Monday, January 16, 2017

How Coincidental!

It just so happens that I'm coming off what turned out to be a pretty bad cold. It's funny, because I'm a health care provider, right? I mean, how can we get sick? And when we do, don't we know all the tricks for beating it it quickly?


Ok, yeah, well, some. Normally I'd either drop some professional quality echinacea or eat some raw garlic at the very first hint of symptoms. (If you're trying this at home: it's just one clove of garlic and you have to eat it with something bland.) This time the initial symptoms were really mild for over a day and I thought I'd let it roll.

Well it turned into a whole lot of no fun, but after a couple of days things started to improve and I'll be fine. I have no evidence for this whatsoever, but I believe that every once in a while it's good to give your immune system a proper workout. I think it could prevent worse things later, but like I said, I've got no proof for this.

Beliefs about our health, beliefs about how we can (and can't) control our health abound, and I've found are often really personal. A lot of them are shared. For example, a lot of my female patients of childbearing age dislike the idea of using chemical means of birth control because some can interfere with having menstrual periods. Here in particular I'm talking about oral contraceptives like Seasonale or injections like Depo-Provera. They tell me that it feels strange and somehow unnatural or unclean to halt the process the body has of clearing the lining of the uterus, as happens each month during normal menstrual periods.

I haven't been able to locate any evidence that halting this process, or minimizing it, actually leads to a "buildup" of any toxic substance, or leads to any higher risk of disease...although all of these drugs do lead to potentially higher risks of things like stroke or breast cancer. Presumably that's just due to the drugs themselves.

In regular medicine, we have various recommendations that are said to be based on scientific evidence. Do this. Don't do that. Patients express some frustration to me about how often these recommendations seem to change, and how often they are in conflict with one another. To be fair, there are a few really carefully researched, very specific recommendations that change little over time. For example, don't smoke cigarettes.

But then there are those that are flung about from TV news anchors, Facebook newsfeeds, the daily paper, and pop-up ads on the internet. It's not that all of those recommendations are bad, but it does highlight that there's a spectrum of health recommendations that spans from really sound and worth paying attention to, to those that are nascent and possibly just fleeting static.

In the previous blog I wrote about intention. Intention manifests itself in various ways, from focused, meditative thought designed to influence a specific bodily response or symptom, to mere behaviors, such as declining a sugary snack in order to maintain a health body weight. Intention doesn't exist in a vacuum. It is nested within a matrix of other aspects of our psyche and experience. Critical thinking is another aspect. Combine a strong behavioral intention with an uncritical analysis of your Facebook newsfeed about something like, say, the need for vitamin D, and you might get someone taking gigantic doses of vitamin D daily, for no purpose--and potentially to a bad end.

After all, just because it's a vitamin doesn't mean that taking a truckload is automatically good for you. And some evidence shows it can be bad--but that little caveat doesn't seem to get passed around on Twitter so much.

And don't imagine I'm letting regular medicine off the hook here. For decades doctors pushed women into taking hormone replacement therapy after menopause. Until a large analysis found that this significantly increased risks for strokes! One can argue, the doctors meant well, but I lived through that and found that most doctors were too easily buying the "research" of pharmaceutical companies, and too readily latching onto the notion that "one pill can do it all": prevent heart disease and osteoporosis, treat hot flashes, improve post-menopausal sex life, increase energy, improve sleep, etc. etc.

Hormones were the wonder drugs that worked wonders...until they killed you, apparently.

Intention is more than just wanting to do the "right" thing. It's about intending to do your thing. During my recent bad cold, the latter part came on, that's the part where my nose got really stuffed up. I hate that. I really hate when I want to sleep, because it makes me breathe through my mouth. Now there're drugs for this, and I have those. But I dislike using nasal sprays. They make my throat sore, taste lousy, and my nose easily gets "addicted" to them.

So I do this thing where I can focus on my nasal passages, and see them swollen and red, which I know is due to a normal physiological response to to a virus. Then I sit or lie still, close my eyes, and focus with each breath on reducing the inflammation, sucking out the excess fluids in the tissues, draining them away...

And gradually, my nose starts to open up. This works about 50%--it never gets totally unstuffed--and it works about 75% of the time. It's good enough for me. But what about the times when it doesn't work? What about the fact it doesn't fully resolve the symptom? Is that a failure on my part? Is it underdeveloped mental discipline? Does it even matter?

In the previous article, I highlighted a conflict between intention and responsibility. If we can control what happens to us, then when bad things happen, we have "failed." On the other hand, if we aren't responsible, if intention doesn't "work", then whatever happens to us isn't our fault. It's just bad luck.

Now one could easily argue that the only things that matter are behavioral, and proven by medical science. So if you get lung cancer and you smoked, you did this to yourself. If you got lung cancer and you didn't smoke, you just have bad luck. This is where a lot of health care providers are. It means you can easily sort people into piles, "blameworthy" and "blameless." Now I could further ague that this just makes nurses and doctors sanctimonious twits, but then that wouldn't be a very deep analysis. (Even if it feels true sometimes!)

This analysis suffers from several problems. First, we don't know everything. Look at hormone replacement therapy. Oops. Second, we don't actually know that other forms of intention have an impact on health. Maybe there's more to it than we know now. In my experience a lot of doctors and nurses acknowledge the existence of some mysterious power of the mind, or perhaps the spirit. However, unless they are religious, they often don't know what else to do with that information.

One evening in the ICU I had a student come to me and ask me to explain how a woman could still be alive when her "numbers" on the monitors were "incompatible with life." The woman was dying, and the family had been gathering all day from the places they lived. There was one more person--I think it was a son--who was still traveling to the hospital. I told her, "When the son gets here, she'll die within an hour or so."

I could say this because I'd seen it before. It happened exactly as I predicted. By the way, the woman was never conscious the entire shift we were there, until about 7 PM when she briefly seemed to be conscious. Then she died.

What is "intention"? Is it a coherent thought? Is it a mood? Is it the energetic "work" expressed by the sum of the being's narrative, or "story"? Is it a technique? Or is it something more complicated? Is an "intention" ever really one thing, one direction, one thought, one action? And if it isn't, how can we be so certain of our ourselves as healers? How can we say of a patient (as I have heard many times)? "Oh that guy's evil! He doesn't take his meds. He gives the nurses a hard time!"

Hey, I'm not saying some people aren't evil. I'm not getting that metaphysical. Rather most people aren't "evil", it's just that we either refuse to listen or can't understand their "story", the story they are writing with their life, as if it were our place to judge.

I started out this blog with a simple share about getting a cold. Really, you could say I "allowed" myself to get a cold, perhaps out of a belief about immune health that may or may not be true. What I don't know, and what nobody does, is what would have happened if I had tried to abort it with one of my methods. Would it have worked or not? What does that mean? Was I irresponsible? Was I more responsible than the busy professional who says "I never let myself get a cold"? Or did I actually do the right thing, and sometime down the road I'll be rewarded for it? We can't know this.

To understand intention means to understand that--whether one knows it or not--one is telling a life story. Like all good stories, there will be surprises. Not all endings are happy, and sometimes the unhappiest event in a tale ends up manifesting redemption. We just don't know. We want to know, because we all want to be free of suffering, we want to live long and prosper, we want to know it's going to be okay.

For nurses and doctors and other professionals out there ministering to the sick and injured, it means stepping back from prejudice based on what we think we know. It means withholding judgments. It means not seeing a patient as a subject, but as a storyteller. It means trying to learn from that story even as we are participating in the telling of it. For caregivers, family, and friends it gets a bit more complicated, since they have been more intimately "in" the person's story than any of us healers ever get. But I think it still matters. I heard family say, "Oh why doesn't dad just stop...?" fill in the blank with drinking, smoking, whatever. It doesn't matter, the overall slant is the same. It is painful when loved ones do things that seems to contradict survival, but it is part of the story they are telling. In the end, that's all we are left with anyway.

Until our own story ends.

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