Wednesday, March 27, 2013

Trying not to cast our own shadows over our patients

Yesterday I caught myself talking to a patient about something personal to me, prompted by what the patient was telling me.  As I said it, I realised that I had made a mistake, for I could feel that my remark had slightly changed the direction of what the patient wanted to tell me.  It was as if I had interposed my shadow between the patient and me.

I have often said that we should try to cast as few of our own shadows over those we encounter, because these distort our relationships with them.  This is particularly true of our encounters with our patients, where the need for maturity on the practitioner’s part is at its greatest.  For if we utter an unwise remark or react clumsily, our patient will feel constrained to adapt his/her behaviour, however slightly, to take account of what appears to be a problematic area they perceive in us, and may well hesitate to open themselves up further.  Then the chance for them to feel free to explain themselves without inhibition may be lost, and our relationship with them may descend into the kind of superficial encounter which characterizes much of everyday life.

The practice room should not reflect such superficialities.  It should be the place where the patient feels free not to have to adapt their behaviour to take their practitioner’s personal needs into account. As practitioners we have to learn to remain true to ourselves, whilst assessing with each patient how far it is appropriate to share some of our personal views, but never to burden them with our problems.


Monday, March 25, 2013

Latest update from the practitioner treating the patient with lung cancer

See my blogs of 27 February and 7 March 2013

I have just received this heartening email from the practitioner:

Just thought I'd update you briefly - I have continued to visit my patient twice weekly in the Hospice and he is going from strength to strength, despite a major setback a couple of weeks ago. At that time, he had been doing very well indeed - he was no longer reliant upon oxygen, his breathing was normal, he had good pain control and had regained his appetite. In acupuncture terms, H/W had cleared and I was treating him very minimally, purely on command points. However, things went pear-shaped a couple of days later when his bowels appeared to be blocked - he was eating an enormous amount of food (2500 calories per day) but his bowels had stopped working (probably due to the morphine and other drugs) and nothing was getting through. He was once again in tremendous pain, had a stomach drain in situ, was nil by mouth and was scheduled to have ileostomy surgery. H/W had returned with a vengeance, he was in very low spirits and did not feel up to any needling, so I treated the H/W with acupressure instead.
A few days later, I received a message that his bowels had started to work again and that he had a reprieve from surgery - and when could I come to give him another treatment!  At my next visit, once again I was amazed at the difference in him - H/W had disappeared again, and the pulses were the most even to date. This time I cleared AE and finished on source points.
I am due to see him again today and he is due to go home on Wednesday all being well, though he will be continuing with his chemotherapy as an outpatient. He feels that the work we are doing together is extremely worthwhile and really looks forward to his treatments, as he says he feels very focussed and strong afterwards, and also relaxed and rested, but energised. Above all, he says I'm probably his only visitor who comes without making any demands, physically or emotionally - for which he is immensely grateful.
This experience brings home to me how important it is to be aware of our own emotions and to maintain a balance, especially through difficult times, where words can be superfluous - a mere presence is enough.”
I cannot praise this practitioner enough for her courage in keeping things simple and refusing to panic.  As I wrote to her in reply to this email:
“It is never easy to treat somebody who is so ill. There will always be times when their health deteriorates suddenly, as their body struggles to cope both with the disease and with the side-effects of the drastic treatment they are getting. But you seem really to be helping him.
I love what the patient said about you being “probably the only visitor who comes without making any demands, physically or emotionally”. You can’t have a better compliment!”
Nor can we have a better illustration of the rare quality we all need to nurture in ourselves as practitioners and as human beings, too, not to make demands, either physical or emotional, upon those around us which they are unable to meet.





Tuesday, March 12, 2013

Learning to build up a good relationship with Metal and Water patients

With Metal I seem to have a far less difficult relationship than with the other elements, perhaps because it demands space to be itself and allows me time to catch my breath, as it were.  No immediate reaction is demanded of me, except an acceptance that it wants to be the judge of how our relationship should develop in a way satisfactory to itself.  It is happy with space and is the most comfortable of all the elements with silence, for it needs silence in which to work out its own solutions to life’s problems.  This need for space and silence offers a great challenge to my Fire element, if I do not recognise it in time, and find myself starting to gabble to fill the silence.  With all Metal patients I have learnt, too, that I must hold back my own impulse to share my thoughts, for this can easily lead to a kind of role reversal since I find that I can often learn from Metal’s detached wisdom.

Metal patients are not, however, there to teach me, nor for me to teach them, but to find the support for their Metal energies which treatment will offer them.  With Metal I need almost say nothing and let the treatment do its work silently.  The practice of silence which Metal needs is that which respects its need to solve its own problems.  The silence which I have to encourage myself to offer Fire is different;  it is aimed at preventing it from talking so much that it forgets why it is coming for treatment.

Finally I come to the problems I may experience in dealing appropriately with my Water patients.  I do not find the demands Water makes upon me difficult to meet, although others may.  The need for a reassuring approach to still the panic which lies deep within the heart of all Water people is not something alien to me, but something I feel at ease with and able to offer without feeling in any way diminished, as I may do with Earth. 
My main difficulty comes from my inability to recognise the Water element in my patients quickly enough in the first place.  We all know how Water likes to disguise itself and hide, and it has taken me longer to detect its presence than that of the other elements.  Even now I have a tendency to see Water’s uneasy laughter as coming from Fire.  Its elusive nature will often make me question whether I am really in the presence of Water or not.  Once recognised, though, I feel able to offer what I think it needs, provided that I stay focused on the profound fears which lie beneath its often apparently confident surface.  This most ambitious of all elements, and the one most likely to get to the top of whatever profession it chooses, harbours a terrified underbelly.  I must never overlook its need for these hidden fears to be acknowledged by me, and for me to offer them the correct level of reassurance.




Learning to build up a good relationship with Earth patients

The difficulties I experience with Earth patients are of a different kind from those with Wood or Fire.  I have found that the need to be nurtured which all Earth people have awakes an echo of the same need in me, because at some deep level within me I would like some of the same kind of nurturing I am being asked to offer Earth.  A few days ago, interestingly, an Earth practitioner told me that he finds his first interaction with his patients disturbing because he feels their differing needs tugging at his Earth element which is reluctant to offer what is being demanded of it.  

Once I am aware of this reaction in myself, I remind myself firmly that I am here for the patient and not for my own needs.  What Earth needs is not a blanket response of sympathy of the “Oh, you poor dear” kind, but instead it needs to be understood.  It wants to be heard, and wants to be heard to the end if possible without interruption.  Its thinking is a circular process, ending where it began and then beginning again.  If it is out of balance, it begins again with the same words and goes over the same ground, like an oxen tied to a circular grindstone, going round and round.  When it is in balance, this need to churn over the same thoughts is lessened, but never disappears completely.  Since its function is to process all things, thoughts as well as food, it has to perform this task endlessly as the other elements pass their energies to it for processing. 
If I remain clear that my Earth patients need to be allowed time to circle round a subject, even though I may have heard the same thing in the same words before, I am able to stand back and allow this circular movement to continue without getting irritated.  But being a quick thinker and talker myself, the slow chewing-of-the-cud which is Earth’s way of thinking can tend to irritate me and make me want to interrupt it if I am not careful.  So a warning sign goes off in my head with every Earth patient I treat:  Let the patient speak, Nora, and only interrupt or add your own comments when you have given your patient time to process his/her thoughts and express them fully in the way they want. 


Monday, March 11, 2013

Learning to build up a good relationship with Wood and Fire patients

If I look at my relationship with the Wood element, as my first example, I realise that it has taken me a long time to work out a way of dealing with its strong needs.  I tend to go through almost the same pattern of behaviour each time I encounter a Wood patient.  I pass through an initial period of wanting to step away, as though shrinking from the push I feel coming towards me, then I experience a flicker, or more than a flicker, of irritation at feeling that I am being outmanoeuvred in some way, before I finally reach a more balanced stage of understanding where I know that to help my Wood patient I have to stand firm and, as it were, counter-punch, however gently.
With all Fire patients, on the other hand, I experience first a slight feeling of relief, sinceI am moving on to the familiar territory of my own element, accompanied by an initial sense of relaxation.  Fire is the most articulate of all elements, enjoying speech as its way of communicating.  Since I, too, like communicating through speech, it is easy for the patient and me to fall into the habit of indulging in a kind of idle chatter with which we both feel at ease.  Experience has taught me, though, that I must issue a warning to myself to take care and not let the ease of this interaction divert from with the reason why the patient is here.  I have to be aware, too, that in its need to make other people happy, Fire may also feel it should make light of its problems, and I have to be on the look-out in case I buy into the cheerful mask and ignore what lies beneath it. 
One way I have devised of helping me here is through the simple expedient of employing silence, a tool we too seldom use in the practice room.  I try consciously to quieten the emotional tone by reminding myself to fall silent.  Silence on my part gives my patient permission to stop any superficial chatter, and offers them the space to think out what they really need to tell me.   I have often found falling silent is the most difficult thing for me to do, and I have had to train myself to be on the alert against encouraging a babble of words to flood the practice room. 
Although it is easy for me to develop a very warm relationship with all my Fire patients, this ironically makes it harder to set the correct emotional tone which is helpful for my patients.  Familiarity does not breed contempt, far from it in this case, but it certainly breeds a false sense of relaxation.

Learning to build up a good relationship with our patients

Like all skills, we have to practise how to create a good relationship with our patients.  A successful relationship is one where we are able to match what we have to offer with what our patients need as smoothly as possible.  Here, of course, our knowledge of the elements will act as our guide, for what one person needs will differ very markedly from what somebody of a different element will need. Some people are lucky, and either by their nature or by the circumstance of their lives have an ability to empathize with other people that a fellow practitioner has first to learn, and all of us will find it easier dealing with some elements than with others.  Perhaps to some people’s surprise we are not necessarily most at our ease with those of our own element, because seeing our own needs reflected in a patient may make it difficult for us to maintain an appropriate distance.  The secret here is to recognise that we may always find relationships with patients of some elements more complex and difficult than others, and remain aware of this as we engage with these patients.

I will describe some of my own reactions and difficulties with patients of certain elements (see the following blogs). These are personal to me, and every other practitioner must study their own responses and learn from them.  But learn they must, otherwise they will not understand their patients’ needs.  More importantly their patients will not feel understood, and then their elements will take to hiding themselves away. How can a five element acupuncturist treat if we don’t know which element is crying out for help?

Nobody should think that this comes easily to any of us.  When I look back at my own practice, I can see many instances where I did not understand what a patient needed, and I offered my help in a way which was not wanted.  Inevitably it was these patients who decided quite quickly that I was not the practitioner for them.  And they were right!  How could I help somebody if I was misreading what they were asking of me?  It was as though I was talking in an emotional language foreign to these patients, or rather assuming that both of us were talking in the same language when we very obviously were not.  One way of looking at relationships with our patients is thus to see them as though they require us to learn to speak in an emotional language with which only our patient is familiar and at ease in.  We therefore need to learn to speak in a different emotional language for each patient.  And like learning any new language, this takes time and a good deal of practise.  

We all know the warm feeling we have when we have got it right with a patient.  It is those times when we know that we have not which we should accept as teaching us the most.  JR always said that it was far better if students observing him with patients did not get the elements he diagnosed right, because the only true learning is through our mistakes.  

"To save everything, click here"

This is the title of a book by a very interesting technology writer called Evgeny Morozov, who has followed up his first book, The Net Delusion, with this one.  He warns against our increasing abdication for the responsibility for our lives to networks such as Google.  I am off to buy his books, but, for a condensed read, look up his article in yesterday’s Observer New Review (10 March 2013), and the lead article on him entitled “Time to question our love affair with new tech”.

I love one answer he gives in his interview to the question “How do you manage your own net use?”

“I’ve become very strategic about my use of technology as life is short and I want to use it wisely. I have bought myself a type of laptop from which it was very easy to remove the Wi-Fi card – so when I go to a coffee shop or the library I have no way to get online.  However, at home I have cable connection.  So I bought a safe with a timed combination lock. It is basically the most useful artefact in my life. I lock my phone and my router cable in my safe so I’m completely free from any interruption and I can spend the entire day, weekend or week reading and writing.”….“To circumvent my safe I have to open a panel with a screwdriver, so I have to hide all my screwdrivers in the safe as well.

Despite years of owning a laptop, I haven’t yet worked out how to use Wi-Fi properly outside my home,  so I am able to go off to one of my favourite coffee shops to read and write without any kind of computer aid, but I do think the idea of locking off my home computer securely at certain times is a very sound idea.  At the moment, I switch it off early in the evening, thinking in that way that I can control its power over me, but then find myself compelled to turn it on again a little later “just in case”.  Maybe I need to lock my cable connection away in a safe, as he does!  

Friday, March 8, 2013

There is no place for arrogance in the practice room

I was looking at a patient with a class of students recently, and after 10 minutes talking to the patient in front of the class I asked them if anybody had seen, heard, (smelt!) or felt anything which pointed to a particular element.  One of them said, “Well it’s obviously Fire.” This gave me a jolt, because it reminded me how I, too, at this student’s stage of learning, had often thought that a patient’s element was obvious, only to find with surprise that I had got it quite wrong.  It is the word “obviously” that a five element acupuncturist must avoid at all costs, because no element will ever be obvious to even the most experienced acupuncturist after a mere 10 minutes.  We can so easily fall into a trap of relying upon stereotypes of different elements we have formulated for ourselves, and sticking to them through thick and thin, only to find out later on how wrong we have been.

We should always respect the mystery which lies deep within another human being, and which the elements express in all their subtlety.  Learning to fathom this mystery can never be a matter of a mere few minutes’ superficial interaction.  

Nothing about our practice can ever be described as dealing with the obvious.  We deal with the not-obvious, however challenging this may be.  And this is why I love what I do.

Thursday, March 7, 2013

Update on the patient with lung cancer (see my blog of 27 February)

Here is what the practitioner has just emailed me:

"My patient continues to amaze me!  I saw him again today - day 3 after his second round of chemo - he looks, sounds and feels extremely well and positive, with very few side effects from all the drugs, save some quite extreme mood swings for the first couple of days immediately after the chemo. His lungs have remained free from fluid and his abdominal pain has subsided, so he is now able to sleep almost horizontally instead of in the upright position which he has had to adopt continually for the past 3 months or so.

Pulses showed a significant improvement in the HT/SI position, with a modicum in the BL/KI position. LU/LI was still dominant by far, and I could also detect a very small amount of energy in the other two right-hand positions. The Guardian Element (Wood) is still very much depleted however.

I repeated H/W today and finished on source points of Wood again, and left it at that. He always falls into a very deep sleep during treatment and for a short while afterwards, and wakes feeling very calm and relaxed

And I continue to feel humbled by the effects of such a simple treatment, made so much more powerful by the patient himself in choosing to fight to live.”

Well done, Jo!