Sunday, June 3, 2012

Healing Patients

     Doctors have been healing patients for thousands of years.  The patient arrives at the doctor's office (or hut, or shamanic locus, or hospital) with a set of problems.  Sometimes the doctor visits the patient at home, or in a third space like a nursing home or rehabilitation center. There are times when the patient "bumps into" the doctor at the hardware store, town square, or gym.
     As soon as the patient enters the sphere occupied by the doctor, healing begins.  (It may even begin in advance of an actual meeting, once the patient anticipates an interaction with the doctor, as when patients say, "Once I made the appointment with you I started to feel better!")  There is a "healing aura" around the doctor.  In a clinic, it may occupy the entire building, which is perceived by the patient to be a curative place.  The healing space is projected onto the doctor and his/her surroundings by the patient, and is supported by the doctor's assumption of the role of healer, along with all the paraphernalia used to authenticate this role.  What happens henceforward has almost nothing to do with the pharmaceuticals administered, the outcome of tests performed, or the procedures carried out.  It has everything to do with the relationship constellated between the patient and the doctor or, more accurately, between the patient and the patient's "inner healer," supported by the doctor's participation in this enactment.
     I have often felt, in my role as physician, that I am on-stage taking part in a dramatic performance.  When I arrive at the office I don the starched white coat.  It has my name printed in block above the left upper pocket, with "MD," the powerful suffix.  I curl the stethoscope across my neck like a caduceus;  I insert the prescription pad into my right coat pocket;  I place a tape measure and sticky pad (for quick instructions to nursing staff) in my left coat pocket;  I insert fresh pens in the top left pocket--and I feel myself inflate, ever so slightly, as I step out, into the clinic hallway.  My posture changes; my level of confidence increases.  I assume the role assigned to me.  I am the incarnate representative of that healing other which will emerge from the patient's inner world, bearing the magical remedy, administering it, and returning the patient--suddenly feeling better--to ordinary life.
     What's going in this drama?  The space, props, layout of the exam rooms, and especially the relationship to a compassionate physician, who takes on the archetypal role of healer, are essential to a patient's cure.  If any one of these is out of place, there is diminution of the healing effect.  But of paramount importance is the doctor's humanity, and the relationship that springs from that humanity when it is nestled among the contrivances of the doctor's office.  The relationship I have with my patient, in all its nuances, is the healing element par excellence.
     For thousands of years this relationship has been one-on-one, unfolding in the sanctity and privacy of the space encircled by the healer and the to-be-healed.  These days this is most often the container of the exam room.  "I am lost," the patient says, in effect.  "Please help me locate the source of my well-being."  The doctor examines the wounded place, whether psychic, anatomical, or both, and traces it back like an umbilical cord to its beginning.  The source is simultaneously the cause of the problem and the font of healing, a place where everything can be reconfigured with a word or gesture, as long as it extends into the far reaches of the patient's inner world.  The doctor's words are the same as those of the Oracle at Delphi--inscrutable, cryptic, unscripted, or even unconnected to the problem as the patient perceives it.
     More often than not what comes out of my voice when I see patients, one after another, who crowd the waiting room, are words and ideas I did not intend and which might have very little to do with a patient's obvious complaint.  When I first began practicing medicine I censored the spontaneous statements of advice I gave, and therefore I was less useful to the patient.  
     Now I attend to the images that form themselves around a patient who sits anxiously before of me.  I talk out of those images, as though they were the true object of my work.  The patient's eyes and ears are on me, but what I see is a landscape within which the patient is being held.  I see the pattern of the patient's inner drives, which have been obstructed, and are pining, howling, or abscessed.  It is this pattern which needs to be addressed, which I do out of the depths of my being, sometimes effortlessly, and sometimes with great tact, for the patient's conscious response can also interfere with the course of the cure.  The main thing is to invoke the patient's  inner world, and then reconfigure it, ever so slightly.  What was taut becomes relaxed, and what was slack begins to strengthen, so that the patient's sore throat is set right, for example, and the reason for the sore throat goes away.  There may be a change in attitude that affects the whole course of the patient's life, set in motion by a sore throat.
     Treatment is complex.  How can healing like this take place within the large, complexly-organized, corporate, profiteering industry of medicine that is being constructed like skycrapers all around, taking over American medicine?  
     Even if the doctor-patient relationship could be preserved, despite the loss of physician autonomy in the midst of corporate take-overs, is it right for mega-industry to profit from the delicate and hallowed relationship between patient and doctor?  Given the amoral corporate mentality we in America have come to accept, can we even ask the question, "Is this what we want to do to our doctors?"

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