The Messy Art of Medicine
Making an appointment to see your doctor isn't all about the diagnosis.
Often, when people sit across from me in a clinic room, I’m preparing to board the ship that is their life and have a fossick around. I ask, “What would you like to talk about today?” But don’t add (even though I’m thinking it), “…because we’ll probably end up talking about things you weren’t expecting to and maybe didn’t want to.” And with that, I waltz up the gangplank of the first symptom they list. I have fifteen minutes to look around this vessel, so I will listen as I walk; I will answer a question with a question as I pull open doors to see where they lead; I will notice if the wind changes as I peer under covers to discover what has been stored there.
I rarely accept a symptom in isolation. Every individual is a whole person who exists within the context of their life, and I have written before about the reductive way we are taught to approach them. I have never done or will do this as I was told, separating the person from their physical experience. It rubs against my innate understanding of the human condition, and the longer I do this job, the more anecdotal evidence I collect to support my conviction.
Only some people are ready to hear my thoughts on this, though, because most visit a doctor wanting a diagnosis and a cure…thank you very much. They rarely get just that from me, though: sorry…not sorry. And it is not bells and whistles that are added; instead, it is often hammers and bombs. Every clinical conversation is an opportunity to understand better the intricate weaving that inextricably links mind and body. I usually say to people, “At any one time, your body is telling the story that is going on for you,” but this doesn’t mean it is all in their head, far from it. Many look back at me suspiciously after my comment and fidget in their seat while I attempt to broaden the space so that we might explore their predicament. What I mean by this is that there will be a bigger story if we are brave enough to ask ourselves tricky questions.
In many ways, I blame medicine for our current situation. For the last few centuries, we have insisted that people don’t need to know what is wrong with them because we will tell them. Humans have outsourced their knowing to doctors and deactivated their intuition, and now we are in a relationship of codependence, attachment, and fear. There is a power imbalance that, if not acknowledged, will only exacerbate the dynamic of disempowerment and lead us further from the truth.
The symptom that best illustrates these concepts is fatigue. If I work five full days a week, I will see around one hundred and twenty-five people, and twenty to thirty will complain of disruptive fatigue. They believe I will do a test to locate the cause of their overwhelming tiredness, such as low iron or an underactive thyroid gland. Nearly always, the test results return within normal range, but before I even order them, I ask, ‘ What are you tired of?’ This can be a confronting question, yet people can usually think of something in their life that is exhausting them: a job they hate, a relationship that is past its use-by-date, kids that have gone off the rails, the list is endless, and even if someone’s iron is low, prescribing them an iron supplement isn’t going to fix their problems. Once, I said to someone, “I can’t prescribe you a new life; only you can do that.”
I’m blunt. People are perturbed by it, but critical perturbation accelerates change, and some change is usually needed to relieve the heavy weight of fatigue and most other symptoms, to be honest. IT WILL RARELY BE A VITAMIN SUPPLEMENT…at least in isolation. As there are multiple contributing factors to any given state one finds oneself in, there will also be many things to tweak, adjust, and change to improve the situation. It is difficult to get this across in fifteen minutes, and even though I am blunt, there is a loving method to my madness.
Someone told me tonight, “People are either problem or opportunity focussed…” I stopped him and said, “I don’t think I am either of those, so what am I?” he replied, “You are joy-focused…and it is a delightful focus to have.” He is right. I am joy-focused and want this for others, especially those who come to me for help. I know how to find joy, and it starts with listening very closely to the story your body is telling and intuiting what it needs to feel better and eventually joyful. My loving method is to make a crack in the shell that encompasses someone’s understanding, and sometimes that takes the blunt instrument of confronting questions. When I see the light shining out from the crack created, I soften, and people can see that love is my motive.
It doesn’t always work. People have different degrees of readiness, and some don’t give a jot for my theories. Those people get the standard medical spiel I am trained to provide and likely leave wondering why they feel ripped off, and it’s because a part of them knows that can’t possibly be the whole story.
I rarely tell anybody anything that they don’t already know on some level. I believe this with my whole being, but very few have complete access to this information. When someone comes to see me, I see it as them contracting with themselves. Telling me what is wrong helps them uncover what they need to do to make it better. Sometimes, it will be an investigative journey to locate pathology; this is my job. Often, it is a process of turning up to the truth, which means I hold a mirror for them. It can be painful. Suppose you are fat and have obesity-related diseases. In that case, discovering why you are fat is more important than insisting you hardly eat anything. Examining your relationship with food is going to be of more value than despairing at the unfairness of believing your size doesn’t reflect what you put in your body. This is a harsh and emotive example, but I have come up against this angst almost as often as I have sat with people’s overwhelming fatigue. One day, I will write about my ‘blocked weight loss’ theory, which is way more than what does or doesn’t go in someone’s mouth.
Fifteen minutes is not long enough to get to the heart of these matters with people, and it isn’t my job. My lawyer friend tells me some of what I tell patients isn’t my job, either. She says I’m not qualified to encourage people to leave a job that is exhausting them. It is a messy line of responsibility, and in that small window we have together, I try to impress upon people that the change is up to them. This feels like a much better use of my time than ordering endless tests that ultimately fuel a person’s narrative that the problem lies external to them and, therefore, is someone else’s job to correct.
Most of my colleagues, and rightly so, accept that excluding or finding and treating pathology is what we’re trained to do and so should do that. This doesn’t seem enough to me, so I try to cause a jolt that will help people awaken to the reality of their existence. I’m like an unwelcome psycho-spiritual defibrillator, but I make no apologies for that. I also practice what I preach and am in existential angst as often as I am joyful because life is a balance and a paradox. I want to do the work it takes to grow my understanding of this strangely beautiful life gig. We are on a journey from one end of our life to the other, and shit happens. Our bodies are like a journal, where everything is recorded. We need to read the journal.
Being human is messy, and helping humans gain a greater understanding of their messiness brings me joy. I do it within a reductive paradigm, but I have secret tools in my consulting room that are hidden amongst the stethoscopes, sphygmomanometers, and reflex hammers. I have crystal balls, glitter bombs, and tissues…lots of tissues. To my mind, it is the messy art of medicine.