s been doing quite well, all things considered.”

“I’m going to make some coffee. Would you like some?”

“Don’t put yourself out,” I said.

“It’s no trouble,” Avery’s wife said.

Loki lay in the metal cage, his head on his paws, watching Avery.

“How many dogs have you had over the years?” I asked.

“Oh, quite a few,” Avery said. “Before Loki we had three at the same time: a yellow lab, a Welsh corgi, and a black spaniel. I used to take all three of them for walks in the woods together. They never gave me any trouble. Not like Loki,” he said, eyeing the dog. “I always had to leash him. He has a car chasing fetish.”

“Was the yellow lab a pure bred?”

“No, she was a mix of some sort. Had the longest set of legs of any dog I ever saw. It was something to watch her run. She’d lope along with no effort, like a gazelle. She was strong, too. I’d lie down across her back, and she’d lift me off the floor with her body as she stood up.”

“Wow, that’s amazing! How long did she last?”

“About nine years,” Avery said. “One day she had a stroke. We took her to the vet. They kept her for a day, then let us take her home. She had another stroke a week later. After that there was nothing else to be done, so we had her put down.”

“That’s always a tough decision.”

“Usually it is. But not that time. She wasn’t the same after the first stroke. She’d go out, come in, eat, sleep—same as always. But when I looked into her eyes, I knew. It was like she wasn’t there. Something was missing; she just wasn’t the same dog.”

We sat in silence and looked at Loki, now on his side, fast asleep.

“So how have you been faring lately?” I asked Avery.

“Up until today it’s been a rough three weeks. For some reason the chemo really hit me hard this time round. I couldn’t focus—couldn’t watch TV; couldn’t read; couldn’t even eat for a while.”

“Were you in a lot of pain?”

“No, they have me on the patch for pain. It works well, but I get constipated from the medicine. Doctors seem to like treating constipation. I guess it’s gratifying for them, because they can see results right away.”

“Doctors are concrete operational people,” I said.

Avery nodded his head. I noticed the few wisps of white hair on his largely bald scalp. His beard had turned entirely grey since last I saw him three weeks ago.

“Do you have any trouble sleeping?” I asked him.

“No, not at all. As a matter of fact, I could sleep twenty-four hours a day without any problem. It’s just when I’m awake that things seem to go haywire.”

Avery’s wife brought me a cup of coffee. “Would you stay for dinner?” she asked me.

“Sure,” I said.

We had pot roast, mashed potatoes, green beans and brown gravy. Avery talked about his granddaughter at the table. “She’s usually over a couple of times a week,” he said. “Even when I’m not feeling well and can’t come to the table, it’s nice to hear her giggling in the kitchen. It takes my mind off things, what mind I have left,” he said.

I pushed some mashed potatoes and a piece of meat on my fork. “You seem to have gotten most of your strength back in your arm and leg after the stroke,” I said.

“Yeah, almost all of it. But I can’t hold a pen to sign my name anymore. My hand shakes too much.”

Avery’s wife cleared the table and put a slice of chocolate cake in front of each of us. Then she got out Avery’s pills and placed them in front of him with a glass of water. I looked out the window above the kitchen sink. The muted autumn colors were fading in the evening light.

“Show him the candles before he goes,” Avery said.

Avery’s wife put three small yellow candles into long-stemmed crystal goblets and lit them with a butane lighter. Then she carried them into the parlor and carefully set them inside a glass box. The candle flames danced inside the box, mirroring a string of infinite reflections.

“Turn out the lights,” Avery said from where he stood in the doorway with his cane.

The candles glowed in the darkness. Outside, the leaves rustled in the cold night air.

“They’ll burn like that through the night until the sun comes up,” Avery explained. “When you wake up in the middle of the night, it’s nice to see them.”

Weaving Reconciliation

Thirteen years ago Pascasie Mukamurigo watched in horror as Hutu militants hacked scores of Tutsi men and women to death in a Kigali church. Ms. Mukamurigo managed to survive by remaining in a crouched position for three months inside the sanctuary. She returned home to find that her husband and one of her three children had been murdered by the same group.

Today’s New York Times carries the story of how Ms. Mukamurigo gathered twelve other widows to form Avega (Association des Veuves du Génocide d’Avril), a group dedicated to weaving exquisitely designed baskets to help support children orphaned in the Rwandan genocide. She also invited members of the Hutu families who had committed the atrocities to join the group.

“What struck me,” Willa Shalit, an artist and a producer of “The Vagina Monologues,” said, “was that these women who’d suffered so horribly — who’d been raped, machete-hacked and watched their children get killed — had created this object that was so exquisite and elegant, with tiny, even stitches.” The fact that the weaving groups included both Hutus and Tutsis, Rwanda’s two main ethnic groups, heightened the appeal. “I thought, what an incredible embodiment of reconciliation,“ Ms. Shalit said.

During my presentation at our second annual Cell2Soul conference last month, we examined a poem by e. e. cummings, “A Man Who Had Fallen Among Thieves.” Cummings used the story of the Good Samaritan as a venue to get inside the head of the helper/healer character. In his version, Cummings’ helper/healer wrestles with the decision to render aid to the victim. After overcoming his aversion, he finally does so, taking that necessary first step toward reconciliation in his own mind—

Brushing from whom the stiffened puke
i put him all into my arms
and staggered banged with terror through
a million billion trillion stars.

In forming her group, Ms. Mukamurigo has done just that. Now in Rwanda, banners bearing the words “Never again” hang from buildings; and the same slogan is stamped on rubber bracelets the weavers wear.

Doctor X, Humane Medicine Mentor

When I was an adolescent I spent my summers working on the staff of a local Boy Scout camp. The camp had been converted from an old farm, and many of the original structures had been refurbished. One bay of the barn functioned as a hands-on classroom. Here boys could practice newly acquired skills like basket weaving, wood carving and leather tooling. Overhead a heavy wooden board bore the words: “He who gets ten men to work is greater than he who does the work of ten men.”

This made little sense to me at the time. When you’re a sixteen year old boy, nothing beats testosterone. The older boys I looked up to were strong, agile and fast; and more than anything, I wanted to be like them.

Perspectives change when you get older, as you mature. Now I’m in my fifties, and that proverb makes perfect sense.

Last night, while thousands of thoughts swirled through my mind after our recent weekend Cell2Soul conference in the Berkshires, I read through a conference handout of selections written by undergraduate and medical students in response to the question: “What has Doctor X meant to you as a mentor, colleague and friend?” (Doctor X is the founding editor of Cell2Soul as well as a practicing dermatologist.)

Responses were overwhelmingly positive. “He listened to me, took the time to get to know me. He helped me believe in myself, told me that he was sure I could accomplish something if I had the will to do it. He suggested that I get involved with a project— journey to another country to learn how folks in other cultures solved problems, dealt with issues, survived.”

At Doctor X’s suggestion, one former student arranged housing for a guest speaker, and spent the evening talking with Patch Adams, M.D. The same student, again at Doctor X’s request, picked up another guest speaker at the airport and accompanied him to the Clark Art Institute, where the student spent several hours listening to Sir Roger Bannister, the first man to break the four-minute mile mark, comment on the paintings and the artists who created them.

Dr. X recommended to another young intern that she spend the summer at a camp for children severely disabled from chronic dermatological disease. The insight she gained continues to affect the way she treats patients in her medical practice.

Over the past two decades Dr. X has sponsored numerous conferences on humane medicine and the medical humanities, where folks from all walks of life come together to learn from one another in a communal setting. I have been amazed at the variety of individuals who attend these affairs—holistic healers, musicians, artists, sculptors, photographers, actors, vocalists, writers, patients, family members, students, psychologists, counselors … and physicians.

The venues for these gatherings provide a relaxing ambiance conducive to interactive learning. Conferences have been held on the islands of Kauai and Cuba, the University of British Columbia in Vancouver, Canada, and Williams College and the Mason Hill retreat center in the Berkshires of western Massachusetts.

According to the physician and Jewish sage Maimonides, the highest level of giving is when the giver provides support to enable the recipient to become self-supporting.

And testosterone aside, he who gets ten men to work is greater than he who does the work of ten men.