Monday, January 20, 2014

Approach to treating a very ill patient

Learning to cope with treating very ill patients has always been one of the hardest things for me to do, as it probably is for practitioners of any medical discipline.  This is made even more difficult when I am asked to treat a long-standing patient with whom I have built up a close relationship over the years.  This has now happened in the case of one of my patients.

This patient has been fighting a complex history of severe ill-health over many years, and to the surprise of many has managed to stay as healthy as she has through what she maintains is help not only from her Western medical team but from her regular acupuncture treatments.  The chance that she would continue to live as productive a life as she has over the past few years must already have been rather slim, but I always lived in hope that what I was doing with the needle might be miraculous enough to stave off more serious illness.  Sadly this has not been the case, and she is back in hospital on a morphine drip, and has asked me to come and treat her there.  I have now visited her twice, and at each visit I am faced with having to decide what treatment to give.

We all have a tendency to blame our own inadequacy when a patient succumbs to ill-health so I had first to remind myself not to regard what I had done so far as a failure.  I had to tell myself that I had done the best I could.  Looking at the notes I made the last time she came for a treatment a few weeks ago, I see that she told me that everything in her life was going well and she was feeling fine.  We were then neither of us to know that this illness would descend upon her so suddenly like a tragic bolt from the blue.

It is always difficult treating somebody in hospital.  We can’t use moxa because of the risk of setting off the fire alarms, and access to a patient in a hospital bed, attached to various drips, is always somewhat hazardous, and requires us to move carefully round the bed, manoeuvring ourselves past the apparatus and the bedside table with all its necessary paraphernalia.  Then we have to consider how far it is fair to ask an already uncomfortable patient to change position or to sit up to expose the back.  Bl 38 (43), that most wondrous point which “helps every cell in the body”, as JR Worsley told us, is therefore sometimes ruled out altogether, or is difficult to locate when perhaps only a small area of the back is available to us and finding the scapula proves difficult.  Certainly the many moxa cones it needs to do its miraculous work are unfortunately out of the question.  Luckily, at my last visit, my patient’s husband appeared at just the right moment to help prop his wife up slightly to expose the top of the back.  But I still had to send a prayer up to heaven asking for help in locating the point, so little of the back could I see.  There was no question of doing an AE drain at either visit, as I would have liked to have done.

Then, because her lungs were very painful and her breathing laboured, I decided I needed to clear what I assumed to be an VIII-IX (Liver-Lung) entry-exit block, even though my pulse-readings did not absolutely confirm this for me, pulses also being difficult to take and to interpret in view of all the medication she is being given.  Again I could hardly find the ribs because of a distended stomach, and hoped that I correctly needled Liv 14, and not some other point on the abdomen.  Lu 1 was much easier to find, and I finished the treatment with command points on the Water element, her guardian element.  As I left, I was delighted to receive confirmation that I had indeed got the points when she suddenly said, with surprise in her voice, “I really feel better.”  How long this improvement will last only time will tell, but evidence of even the slightest relief was a gift to me, and sent me home slightly happier, as I left her sleeping peacefully, her breathing less laboured.

I’m not sure which of the points I needled helped her feel better, or whether it was a combination of all of them.  I like to think that it is probably clearing the Liver/Lung block which had the biggest effect, but it really doesn’t matter and I will never know.  The important thing is that, as I left, she had a slight smile on her face which lightened my journey home.

At my first visit last week she was lying in such a position that I was able only to reach the source points of Water on her feet, but again these were effective, removing that desperate look in the eyes which very ill patients have.  I interpreted the change in her to her Water element regaining control of her fear.  This look of fear had not returned when I saw her the second time, even though her physical condition had deteriorated.

The prognosis is not good, but I will continue to do whatever I can to help the elements ease her pain and distress.


  1. Thanks Nora. As usual your posts are not just informative but also so full of care and love for your patients, they are an inspiration to all of us just setting out on our own journey as acupuncturists.

    1. How lovely that what I write finds its way to exactly where I hope it does, and speeds you a little further on your way to becoming a caring acupuncturist for your patients.